Background and objective:
Despite its effectiveness, compliance to colorectal cancer (CRC) screening remains low. Different strategies to improve uptake are available, including the involvement of stakeholders such as the community pharmacists. In Italy a recent national initiative developed this strategy, scaling-up the collaboration between pharmacies and screening programs from the local level up to the national level.

Methods:
The regional representatives of the CRC screening programs provided to the National Screening Monitoring Centre the agreements arranged between the Regions/Autonomous provinces and their respective pharmacy owners representatives. The agreement decrees were analysed describing the fecal occult blood test pathway (e.g. kit supply and delivery) and supplementary activities provided by the pharmacies together with the CRC screening kit delivery, such as health promotion.

Results:
Eighteen Regions and Autonomous provinces (86% of the total) provided requested data. The amount paid for each kit varies a lot, with a range from 0 to 18 EUR. The number of kit pathway processes covered by the agreements ranged from a maximum of 16 (out of 18) to a minimum of none. Processes more frequently included were the supply of the kit, the delivery of the kit, and education/awareness of CRC screening (68.8%), followed by sample transfer to the laboratory, test tube tracing and counselling (62.5%). Less covered processes were the warehouse management and awareness of other healthcare initiatives (12.5%); a supplementary agreement on delivery of preparation for intestinal cleansing was included only once.

Conclusions:
The Italian model showed good potential for collaboration, but the lack of a unique collaboration model. Integration of pharmacies in CRC programs is promising and quality standards of the service should be set at international level.