Cardiovascular disease risk screening by pharmacists: a behavior change wheel guided qualitative analysis

The development of a self-management evaluation scale for elderly adults with hypertension based on the capability, opportunity, and motivation-behaviour (COM-B) model

BACKGROUND

Using accurate assessment tools to assess patients in clinical practice is important to mining influencing factors and implementing interventions. However, most evaluation tools for the self-management of elderly patients with hypertension lack a theoretical basis and wide applicability, which makes the intervention effect insignificant.

METHODS

Based on the Capability, Opportunity, and Motivation-Behaviour (COM-B) model, combined with literature review and qualitative research, a questionnaire item pool was initially formulated; then the initial items were screened and adjusted through expert consultation and pre-testing to form an initial scale. A field survey of 450 elderly hypertensive patients was then performed using the initial scale to test the reliability and validity of the scale. Cronbach's alpha, test-retest reliability and composite reliability were used to test the reliability of the scale, and the validity of the scale was evaluated from two aspects: content validity and construct validity. The evaluation results of the content validity of the scale by experts were used as the content validity index; the results of exploratory factor analysis and confirmatory factor analysis were used as the structural validity index to further verify the model structure of the scale and develop a formal scale.

RESULTS

The final self-management scale included 4 dimensions and 33 items. The Scale-Content Validity Index was 0.920. Exploratory factor analysis extracted four factors that explained 71.3% of the total variance. Cronbach's alpha of the formal scale was 0.867, test-retest reliability was 0.894, and composite reliability of the 4 dimensions were within 0.943 ~ 0.973. Confirmatory factor analysis showed the scale had good construct validity.

CONCLUSIONS

The Self-management Capability, Support and Motivation-Behaviour scale for elderly hypertensive patients has good reliability and validity, providing a tool for medical staff to evaluate the self-management level of elderly hypertensive patients.

Developing pharmacists' competencies in Saudi Arabia: A proposed national competency framework to support initial education and professional development

INTRODUCTION

With the currently accelerating changes in pharmacists' roles in Saudi Arabia, evidence-based developmental tools are required to guide initial pharmacy education and define competencies for early career (foundation level) pharmacists' progression. This study aimed to develop a profession-wide competency framework for foundation level pharmacists in Saudi Arabia using the International Pharmaceutical Federation (FIP) Global Competency Framework (GbCF) as the source framework.

METHODS

An online nominal group technique was used to develop consensus on a profession-wide national competency framework in Saudi Arabia. Purposive sampling was used to recruit experts from local various pharmacy sectors. A combination of self-administered surveys and online meetings was used to measure and develop consensus. The survey items were adopted from the FIP GbCF version 2.

RESULTS

Nine pharmacy experts participated in five iterative rounds of consensus measurement and development between July and November 2021. Consensus was achieved on appropriateness to Saudi pharmacy practice for all the behaviours in the "Pharmaceutical Public Health," "Pharmaceutical Care," and "Professional/Personal" clusters. The "Organisation and Management" cluster caused most differences of opinion. The final consensus generated a list of 125 behavioural statements for inclusion in the national competency framework.

CONCLUSION

This study proposes the first competency framework for foundation level pharmacists in Saudi Arabia. The developed framework represents a consensus on competencies for foundation level pharmacists working across all pharmacy sectors and is eligible for supporting further improvement of initial pharmacy education and support excellence in pharmacists' performance to address the country's needs from pharmaceutical services.

Cardiovascular disease risk prevention services by pharmacists in Saudi Arabia: what do policymakers and opinion leaders think?

Background

Cardiovascular disease (CVD) is an emerging contributor to national morbidity and mortality in Saudi Arabia. CVD risk prevention services are limited, particularly with an over-utilised public health sector and an under-utilised and under-resourced primary care sector. Globally, there is evidence that community pharmacists can play a key role in CVD prevention within primary care. However, the perspectives of policymakers and opinion leaders are critical to successful translation of evidence into practice. Thus, the aim was to engage policymakers and professional leaders in discussions about implementing high-quality CVD risk prevention services in community pharmacy.

Methods

Qualitative semi-structured interviews were conducted, audio-recorded and transcribed verbatim. All transcripts were thematically analysed.

Results

A total of 23 participants (87% male) from government and non-government sectors were interviewed. Of these, almost 65% had pharmacy qualifications. Limited provision of CVD risks preventative services in primary care was acknowledged by most participants and building community pharmacists’ capacity to assist in preventive health services was viewed favourably as one way of improving the status quo. The data yielded four key themes: (1) future pharmacy CVD health service models; (2) demonstrable outcomes; (3) professional engagement and advocacy; and (4) implementability. CVD health services roles (health screening, primary and secondary prevention services), pragmatic factors and tiered models of care (minimal, medium, and comprehensive pharmacist involvement) were discussed. The need for humanistic, clinical, and cost effectiveness outcomes to be demonstrated and active involvement of professional bodies were deemed important for such services to be sustainable. Professional pharmacy governance to develop pharmacy careers and workforce, pharmacy curricular reform and ongoing education were posed as key success factors for novel pharmacy roles. Practice policies, standards, and guidelines were seen as required to adhere to stringent quality control for future pharmacy services provision. Participant’s implementation vision for such services included scalability, affordability, access, adoption and health system reform. Most discussions focused on the need for structural improvement with limited input regarding processes or outcomes required to establish such models.

Conclusions

Most participants favoured pharmacy-based CVD risk prevention services, despite the variability in proposed service models. However, prior to developing such services, support structures at the health system and health professional level are needed as well as building public support and acceptability for pharmacy services.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40545-021-00319-6.

Implementation of diabetes screening in community pharmacy - factors influencing successful implementation

INTRODUCTION

Community pharmacists are increasingly providing a range of professional health services. Whilst research provides evidence of their benefits, knowledge translation into practice has been challenging both in Australia and internationally. An opportunity to develop a granular understanding of factors driving successful implementation was presented by the Pharmacy Diabetes Screening Trial (PDST), a clustered Randomised Controlled Trial (RCT) implemented in a random sample of 339 Australian community pharmacies. Its aim was to compare the clinical and cost effectiveness of three pharmacy-based diabetes screening interventions.

OBJECTIVE

To investigate the experiences of Australian community pharmacists in the implementation of the PDST and factors influencing implementation success.

METHODS

Semi-structured telephone interviews were conducted with a stratified sample of pharmacist trial participants based on screening performance (number screened relative to target), location, and trial arm. All interviews were audio-recorded and transcribed ad verbatim. Interviews were continued until saturation. Initial thematic analysis was followed by in-depth analysis to test the extent to which the data fitted with three previously described overarching themes driving successful national implementation of innovation in community pharmacy.

RESULTS

From August 2017 to October 2017, 21 interviews were conducted; 12 with high-performing and 9 with low-performing pharmacists. The key enablers and barriers were qualities of a pharmacy champion and active staff engagement, ease of implementation related to the number of working pharmacists and other staff, the external context including engagement with consumers and doctors, and consumer demand. It was also identified that attitudes/emphasis towards implementation planning and conscious prioritisation of service delivery by pharmacists may have been key differences between high- and low-performing pharmacies.

CONCLUSION

Insights into the interaction between individual, organisational, and external factors influencing successful implementation of community pharmacy innovations highlighted in this study should inform the design of future innovations to ensure their success and sustainability.

The role of community pharmacists and their position in the delivery of diabetes care: an update for medical professionals

Pharmacists are the third largest group of healthcare professionals worldwide, but are underused in the delivery of diabetes care. The aim of this narrative was to describe how integration of community pharmacy services into existing healthcare models may improve diabetes care. Relevant literature exploring pharmacy-led interventions for diabetes were identified from a search of Medline, Embase and Cinahl online databases. This review highlights that community pharmacists are accessible, experts in medicine management, trusted by the public and able to achieve financial savings. They are poorly integrated into existing healthcare models, and commissioning arrangements can be poorly perceived by the public and those working in primary care. Community pharmacy interventions in type 2 diabetes have similar, if not greater effects compared to those delivered by other healthcare professionals. It was concluded that community pharmacy interventions in diabetes are feasible, acceptable and deliver improved health outcomes. Future work should build public recognition of pharmacists and improve communication between them and other healthcare professionals.

Health consumer engagement in developing novel preventive health community pharmacy roles in cardiovascular disease in Saudi Arabia: A qualitative analysis

Introduction

Cardiovascular diseases (CVD) are one of key leading causes of mortality worldwide. Both modifiable and non-modifiable risk factors contribute to the development of CVD. Modifiable risk factors such as smoking, unhealthy diets and lack of exercise are increasing in prevalence in Saudi Arabia but may be mitigated using pharmacological and non-pharmacological approaches. Thus, identifying, assessing and managing these modifiable risks at an early stage is essential. Pharmacists are highly accessible primary health professionals and can play a crucial role in screening and managing these risk factors in collaboration with primary care physicians. There is currently no research in Saudi Arabia exploring the views of health consumers with CVD risk factors regarding their preferences for or willingness to engage with community pharmacy CVD preventive health services.

Objectives

To explore the perceptions of health consumers about current and feasible future services by pharmacists with a specific focus on CVD risk screening and management in Saudi Arabia.

Methods

Semi-structured interviews were conducted with consumers with at least one modifiable CVD risk factor. The interviews were audio-recorded, transcribed verbatim, translated into English and then thematically analysed.

Results

A total of 25 individuals, most of whom were Saudi (88%) and women (65%), participated in face to face interviews. Five main themes emerged from the analysis of consumers’ responses. 1. Perception of pharmacists’ role, the pharmacists’ main role was perceived as medication supply. 2. Trust and satisfaction with current service, most participants appeared to have low trust in pharmacists. 3. Preferences for future pharmacy services, most participants were willing to engage in future pharmacy delivered CVD preventive health services, provided there was stringent regulation and oversight of the quality of such services. 4. Viability of new pharmacy services was raised with promotion of such services to the public, collaboration with other health professionals, financial incentivization and motivational rewards thought of as essential ingredient to ensure service feasibility. 5. Health beliefs and help seeking behaviours of consumers were diverse and low health literacy was evident; it was thought that pharmacists can help in these matters by educating and advocating for such consumers. Overall, the data suggested that clinical, communication and professional skills need to be enhanced among Saudi pharmacists to enable them to provide optimal patient cantered services.

Conclusion

Health consumers participants were willing to participate and utilise CVD risk screening and management pharmacy-based services, when offered, provided their concerns are addressed. Therefore, in light of the burden of CVD disease in the country, development, implementation and evaluation of pharmacist provided CVD risk screening and management should be undertaken.

Challenges in Managing Acute Cardiovascular Diseases and Follow Up Care in Rural Areas: A Narrative Review

This narrative review explores relevant literature that is related to the challenges in implementing evidence-based management for clinicians in rural and remote areas, while primarily focussing on management of acute coronary syndrome (ACS) and follow up care. A targeted literature search around rural/urban differences in the management of ACS, cardiovascular disease, and cardiac rehabilitation identified multiple issues that are related to access, including the ability to pay, transport and geographic distances, delays in patients seeking care, access to diagnostic testing, and timely treatment in an appropriate facility. Workforce shortages or lack of ready access to relevant expertise, cultural differences, and complexity that arises from comorbidities and from geographical isolation amplified diagnostic challenges. Given the urgency in management of ACS, rural clinicians must act quickly to achieve optimal patient outcomes. New technologies and quality improvement approaches enable better access to rapid diagnosis, as well as specialist input and care. Achieving an uptake of cardiac rehabilitation in rural and remote settings poses challenges that may reduce with the use of alternative models to centre-based rehabilitation and use of modern technologies. Expediting improvement in cardiovascular outcomes and reducing rural disparities requires system changes and that clinicians embrace attention to prevention, emergency management, and follow up care in rural contexts.