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Ou K, Gide DN, El-Den S, Kouladjian O'Donnell L, Malone DT, O'Reilly CL. Pharmacist-led screening for mental illness: A systematic review. Res Social Adm Pharm 2024; 20:828-845. [PMID: 38866605 DOI: 10.1016/j.sapharm.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 05/29/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Early identification and treatment of mental illnesses is imperative for optimal patient outcomes. Pharmacists may play an important role in mental healthcare through the provision of screening services for mental illnesses. OBJECTIVE (s): To systematically review the impact of pharmacist-led mental illness screening on clinical or patient-reported outcomes and identify and report any follow-up or referral systems used in pharmacist-led screening interventions for mental illnesses. METHODS A systematic review was conducted by searching MEDLINE, CINAHL, Embase and APA PsycInfo via EBSCOhost from inception to 9 March 2023 to identify studies involving pharmacist-led screening interventions for mental illnesses. Data was collected on the mental illness in question, setting and population characteristics, screening tools used, clinical or patient-reported outcomes, and follow-up and referral systems reported. RESULTS Twenty six studies were identified that related to screening for mental illnesses, such as depressive disorders and substance use disorders. There were a variety of study designs, including uncontrolled studies (n = 23), pre-post studies (n = 2) and randomised controlled trials (n = 1). Screening was conducted in different settings, with most studies conducted in community pharmacies (n = 21/26, 87.8 %) and focusing on depression screening (n = 12/26, 46.1 %). A range of follow-up and referral methods to other healthcare professionals were reported, including verbal (n = 3/26, 11.5 %), both written and verbal (n = 3/26, 11.5 %), communications via electronic health record (n = 2/26, 7.7 %) and written (n = 1/26, 3.8 %). CONCLUSIONS Pharmacists provide screening for a variety of mental illnesses in different settings. Various referral methods and follow-up pathways may be utilised for post-screening patient care. However, current evidence is insufficient to establish improvements in early detection, treatment, or outcomes. Further large, well-designed studies are required to support the role of pharmacists in mental illness screening, provide evidence on the impact of pharmacist-led mental illness screening services and inform the most effective follow up and referral methods.
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Affiliation(s)
- Kevin Ou
- Pharmaceutical Society of Australia, Sydney, NSW, Australia
| | - Duha N Gide
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Sarira El-Den
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Kouladjian O'Donnell
- Clinical Pharmacology and Ageing, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Daniel T Malone
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Claire L O'Reilly
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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2
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Bales ME, Zhu J, Ganzer CA, Aboharb F, Keeler A, Ryon KA, Ehrmann BJ, Imperato-McGinley J. A retrospective case study of successful translational research: Cardiovascular disease risk assessment, experiences in community engagement. J Clin Transl Sci 2024; 8:e84. [PMID: 38784106 PMCID: PMC11112429 DOI: 10.1017/cts.2024.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 04/09/2024] [Indexed: 05/25/2024] Open
Abstract
In underserved communities across New York City, uninsured adults encounter a greater risk of cardiovascular disease (CVD) and diabetes. The Heart-to-Heart Community Outreach Program (H2H) addresses these disparities by screening for CVD risk factors, identifying healthcare access barriers, and fostering community engagement in translational research at the Weill Cornell Medicine Clinical and Translational Science Award (CTSA) hub. Screening events are hosted in partnership with faith-based institutions. Participants provide a medical history, complete a survey, and receive counseling by clinicians with referrals for follow-up care. This study aims to quantify H2H screening participant health status; identify socioeconomic, health access, and health-related barriers disproportionately promoting the onset of CVD and diabetes; and develop long-term community partnerships to enable underserved communities to influence activities across the translational research spectrum at our CTSA hub. The population served is disproportionately non-white, and uninsured, with many low-income and underserved individuals. The program was developed in partnership with our Community Advisory Board to empower this cohort to make beneficial lifestyle changes. Leveraging partnerships with faith-based institutions and community centers in at-risk New York City neighborhoods, H2H addresses the increasing burden of diabetes and CVD risk factors in vulnerable individuals while promoting community involvement in CTSA activities, serving as a model for similar initiatives.
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Affiliation(s)
- Michael E. Bales
- Weill Cornell Clinical and Translational Science Center, New York, NY, USA
| | - Jifeng Zhu
- Weill Cornell Clinical and Translational Science Center, New York, NY, USA
| | - Christine A. Ganzer
- Hunter-Bellevue School of Nursing, School of Health Professions, Hunter College, CUNY, New York, NY, USA
| | - Farid Aboharb
- Tri-Institutional MD-PhD Program, Weill Cornell Medicine, Rockefeller University, Memorial Sloan Kettering Center, New York, NY, USA
| | - Allegra Keeler
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Krista A. Ryon
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
| | - Brett J. Ehrmann
- Division of Primary Care of the Weill Cornell Physician Organization, Weill Cornell Medicine, New York, NY, USA
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Sahid MA, Babar MUH, Uddin MP. Predictive modeling of multi-class diabetes mellitus using machine learning and filtering iraqi diabetes data dynamics. PLoS One 2024; 19:e0300785. [PMID: 38753669 PMCID: PMC11098411 DOI: 10.1371/journal.pone.0300785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/05/2024] [Indexed: 05/18/2024] Open
Abstract
Diabetes is a persistent metabolic disorder linked to elevated levels of blood glucose, commonly referred to as blood sugar. This condition can have detrimental effects on the heart, blood vessels, eyes, kidneys, and nerves as time passes. It is a chronic ailment that arises when the body fails to produce enough insulin or is unable to effectively use the insulin it produces. When diabetes is not properly managed, it often leads to hyperglycemia, a condition characterized by elevated blood sugar levels or impaired glucose tolerance. This can result in significant harm to various body systems, including the nerves and blood vessels. In this paper, we propose a multiclass diabetes mellitus detection and classification approach using an extremely imbalanced Laboratory of Medical City Hospital data dynamics. We also formulate a new dataset that is moderately imbalanced based on the Laboratory of Medical City Hospital data dynamics. To correctly identify the multiclass diabetes mellitus, we employ three machine learning classifiers namely support vector machine, logistic regression, and k-nearest neighbor. We also focus on dimensionality reduction (feature selection-filter, wrapper, and embedded method) to prune the unnecessary features and to scale up the classification performance. To optimize the classification performance of classifiers, we tune the model by hyperparameter optimization with 10-fold grid search cross-validation. In the case of the original extremely imbalanced dataset with 70:30 partition and support vector machine classifier, we achieved maximum accuracy of 0.964, precision of 0.968, recall of 0.964, F1-score of 0.962, Cohen kappa of 0.835, and AUC of 0.99 by using top 4 feature according to filter method. By using the top 9 features according to wrapper-based sequential feature selection, the k-nearest neighbor provides an accuracy of 0.935 and 1.0 for the other performance metrics. For our created moderately imbalanced dataset with an 80:20 partition, the SVM classifier achieves a maximum accuracy of 0.938, and 1.0 for other performance metrics. For the multiclass diabetes mellitus detection and classification, our experiments outperformed conducted research based on the Laboratory of Medical City Hospital data dynamics.
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Affiliation(s)
- Md Abdus Sahid
- Department of Computer Science and Engineering, Hajee Mohammad Danesh Science and Technology University, Dinajpur, Bangladesh
| | - Mozaddid Ul Hoque Babar
- Department of Computer Science and Engineering, Hajee Mohammad Danesh Science and Technology University, Dinajpur, Bangladesh
| | - Md Palash Uddin
- Department of Computer Science and Engineering, Hajee Mohammad Danesh Science and Technology University, Dinajpur, Bangladesh
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4
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Krass I, Twigg MJ, Mitchell B, Wilson F, Mohebbi M, Trinder P, Shih STF, Carter R, Versace VL, McNamara K. Participant and GP perspectives and experiences of screening for undiagnosed type 2 diabetes in community pharmacy during the Pharmacy Diabetes Screening Trial. BMC Health Serv Res 2023; 23:1337. [PMID: 38041094 PMCID: PMC10693079 DOI: 10.1186/s12913-023-10269-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 11/01/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND The Pharmacy Diabetes Screening Trial (PDST) evaluated three approaches to screening for undiagnosed type 2 diabetes mellitus (T2DM) in community pharmacy: (1) paper-based risk assessment (AUSDRISK) alone; and AUSDRISK followed by a point of care test if AUSDRISK ≥ 12; with either (2) HbA1c; or (3) small capillary blood glucose Test (scBGT). This paper reports the perspectives and experiences of the pharmacy screening service of two key stakeholder groups: screening participants and general practitioners (GPs). METHODS All referred participants (n = 2242) received an online survey to determine the outcome of the referral, as well as their level of satisfaction with the service. In addition, a random sample of 2,989 (20%) of non-referred participants were surveyed to determine their overall experience and level of satisfaction with the service. GPs to whom participants were referred were contacted to establish if, since the date of the screening service, their patient had (1) been to see them; (2) had further tests performed (FBG, RBG, OGTT, HbA1c); or (3) been diagnosed with diabetes or prediabetes. Descriptive statistics were reported for quantitative data. Factors associated with visiting the GP following screening were assessed using multivariable logistic regression. Qualitative data were analysed using content analysis. RESULTS Response rates 16% (n = 369) and 17% (n = 520) were achieved for the three-month referred and non-referred participant surveys, respectively. Over 90% of respondents were very positive about the screening service (n = 784/853) and would recommend it to a family member or friend (n = 784/853). Participants also reported making significant improvements in diet and exercise, because of the screening. Among referred respondents, those who received a POC test were twice as likely to visit their GP compared to those who received a risk assessment only (OR 2.11 95% CI 1.46-3.06). GPs (15.8% response rate, n = 57/361) indicated that the referral worked well and that recommendations for follow-up care by the pharmacist were appropriate. CONCLUSION Opportunistic screening of individuals during routine encounters with the community pharmacy in a previously undiagnosed population has been shown to foster positive engagement with consumers and GPs, which may assist in reducing the burden of T2DM on the individual and the community.
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Affiliation(s)
- Ines Krass
- School of Pharmacy, University of Sydney, Sydney, NSW, 2006, Australia.
| | - Michael J Twigg
- School of Pharmacy, University of East Anglia, Norfolk, NR47TJ, UK
| | | | - Frances Wilson
- School of Pharmacy, University of Sydney, Sydney, NSW, 2006, Australia
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Peta Trinder
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool, VIC, Australia
| | - Sophy T F Shih
- Kirby Institute, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Rob Carter
- Deakin Health Economics, Institute of Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Vincent L Versace
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool, VIC, Australia
| | - Kevin McNamara
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool, VIC, Australia
- Deakin Health Economics, Institute of Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
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5
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Welch S, Moles R, Viardot A, Deweerd P, Daly S, Lee K. Connecting the Dots of Care: A pilot study linking Aboriginal and/or Torres Strait Islander peoples with diabetes care in hospital, using hospital pharmacists. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100351. [PMID: 37965249 PMCID: PMC10641541 DOI: 10.1016/j.rcsop.2023.100351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023] Open
Abstract
Background Diabetes is common among Aboriginal and/or Torres Strait Islander peoples, yet often undetected in hospital. Objective To identify how urban hospital pharmacists can detect if Aboriginal and/or Torres Strait Islander patients have diabetes or a higher chance of getting diabetes. Methods A multi-methods study used data from patients, and researcher field notes. Aboriginal and/or Torres Strait Islander peoples admitted to hospital over 12-weeks (July-October 2021) were prospectively identified from admissions lists. A hospital pharmacist-researcher visited eligible patients. Consenting participants had their blood glucose and HbA1c checked. Participants with HbA1c > 6.5% (no known diabetes) or 7% (known diabetes) were referred for endocrinology review during their stay. Test results and resultant diabetes plan were shared with their general practitioner. Two days after discharge, participants were called to gauge views on their hospital-based diabetes care. Barcode technology recorded pharmacist time. Voice-recorded field notes were thematically analysed. Ethics approval was obtained. Results Seventy-two patients were eligible for inclusion, 67/72 (93%) consented to take part. Sixty-one (91%) patients returned a HbA1c < 6.5, of which, 4/61 (6.5%) returned a HbA1c, 6-6.4. They were contacted to yarn about diabetes prevention. Six of the 67 (9%) qualified for endocrine review, 5 had known diabetes, one newly diagnosed. None were known to endocrinology. All participants telephoned were satisfied with their hospital-based diabetes care. Pharmacist time for initial introductory yarn, consenting process, organisation of HbA1c and results discussion was 20 min or 40 min if referred for endocrine review. Field notes guided understanding of service implementation. Conclusion This novel pharmacist-led diabetes screening service for Aboriginal and/or Torres Strait Islander peoples appeared to provide a unique opportunity for screening and referral links in a holistic way. Future research is required to test this model by upscaling to include more pharmacists and other chronic disease screening and referral pathways.
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Affiliation(s)
- Susan Welch
- St. Vincent's Hospital, 390 Victoria St., Darlinghurst 2010, Australia
- University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Camperdown, Sydney, N.S.W 2006, Australia
| | - Rebekah Moles
- University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Camperdown, Sydney, N.S.W 2006, Australia
| | - Alexander Viardot
- St. Vincent's Hospital, 390 Victoria St., Darlinghurst 2010, Australia
- Garvan Institute, University of New South Wales, Randwick, Sydney, N.S.W. 2010, Australia
| | - Pauline Deweerd
- St. Vincent's Hospital, 390 Victoria St., Darlinghurst 2010, Australia
| | - Scott Daly
- St. Vincent's Hospital, 390 Victoria St., Darlinghurst 2010, Australia
| | - Kylie Lee
- University of Sydney, Addiction Medicine, Faculty of Medicine and Health, Camperdown, Sydney 2006, Australia
- The Edith Collins Centre, Camperdown, Sydney, 2006, Australia
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Vic 3083, Australia
- Burnet Institute, Melbourne, Vic 3004, Australia
- National Drug Research Institute, Curtin University, Perth, WA, 6045, Australia
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6
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Lothspeich E, Werremeyer A, Chase S, Huseth-Zosel A. Patient Experience and Satisfaction with Opioid-Related Screening and Intervention in North Dakota Community Pharmacies. J Pharm Pract 2023; 36:1217-1224. [PMID: 35704458 DOI: 10.1177/08971900221109528] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Screening for patient-level opioid-related risk in the community pharmacy setting has increased patient education about opioids and naloxone distribution, helping to mitigate the impact of the opioid epidemic. However, patient experience and satisfaction with opioid screening and education is unknown. Fear of patient dissatisfaction may limit pharmacists' willingness to implement screening activities. Objective: To report patient experience and satisfaction of a convenience sample of patients undergoing screening and intervention for opioid-related risk as a part of the ONE Program (formerly ONE Rx). Methods: Patients who received ONE Program screening and intervention from their community pharmacist were recruited to participate in a 9 item survey regarding their experience and satisfaction. Results were analyzed by urban and rural location of participants. Results: Urban (n = 42) and rural (n = 32) patients who completed the survey reported positive experiences namely feeling comfortable with the ONE process (86.5%), the process taking an appropriate amount of time (93.2%) and feeling safer as a result of their pharmacist's attention to their opioid-related medication risk (86.3%). Urban patients were significantly more likely than rural patients to report positive attitude and behavior changes as a result of the ONE process. Conclusion: High levels of patient satisfaction and positive experience with the ONE Program screening and intervention process for patient-level opioid-related risks may encourage community pharmacists to more broadly implement such activities.
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Affiliation(s)
- Emily Lothspeich
- School of Pharmacy, North Dakota State University, Fargo, ND, USA
| | - Amy Werremeyer
- Department of Pharmacy Practice, North Dakota State University, Fargo, ND, USA
| | - Sarah Chase
- School of Pharmacy, North Dakota State University, Fargo, ND, USA
- VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA
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7
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Bales ME, Zhu J, Ganzer CA, Aboharb F, Keeler A, Ryon KA, Ehrmann BJ, Imperato-McGinley J. A Retrospective Case Study of Successful Translational Research: Cardiovascular Disease Risk Assessment, Experiences in Community Engagement. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.26.23296161. [PMID: 37808806 PMCID: PMC10557840 DOI: 10.1101/2023.09.26.23296161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
In underserved communities in New York City, uninsured adults encounter a greater risk of cardiovascular disease and diabetes. The Heart-to-Heart Community Outreach Program (H2H) is addressing these disparities by providing screenings for diabetes and other cardiovascular disease risk factors, fostering community engagement in translational research at our CTSC. Screening events are hosted in partnership with community faith-based institutions. Participants provide medical history, complete a survey, and receive individualized counseling by clinicians with referrals for follow-up care. The population served is disproportionately non-white, uninsured, with low-income, and underserved. The program empowers participants to make beneficial lifestyle changes using myriad strategies to reach those most in need. This required strong foundational program leadership, effective inter-institutional collaboration, and maintaining of community trust. Leveraging partnerships with faith-based institutions and community centers in at-risk NYC neighborhoods, H2H addresses the increasing burden of diabetes and cardiovascular disease risk factors in vulnerable individuals and provides a model for similar initiatives.
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Affiliation(s)
- Michael E. Bales
- Clinical and Translational Science Center, Weill Cornell Medicine
| | - Jifeng Zhu
- Clinical and Translational Science Center, Weill Cornell Medicine
| | - Christine A. Ganzer
- Hunter-Bellevue School of Nursing, School of Health Professions, Hunter College, CUNY
| | - Farid Aboharb
- Tri-Institutional MD-PhD Program, Weill Cornell Medicine, Rockefeller University, Memorial Sloan Kettering Cancer Center
| | | | - Krista A. Ryon
- Department of Physiology and Biophysics, Weill Cornell Medicine
| | - Brett J. Ehrmann
- Division of Primary Care of the Weill Cornell Physician Organization, Weill Cornell Medicine
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8
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Newell BJ, Kells AM, Robertson AD, Braun TM, Ward KS, Rohling BJ, Melton BL. Identifying Opportunities for Impact of Community-Based Pharmacist-Led Biometric Health Screenings on ASCVD Risk. Kans J Med 2023; 16:88-93. [PMID: 37124101 PMCID: PMC10136613 DOI: 10.17161/kjm.vol16.18514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 03/07/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Community-based pharmacists are positioned uniquely to assist in the early detection of underlying cardiovascular disease (CVD) which affects approximately 50% of adults in the United States. Organizations utilize community-based pharmacists to conduct annual biometric health screenings to help employees identify health risks previously undetected. The goal of this study was to evaluate how community-based pharmacists could impact lifetime atherosclerotic cardiovascular disease (ASCVD) risk for a large population. Methods This study was a retrospective analysis of annual pharmacist-led 15-minute biometric health screening data from a large regional community-based pharmacy chain. Employees between the ages of 20 and 79 who had completed at least three biometric health screenings between July 1, 2015 and June 30, 2020 were included. Incomplete biometric health screening records were excluded. To calculate lifetime ASCVD risk and identify perceived gaps in care, prescription fill history of study participants was used. The pharmacists did not make clinical interventions; however, education was provided with the information found. Results A total of 10,001 patients were included. Median baseline ASCVD risk was 1.5% and increased to 1.8% (p < 0.001). Additionally, 1,187 patients with an elevated ASCVD risk ≥ 7.5%, showed statistically significant improvements in blood pressure, body mass index, and cholesterol. Conclusions Improvements for high-risk patients were seen in several biometric health screening parameters including blood pressure, body mass index, and cholesterol. Community-based pharmacists were well positioned to intervene clinically to support reduction of ASCVD life-time risk.
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Affiliation(s)
- Bradley J Newell
- Department of Pharmacy Practice, University of Kansas School of Pharmacy-Wichita, Wichita, KS
| | | | - Amy D Robertson
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy, Northwest Regional Campus, Fayetteville, AK
| | | | | | | | - Brittany L Melton
- Department of Pharmacy Practice, University of Kansas School of Pharmacy, Kansas City, KS
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9
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Krass I, Carter R, Mitchell B, Mohebbi M, Shih STF, Trinder P, Versace VL, Wilson F, Mc Namara KP. Pharmacy diabetes screening trial (PDST): Outcomes of a national clustered RCT comparing three screening methods for undiagnosed type 2 diabetes (T2DM) in community pharmacy. Diabetes Res Clin Pract 2023; 197:110566. [PMID: 36738834 DOI: 10.1016/j.diabres.2023.110566] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 11/04/2022] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
AIMS To compare the effectiveness of three pharmacy-based screening methods for type 2 diabetes (T2DM): (1) risk assessment (AUSDRISK) alone (Group A); AUSDRISK followed by a point of care test if AUSDRISK ≥12; either (2) HbA1c (Group B); or (3) small capillary blood glucose test (Group C). METHODS A cluster RCT with a nationally representative sample of Australian pharmacies was implemented with random allocation of eligible pharmacies to Groups A, B or C. GP referral was based on prespecified cut offs. Diagnoses were considered positive if confirmed by a GP, pathology laboratory, or national diabetes register. RESULTS Of the 14,093 people screened in 339 pharmacies, 3059 participants met group-specific referral criteria: 1775 (45%) (Group A); 893 (17%) (Group B); and 391 (8%) (Group C). For the total screened population rates of T2DM diagnoses were significantly higher in Group B (1.5%), compared with Groups A (< 0.8%) and C (< 0.6%) with the odds of detection in Group B compared with Group A (1.8 [1.0;3.0]), and no difference between Groups A and C. CONCLUSIONS In community pharmacy, the most effective method to uncover undiagnosed T2DM was a stepwise approach; initial risk assessment; and if appropriate an HbA1C POC test and referral.
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Affiliation(s)
- Ines Krass
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia.
| | - Rob Carter
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Bernadette Mitchell
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Mohammadreza Mohebbi
- Biostatistics unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Sophy T F Shih
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia; Kirby Institute, UNSW Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Peta Trinder
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warnambool, Victoria, Australia
| | - Vincent L Versace
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warnambool, Victoria, Australia
| | - Frances Wilson
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Kevin P Mc Namara
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia; Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warnambool, Victoria, Australia
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10
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Serhal S, Krass I, Emmerton L, Bereznicki B, Bereznicki L, Bosnic-Anticevich S, Saini B, Billot L, Armour C. Patient uptake and outcomes following pharmacist-initiated referrals to general practitioners for asthma review. NPJ Prim Care Respir Med 2022; 32:53. [DOI: 10.1038/s41533-022-00315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/21/2022] [Indexed: 11/18/2022] Open
Abstract
AbstractUptake and outcomes of pharmacist-initiated general practitioner (GP) referrals for patients with poorly controlled asthma were investigated. Pharmacists referred at-risk patients for GP assessment. Patients were categorized as action takers (consulted their GP on pharmacist’s advice) or action avoiders (did not action the referral). Patient clinical data were compared to explore predictors of uptake and association with health outcomes. In total, 58% of patients (n = 148) received a GP referral, of whom 78% (n = 115) were action takers, and 44% (n = 50) reported changes to their asthma therapy. Patient rurality and more frequent pre-trial GP visits were associated with action takers. Action takers were more likely to have an asthma action plan (P = 0.001) at month 12, and had significantly more GP visits during the trial period (P = 0.034). Patient uptake of pharmacist-initiated GP referrals was high and led to GP review and therapy changes in patients with poorly controlled asthma.
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11
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Priede A, Lau P, Darby I, Morgan M, Mariño R. Referral Compliance Following a Diabetes Screening in a Dental Setting: A Scoping Review. Healthcare (Basel) 2022; 10:2020. [PMID: 36292467 PMCID: PMC9601736 DOI: 10.3390/healthcare10102020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 11/04/2022] Open
Abstract
With type 2 diabetes prevalence increasing in Australia, and the condition associated with significant morbidity and mortality, screening for dysglycaemia in the dental setting has been proposed to identify asymptomatic individuals. Screening commences with a risk assessment, and individuals identified at elevated risk for having diabetes are then referred to their medical practitioner for confirmation of their glycemic status. Therefore, for screening to be effective, individuals need to adhere to their oral health professionals' (OHP) advice and attend their medical follow-ups. This review aims to investigate the literature on referral compliance following a risk assessment in the dental setting and identify barriers and facilitators to screened individuals' referral compliance. A scoping review of the literature was undertaken, selecting studies of diabetes screening in a dental setting that recorded compliance to referral to follow-up, and explored any barriers and facilitators to adherence. Fourteen studies were selected. The referral compliance varied from 25 % to 90%. Six studies reported barriers and facilitators to attending medical follow-ups. Barriers identified included accessibility, cost, knowledge of the condition, and OHP characteristics.
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Affiliation(s)
- Andre Priede
- Melbourne Dental School, University of Melbourne, Parkville 3010, Australia
| | - Phyllis Lau
- Melbourne Dental School, University of Melbourne, Parkville 3010, Australia
| | - Ivan Darby
- Melbourne Dental School, University of Melbourne, Parkville 3010, Australia
| | - Mike Morgan
- Faculty of Dentistry, University of Otago, Dunedin 9054, New Zealand
| | - Rodrigo Mariño
- Melbourne Dental School, University of Melbourne, Parkville 3010, Australia
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12
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Rondeaux S, Braeckman T, Beckwé M, Biset N, Maesschalck J, Duquet N, De Wulf I, Devroey D, De Vriese C. Diabetes and Cardiovascular Diseases Risk Assessment in Community Pharmacies: An Implementation Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148699. [PMID: 35886551 PMCID: PMC9316424 DOI: 10.3390/ijerph19148699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 02/04/2023]
Abstract
The implementation of a new service is often challenging when translating research findings into routine clinical practices. This paper presents the results of the implementation study of a pilot project for a diabetes and cardiovascular diseases risk-assessment service in Belgian community pharmacies. To evaluate the implementation of the service, a mixed method was used that follows the RE-AIM framework. During the testing stage, 37 pharmacies participated, including five that dropped out due to a lack of time or COVID-19-related temporary obligations. Overall, 502 patients participated, of which 376 (74.9%) were eligible for according-to-protocol analysis. Of these, 80 patients (21.3%) were identified as being at high risk for the targeted diseases, and 100 (26.6%) were referred to general practice for further investigation. We presented the limited effectiveness and the key elements influencing optimal implementation. Additional strategies, such as interprofessional workshops, a data-sharing platform, and communication campaigns, should be considered to spread awareness of the new role of pharmacists. Such strategies could also promote collaboration with general practitioners to ensure the follow-up of patients at high risk. Overall, this service was considered easy to perform and feasible in practice but would require financial and external support to ensure its effectiveness, sustainability, and larger-scale implementation.
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Affiliation(s)
- Sarah Rondeaux
- Department of Pharmacotherapy and Pharmaceutics, Faculty of Pharmacy, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium; (S.R.); (N.B.)
| | - Tessa Braeckman
- Department of Family Medicine and Chronic Care, Faculty of Medicine, Vrije Universiteit Brussels (VUB), 1090 Brussels, Belgium; (T.B.); (M.B.); (D.D.)
| | - Mieke Beckwé
- Department of Family Medicine and Chronic Care, Faculty of Medicine, Vrije Universiteit Brussels (VUB), 1090 Brussels, Belgium; (T.B.); (M.B.); (D.D.)
| | - Natacha Biset
- Department of Pharmacotherapy and Pharmaceutics, Faculty of Pharmacy, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium; (S.R.); (N.B.)
| | - Joris Maesschalck
- Association of Pharmacists Belgium, 1000 Brussels, Belgium; (J.M.); (N.D.); (I.D.W.)
| | - Nathalie Duquet
- Association of Pharmacists Belgium, 1000 Brussels, Belgium; (J.M.); (N.D.); (I.D.W.)
| | - Isabelle De Wulf
- Association of Pharmacists Belgium, 1000 Brussels, Belgium; (J.M.); (N.D.); (I.D.W.)
| | - Dirk Devroey
- Department of Family Medicine and Chronic Care, Faculty of Medicine, Vrije Universiteit Brussels (VUB), 1090 Brussels, Belgium; (T.B.); (M.B.); (D.D.)
| | - Carine De Vriese
- Department of Pharmacotherapy and Pharmaceutics, Faculty of Pharmacy, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium; (S.R.); (N.B.)
- Correspondence: ; Tel.: +32-26-505-310
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13
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Dong KR, Beckwith CG, Grossman A, Weiner DE, Lichtenstein AH. Utilizing the Probation Office as an Opportunity to Screen for Cardiometabolic Outcomes: A Feasibility Study. JOURNAL OF CORRECTIONAL HEALTH CARE 2022; 28:274-282. [PMID: 35687477 PMCID: PMC9529367 DOI: 10.1089/jchc.20.11.0102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This cross-sectional study examined whether the probation office setting was feasible to screen adults on probation for cardiometabolic risk factors, measure risk profiles, and estimate the prevalence of obesity, hypertension, hypercholesterolemia, and diabetes. During June and August 2019, screening included blood pressure, anthropometrics, total and high-density lipoprotein (HDL) cholesterol, and glucose. A survey included demographics, medical history, and current medication. The participation rate was 36% (N = 202). The screening identified 5% had hypercholesterolemia, 38% of men and 50% of women had low HDL cholesterol, 70% had overweight/obesity, 31% of men and 55% of women had elevated waist circumferences, and 26.7% had Stage 1 hypertension. Of individuals with a history of hypertension (n = 74), 77% had elevated blood pressure. Of those with a history of diabetes (n = 27), 22% had hyperglycemia, independent of whether they reported being prescribed medication. The screening identified 11% with Stage 2 hypertension, 27% with Stage 1 hypertension, 22% with elevated blood pressure, and 5% with hyperglycemia. Our findings suggest it is feasible to identify individuals at high risk for cardiometabolic disorders during routine probation office visits. These data can then be used to provide referrals for treatment to improve long-term health outcomes.
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Affiliation(s)
- Kimberly R Dong
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Curt G Beckwith
- The Miriam Hospital, Division of Infectious Diseases, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Anna Grossman
- Tufts University Friedman School of Nutrition Science and Policy, Boston, Massachusetts, USA
| | - Daniel E Weiner
- Division of Nephrology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Alice H Lichtenstein
- Cardiovascular Nutrition Laboratory, USDA Human Nutrition Research Center on Aging, Tufts University Friedman School of Nutrition Science and Policy, Boston, Massachusetts, USA
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Elnaem MH, Nuffer W. Diabetes care and prevention services provided by pharmacists: Progress made during the COVID-19 pandemic and the need for additional efforts in the post-pandemic era. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 6:100137. [PMID: 35469121 PMCID: PMC9020490 DOI: 10.1016/j.rcsop.2022.100137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/04/2022] [Accepted: 04/14/2022] [Indexed: 11/26/2022] Open
Abstract
Diabetes is a challenging metabolic disease that significantly impacts people's health worldwide. It requires a comprehensive approach for better prevention and control, especially during challenging times such as the recent pandemic. The COVID-19 pandemic has altered how health care professionals, including pharmacists, provide health care. With the widespread use of virtual and online platforms for service delivery, pharmacist-led diabetes care has been transformed to meet the needs of patients during the pandemic. This article aims to discuss examples of pharmacist-led diabetes care services during the pandemic and highlight areas where additional pharmacist efforts are needed in the post-pandemic era.
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Affiliation(s)
- Mohamed Hassan Elnaem
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
- Quality Use of Medicines Research Group, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Wesley Nuffer
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
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Jones ID, Lane DA, Lotto RR, Oxborough D, Neubeck L, Penson PE, Czanner G, Shaw A, Johnston Smith E, Santos A, McGinn EE, Ajiboye A, Town N, Lip GYH. Supermarket/Hypermarket Opportunistic Screening for Atrial Fibrillation (SHOPS-AF): A Mixed Methods Feasibility Study Protocol. J Pers Med 2022; 12:jpm12040578. [PMID: 35455694 PMCID: PMC9025049 DOI: 10.3390/jpm12040578] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 12/02/2022] Open
Abstract
Aims: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a key risk factor for ischaemic stroke. Following AF detection, treatment with oral anticoagulation can significantly lower mortality and morbidity rates associated with this risk. The availability of several hand-held devices which can detect AF may enable trained health professionals to adopt AF screening approaches which do not interfere with people’s daily routines. This study aims to investigate the effectiveness of a hand-held device (the MyDiagnostick single-lead Electrocardiogram (ECG) sensor) in screening for AF when embedded into the handles of supermarket trolleys. Methods: A mixed methods two-phase approach will be taken. The quantitative first phase will involve the recruitment of 2000 participants from a convenience sample at four large supermarkets with pharmacies. Prospective participants will be asked to conduct their shopping using a trolley embedded with a MyDiagnostick sensor. If the device identifies a participant with AF, the in-store pharmacist will be dispatched to take a manual pulse measurement and a static control sensor reading and offer a cardiologist consultation referral. When the sensor does not detect AF, a researcher will confirm the reading with a manual pulse measurement. ECGs will be compiled, and the sensitivity, specificity and positive and negative predictive values will be determined. A qualitative second phase will consist of semi-structured interviews carried out with those pharmacists and store managers in-store during the running of the trial period. These will explore the perceptions of staff regarding the merits of embedding sensors in the handles of supermarket trolleys to detect AF. Conclusion: This feasibility study will inform a larger future definitive trial.
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Affiliation(s)
- Ian D. Jones
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L3 2AJ, UK; (R.R.L.); (E.J.S.); (A.S.); (E.E.M.); (A.A.); (N.T.)
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 2AJ, UK; (D.A.L.); (D.O.); (P.E.P.); (G.C.); (G.Y.H.L.)
- Correspondence:
| | - Deirdre A. Lane
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 2AJ, UK; (D.A.L.); (D.O.); (P.E.P.); (G.C.); (G.Y.H.L.)
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L7 8TX, UK
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| | - Robyn R. Lotto
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L3 2AJ, UK; (R.R.L.); (E.J.S.); (A.S.); (E.E.M.); (A.A.); (N.T.)
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 2AJ, UK; (D.A.L.); (D.O.); (P.E.P.); (G.C.); (G.Y.H.L.)
| | - David Oxborough
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 2AJ, UK; (D.A.L.); (D.O.); (P.E.P.); (G.C.); (G.Y.H.L.)
- School of Sport and Exercise Science, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, Edinburgh EH11 4DN, UK;
| | - Peter E. Penson
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 2AJ, UK; (D.A.L.); (D.O.); (P.E.P.); (G.C.); (G.Y.H.L.)
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Gabriela Czanner
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 2AJ, UK; (D.A.L.); (D.O.); (P.E.P.); (G.C.); (G.Y.H.L.)
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Andy Shaw
- School of Civil Engineering and Built Environment, Liverpool John Moores University, Liverpool L3 3AF, UK;
| | - Emma Johnston Smith
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L3 2AJ, UK; (R.R.L.); (E.J.S.); (A.S.); (E.E.M.); (A.A.); (N.T.)
| | - Aimeris Santos
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L3 2AJ, UK; (R.R.L.); (E.J.S.); (A.S.); (E.E.M.); (A.A.); (N.T.)
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 2AJ, UK; (D.A.L.); (D.O.); (P.E.P.); (G.C.); (G.Y.H.L.)
| | - Emily E. McGinn
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L3 2AJ, UK; (R.R.L.); (E.J.S.); (A.S.); (E.E.M.); (A.A.); (N.T.)
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 2AJ, UK; (D.A.L.); (D.O.); (P.E.P.); (G.C.); (G.Y.H.L.)
| | - Aderonke Ajiboye
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L3 2AJ, UK; (R.R.L.); (E.J.S.); (A.S.); (E.E.M.); (A.A.); (N.T.)
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 2AJ, UK; (D.A.L.); (D.O.); (P.E.P.); (G.C.); (G.Y.H.L.)
| | - Nicola Town
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L3 2AJ, UK; (R.R.L.); (E.J.S.); (A.S.); (E.E.M.); (A.A.); (N.T.)
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 2AJ, UK; (D.A.L.); (D.O.); (P.E.P.); (G.C.); (G.Y.H.L.)
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 2AJ, UK; (D.A.L.); (D.O.); (P.E.P.); (G.C.); (G.Y.H.L.)
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L7 8TX, UK
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
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Koohi F, Kohansal K, Naz MSG, Derakhshan S, Azizi F, Khalili D. The trend of 10-year cardiovascular risk among diabetic and non-diabetic participants in Tehran Lipid and glucose study: 1999-2018. BMC Public Health 2022; 22:596. [PMID: 35346132 PMCID: PMC8961927 DOI: 10.1186/s12889-022-12981-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Assessing the risk of cardiovascular disease (CVD) is crucial in preventive cardiology. We aimed to determine the trend of CVD risk among individuals with and without diabetes during two decades of follow-up in a Middle Eastern cohort. METHODS We studied 8,450 individuals (55.5% women) aged 40-75 years who participated in the Tehran Lipid and Glucose Study (TLGS). Diabetes status and CVD risk factors were evaluated in six examinations from 1999 to 2018. The individual 10-year CVD risk score was calculated using the ACC/AHA recommended risk equation. We used generalized estimating equation models (GEE) to assess the time trends of CVD risk factors and CVD risk scores in diabetic and non-diabetic groups separately. RESULTS The age-adjusted ACC/AHA risk score significantly decreased in non-diabetic women and men (from 3.2% to 1.6% in women and 6.8% to 5.0% in men; p for trend < 0.001). Whereas the risk significantly decreased among diabetics men (from 13.8% to 11.5%), it increased somehow among diabetics women (from 5.3% to 5.5%). Furthermore, in both sexes, diabetic individuals compared to non-diabetic ones had better control on their systolic blood pressure, total cholesterol, and fasting plasma glucose during the last two decades. CONCLUSIONS The CVD risk and most CVD risk factors improved in individuals with and without diabetes in the past two decades; however, they have not reached the targets yet. So, more stringent lifestyle modifications and treatment strategies are needed, especially for primary prevention in the general population.
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Affiliation(s)
- Fatemeh Koohi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Karim Kohansal
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Saei Ghare Naz
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Derakhshan
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Almansour HA, Aloudah NM, Alhawassi TM, Chaar B, Krass I, Saini B. Physicians' views on cardiovascular disease risk prevention services by pharmacists and potential for collaboration. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 4:100077. [PMID: 35479842 PMCID: PMC9029915 DOI: 10.1016/j.rcsop.2021.100077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/10/2021] [Accepted: 09/26/2021] [Indexed: 10/26/2022] Open
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18
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Nascimento LG, Nascimento RCRMD, Frade JCQP, Pinheiro EB, Ferreira WM, Reis JS, Melo KFSD, Pontarolo R, Lenzi MSA, de Almeida JV, João WJ, Pedrosa HC, Correr CJ, Coura-Vital W. A new Brazilian regional scenario of Type 2 diabetes risk in the next ten years. Prim Care Diabetes 2021; 15:1019-1025. [PMID: 34362696 DOI: 10.1016/j.pcd.2021.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 01/24/2023]
Abstract
AIMS According to a recent national diabetes screening performed by our group in 2018, 18.4% of the Brazilians were found to have high blood glucose. The objective of the present study was to estimate the risk of developing type 2 DM (T2DM) in the next ten years in Brazilian population. METHODS A cross-sectional study was carried out in community pharmacies across Brazil, in 2018, where pharmacists applied the FINDRISC questionnaire to estimate the population's risk of developing T2DM within a ten-year period. RESULTS The study included 977 pharmacists from 345 municipalities distributed across the five geographical regions of Brazil. Of the 17,580 people evaluated, the South region was found to have the highest frequency (59.6%) among people at very low and/or low risk of developing T2DM, while the North region, the most underserved, presented the highest and/or very highest T2DM risk (24.1%). The factors that mostly and importantly impacted these regional differences were body mass index; the highest daily consumption of vegetables and fruits; history of high blood glucose and family history of T1DM/T2DM. CONCLUSION These results showed an impressive change of direction concerning diabetes numbers between the most underserved region in public health care and one of the most developed and best organized regions concerning health assistance, the North and the South, respectively.
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Affiliation(s)
- Lúbia Guaima Nascimento
- Programa de Pós Graduação em Ciências Farmacêuticas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | | | | | | | | | - Janice Sepúlveda Reis
- Santa Casa of Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil; Sociedade Brasileira de Diabetes, Brazil
| | - Karla Fabiana Santana de Melo
- Diabetes Division, Hospital de Clínicas, Escola de Medicina, Universidade de São Paulo, São Paulo, Brazil; Sociedade Brasileira de Diabetes, Brazil
| | - Roberto Pontarolo
- Departamento de Farmácia, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | | | | | | | - Hermelinda Cordeiro Pedrosa
- Sociedade Brasileira de Diabetes, Brazil; Unidade de Endocrinologia-Polo de Pesquisa FEPECS, Hospital Regional de Taguatinga, Secretaria de Saúde, Brasília, Brazil
| | | | - Wendel Coura-Vital
- Programa de Pós Graduação em Ciências Farmacêuticas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil; Departamento de Análises Clíncas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil.
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Alzubaidi H, Hasan S, Saidawi W, Mc Namara K, Chandir S, Krass I. Outcomes of a novel pharmacy screening intervention to address the burden of type 2 diabetes and cardiovascular disease in an Arabic-speaking country. Diabet Med 2021; 38:e14598. [PMID: 33969536 DOI: 10.1111/dme.14598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/05/2021] [Indexed: 12/28/2022]
Abstract
AIMS Aim of this study is to evaluate the capacity of a pharmacist-delivered screening model for type 2 diabetes and cardiovascular disease (CVD) in identifying and referring individuals at risk. METHOD A screening programme was implemented in 12 community pharmacies in three cities in the United Arab Emirates. Trained pharmacists screened adults (≥40 years) without a previous diagnosis of diabetes or CVD. Most participants were recruited during their visits to the pharmacies; pharmacy-based advertising and social media were also used. The screening included medical history, anthropometric measurements, point-of-care glycated haemoglobin (HbA1c ) levels, and a lipid panel. High-risk individuals (HbA1c ≥ 5.7% [39 mmol/mol], a high diabetes risk score, or a 10-year CVD risk ≥7.5%) were given a referral letter and advised to visit their physician. Risk factors for elevated HbA1c were identified by logistic regression. RESULTS Of the 568 screened participants, 332/568 (58%) were identified to be at risk: HbA1c levels were consistent with diabetes 67/560 (12%) or prediabetes 148/560 (26%), high diabetes risk score 243/566 (43%), CVD risk score > 7.5% 79/541 (15%). Obese people were more likely to have prediabetes or diabetes OR (95% CI): 3.2 (1.3, 7.5), as were those who spent more than 11 h/day sitting: 5.7 (1.8, 17.6). Of the 332 at-risk participants, 206 (62%) responded to a telephone follow-up at six weeks; one-third had discussed screening results with their physician. CONCLUSIONS Community pharmacists detected and referred individuals at risk for diabetes or CVD, although participant follow-up with their physician could be improved. Pharmacy screening is feasible and will potentially improve outcomes.
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Affiliation(s)
- Hamzah Alzubaidi
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Sanah Hasan
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
| | - Ward Saidawi
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Kevin Mc Namara
- School of Medicine, Deakin University, Geelong, Vic., Australia
- Centre for Population Health Research, Deakin University, Burwood, Vic., Australia
| | - Subhash Chandir
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- IRD Global, Singapore, Singapore
| | - Ines Krass
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
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Fonseca AA, Lima TM, Castel-Branco M, Figueiredo IV. Feasibility of cardiovascular risk screening in Portuguese community pharmacies. Pharm Pract (Granada) 2021; 19:2255. [PMID: 34188730 PMCID: PMC8203311 DOI: 10.18549/pharmpract.2021.2.2255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Cardiovascular disease (CVD) remains the leading cause of human mortality. As
highly accessible and qualified health professionals, community pharmacists
can be included in the early detection of patients at risk for CVD by
implementing CVD screening programs. Objective: To assess the feasibility of CVD risk screening services in Portuguese
community pharmacies from the evaluation of customers acceptability. Methods: A cross-sectional study was conducted in a community pharmacy in Portugal.
The purpose of entering the pharmacy was recorded for all customers.
Afterwards, the customers were invited to be interviewed by the pharmacist,
who registered their willingness to participate and collected the
participants’ data and biochemical and physical parameters to assess
their CV risk by applying the Systematic COronary Risk Evaluation (SCORE)
model. For the participants who were not eligible for the SCORE-based risk
assessment, the pharmacist considered the major modifiable CVD risk factors
- hypertension, dyslipidemia, smoking habits, obesity, impaired fasting
glucose and sedentary behavior - according to the ESC guidelines. Results: Picking up medication was the most prevalent reason 69.8% (n=1,600)
for entering the pharmacy, and among the contacted customers, 56.4%
(n=621) agreed to have their CVD risk assessed. Of the 588 participants,
56.6% (n=333) were already on CV pharmacotherapy and were therefore
not eligible for screening. Of the 43.4% (n=255) CV
pharmacotherapy-naïve participants, 94.9% (n=242) were
screened with at least one CVD risk factor; 52.9% (n=135) were not
eligible for the SCORE assessment, of which 92.6% (n=125) presented
CVD risk factors. Of the 120 SCORE eligible participants, 80.0%
(n=96) were at least at moderate risk of CVD. Conclusions: We determined the feasibility of CVD risk screening in Portuguese community
pharmacies, as we found high customer acceptability, noted the reasons for
nonattendance, and found a high prevalence of CVD risk factors in at-risk
patients. This is an opportunity for Portuguese community pharmacists to
take a leading role in the early detection of CVD.
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Affiliation(s)
- Anabela A Fonseca
- Faculty of Pharmacy, Pharmacology and Pharmaceutical Care Laboratory, University Coimbra, Coimbra (Portugal).
| | - Tácio M Lima
- PhD. Professor. Department of Pharmaceutical Sciences, Federal Rural University of Rio de Janeiro. Seropédica, RJ (Brazil).
| | - Margarida Castel-Branco
- PhD. Professor. Coimbra Institute for Biomedical Imaging and Translational Research (iCBR), Faculty of Pharmacy, Pharmacology and Pharmaceutical Care Laboratory, University Coimbra. Coimbra (Portugal).
| | - Isabel V Figueiredo
- PhD. Professor. Coimbra Institute for Biomedical Imaging and Translational Research (iCBR), Faculty of Pharmacy, Pharmacology and Pharmaceutical Care Laboratory, University Coimbra. Coimbra (Portugal).
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21
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Almansour HA, Aloudah NM, Alhawassi TM, Chaar B, Krass I, Saini B. Cardiovascular disease risk prevention services by pharmacists in Saudi Arabia: what do policymakers and opinion leaders think? J Pharm Policy Pract 2021; 14:42. [PMID: 33958004 PMCID: PMC8100751 DOI: 10.1186/s40545-021-00319-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/21/2021] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Hadi A Almansour
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Building Number A15, Sydney, NSW, 2006, Australia.
| | - Nouf M Aloudah
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Tariq M Alhawassi
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Betty Chaar
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Building Number A15, Sydney, NSW, 2006, Australia
| | - Ines Krass
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Building Number A15, Sydney, NSW, 2006, Australia
| | - Bandana Saini
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Building Number A15, Sydney, NSW, 2006, Australia.,Woolcock Institute of Medical Research, Sydney, NSW, Australia
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22
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Tong V, Krass I, Luckie K, Aslani P. The evolving profile of cognitive pharmaceutical services in Australia. Res Social Adm Pharm 2021; 18:2529-2537. [PMID: 33992586 DOI: 10.1016/j.sapharm.2021.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/17/2021] [Indexed: 11/19/2022]
Abstract
Globally, the availability and delivery of cognitive pharmaceutical services (CPS) by pharmacists has expanded over time. Australia has been no exception to this trend, with government funding to support the provision of certain CPS significantly increasing over the last two decades. Whilst medication management services have been consistently funded by the government for more than 15 years, fluctuations in the funding of other CPS have been observed; for example, certain disease state management CPS and introduction of funded MedsChecks. Furthermore, legislative changes have broadened pharmacists' scope of practice and the CPS provided, contributing to an increase in user-pay services. Although the literature to date has highlighted positive impacts associated with CPS on economic, clinical and/or humanistic outcomes, context-specific, real world evidence for the benefits of CPS is much needed to ensure the profession engages in evidence-based practice. The aim of this commentary is to outline the changes in CPS provision and funding within the Australian context, the existing evidence for CPS, and highlight the implications for future research.
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Affiliation(s)
- Vivien Tong
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Ines Krass
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Kate Luckie
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Parisa Aslani
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia.
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23
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Nguyen T, Barefield A, Nguyen GT. Social Determinants of Health Associated with the Use of Screenings for Hypertension, Hypercholesterolemia, and Hyperglycemia among American Adults. Med Sci (Basel) 2021; 9:medsci9010019. [PMID: 33806794 PMCID: PMC8005927 DOI: 10.3390/medsci9010019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/02/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022] Open
Abstract
National and international health guidelines have recommended measurements of blood pressure, blood cholesterol, and blood glucose as the first step in detecting hypertension, hypercholesterolemia, and hyperglycemia, respectively. These chronic conditions are modifiable risk factors for chronic diseases such as obesity, diabetes, and cardiovascular disease. Social determinants of health (SDoHs) have contributed to persistent chronic condition disparities in the United States. This study identified SDoHs associated with the use of screening services for hypertension, hypercholesterolemia, and hyperglycemia by analyzing data from the 2019 United States National Health Interview Survey. Examined SDoHs consisted of demographic characteristics, socioeconomic status, and health care utilization. Age, gender, education, annual income, health coverage, and usual care source were positively associated with the odds of receiving secondary preventive services. There was a marginal significance among race/ethnicity and employment status in association with the odds of receiving secondary preventive services. This study's findings inform health educators and providers, public health professionals, and policymakers to fund, plan, and coordinate services and interventions accordingly to improve the population's quality of life and lengthen lifespan by promptly diagnosing and treating these diseases.
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Affiliation(s)
- Tran Nguyen
- College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA;
- Correspondence: ; Tel.: +1-706-721-2940
| | - Amanda Barefield
- College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA;
| | - Gia-Thien Nguyen
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA;
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24
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Fathima M, Bawa Z, Mitchell B, Foster J, Armour C, Saini B. COPD Management in Community Pharmacy Results in Improved Inhaler Use, Immunization Rate, COPD Action Plan Ownership, COPD Knowledge, and Reductions in Exacerbation Rates. Int J Chron Obstruct Pulmon Dis 2021; 16:519-533. [PMID: 33688177 PMCID: PMC7936701 DOI: 10.2147/copd.s288792] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/25/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose To evaluate the effectiveness of a pilot community pharmacy care model for patients with chronic obstructive pulmonary disease (COPD) to improve: 1) inhaler technique; 2) medication adherence; and 3) uptake of non-pharmacological treatment and prevention activities. Patients and Methods Forty "host" pharmacies in Sydney were invited to recruit eligible patients and to provide a counselling room/area in their pharmacy for service provision. Eligible patients were referred to two "consultant" pharmacists, specifically trained to deliver a specialized pharmacy COPD service which involved 3 in-pharmacy visits and 2 follow-up phone calls over a 6-month period. The service consisted of 1) inhaler technique assessment; 2) medication adherence assessment; and 3) referrals to the patient's general practitioner (GP) to facilitate the uptake of non-pharmacological resources as well as to review COPD medications/devices, as required. Pre-post analyses were conducted using paired Student's t-test and Wilcoxon Signed Rank Test for independent variables and chi-squared tests for proportional data. Results Nine "host" pharmacies recruited 40 patients, of whom 37 completed the baseline Visit and 27 completed all Visits. A total of 270 interventions were provided by the "consultant" pharmacists with most provided at Visit 1 (176). The most common interventions were addressing patient gaps in COPD knowledge and inhaler technique. A total of 119 referrals were made to GPs for various reasons, the most common being for a COPD action plan, pulmonary rehabilitation, or pneumonia vaccination. There were significant improvements pre-post intervention in inhaler use competence, COPD knowledge, immunization rate for pneumonia, exacerbation rate and COPD plan ownership. Conclusion In this pilot study, the specialized pharmacy-based COPD care model delivered by "consultant" pharmacists in community pharmacies provided significant health benefits for patients. Further research is needed to assess the model's effectiveness in a larger population as well as when measured against standard care.
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Affiliation(s)
- Mariam Fathima
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Zeeta Bawa
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Bernadette Mitchell
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Juliet Foster
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Carol Armour
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Bandana Saini
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,School of Pharmacy, University of Sydney, Camperdown, New South Wales, Australia
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25
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Basheti MM, Gordon C, Bawa Z, Grunstein R, Saini B. Sleep health management in community pharmacy: Where are we and where should we be heading? Res Social Adm Pharm 2021; 17:1945-1956. [PMID: 33602626 DOI: 10.1016/j.sapharm.2021.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Poor sleep health is now recognised as a significant risk factor for chronic diseases and is associated with considerable comorbidity and mortality. Community pharmacists are primary care clinicians with an integral role in sleep health promotion and chronic sleep disorder management; however, it is unclear to what extent this is currently being undertaken or what the perspectives of Australian community pharmacists regarding their role in sleep health are. OBJECTIVES To explore community pharmacists' current sleep health practice and perspectives on the potential future of sleep health care in community pharmacy. METHODS Qualitative semi-structured interviews were carried out with a maximally varied, convenience-based purposive sample of community pharmacists. Interviews were audio-recorded, transcribed verbatim and subjected to, in sequence; an inductive analysis followed by a deductive approach where the inductively derived thematic structure was used as a framework. RESULTS Twenty-five community pharmacists from two Australian states were interviewed. Insomnia and obstructive sleep apnea (OSA) were the most frequently encountered sleep disorders in community pharmacy presentations. Four key themes were derived from the data: 1) Preparedness, 2) Approach, 3) Capabilities and 4) What needs to change? All participants reported that their sleep health knowledge was insufficient and emphasized the need for more education and training. Although some were engaged in providing OSA services, none of the participants offered services for insomnia or other sleep disorders. Time/task pressures, low health system/health care professional sleep health recognition/awareness and the lack of standardised pharmacy-specific sleep health management guidelines were commonly cited barriers for sleep health service provision. CONCLUSION Community pharmacists commonly manage day-to-day sleep health; however, most expressed a need for increased sleep health recognition/awareness by the health system, targeted education/training for pharmacists and support for the future provision of community pharmacy-delivered sleep health services. With the appropriate implementation strategies, community pharmacists could utilise their availability and accessibility to improve the future of primary care sleep health management.
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Affiliation(s)
- Mariam M Basheti
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Sleep and Circadian Research Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia.
| | - Christopher Gordon
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Zeeta Bawa
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Brain and Mind Centre, School of Psychology, Faculty of Science, The University of Sydney, NSW, Australia
| | - Ron Grunstein
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia; School of Medicine, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Bandana Saini
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Sleep and Circadian Research Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia
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26
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Lewicki J, Religioni U, Merks P. Evaluation of the Community Pharmacy Comorbidities Screening Service on Patients with Chronic Diseases. Patient Prefer Adherence 2021; 15:1611-1619. [PMID: 34305397 PMCID: PMC8294810 DOI: 10.2147/ppa.s312341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/24/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Evaluation of the implementation of pharmaceutical services to detect comorbidities in at-risk patients. METHODS This study was carried out in community pharmacies across Poland in 2019 inside the specially designed service "Refer the Patient". The project was intended for patients with selected chronic diseases. The patients were identified on the basis of their medications (active substances). At-risk patients were referred for prophylactic examinations to detect comorbidities. RESULTS A total of 78 pharmacies took part in this study and 209 at-risk patients were identified. Out of the patients referred for examinations, 30% had deviant results, and 0.95% were diagnosed with new diseases. CONCLUSION Pharmaceutical services supporting screening tests among at-risk patients are highly recommended. Pharmacist intervention allows for early detection of comorbidities and prompt treatment. The pharmaceutical service "Refer the Patient" makes it possible to detect a disease at an early stage. Rapid implementation of treatment can prevent serious health consequences, maintains patient quality of life, and reduce treatment costs.
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Affiliation(s)
- Jędrzej Lewicki
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Urszula Religioni
- Collegium of Business Administration, Warsaw School of Economics, Warsaw, Poland
| | - Piotr Merks
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
- Correspondence: Piotr MerksFaculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, Wóycickiego 1, Warsaw, 01-938, Poland Email
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27
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Asias-Dinh BD, Garey KW. Factors associated with abnormal glucose readings in a pharmacy-led community health fair using the ADA risk assessment tool. J Am Pharm Assoc (2003) 2020; 61:174-180. [PMID: 33257174 DOI: 10.1016/j.japh.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate whether the American Diabetes Association (ADA) risk tool correctly identified high-risk patients with abnormal glucose readings requiring referral to a health care provider in an underserved population at a large student pharmacist-led health fair. In addition, the association of abnormal glucose readings compared with alternative ADA risk score cut point values and other collected variables was evaluated. METHODS This was a retrospective, cross-sectional study using deidentified data from a large student pharmacist-led health fair. RESULTS A total of 35 of 188 (19%) patients were considered high risk per the ADA risk tool, and 11 of those 35 (31%) had abnormal glucose results. After controlling for ADA risk score, no additional collected clinical variables were independently associated with abnormal glucose results. Although the ADA cut point associated with an abnormal glucose screening with the highest area under the curve was greater than or equal to 4, a cut point of 3 or greater resulted in a sensitivity of 91.2%. CONCLUSION The optimal method to identify patients who are at risk for an abnormal glucose screening is the ADA risk tool compared with the individual components of the tool or other evaluated risk factors. We suggest using an ADA risk cut point of greater than or equal to 3 instead of greater than or equal to 5 to identify patients likely to have abnormal glucose results in the health fair setting as this would greatly increase the chance of identifying patients who would need to be referred to their primary care provider for diagnostic testing.
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28
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Williams M, Thomson L, Butcher E, Morriss R, Khunti K, Packham C. NHS Health Check Programme: a qualitative study of prison experience. J Public Health (Oxf) 2020; 44:174-183. [PMID: 33215193 DOI: 10.1093/pubmed/fdaa189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/28/2020] [Accepted: 09/25/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND NHS Health Checks began in England in 2009 and were subsequently introduced into English prisons. Uptake has been patchy and there is limited understanding about factors that may limit or enhance uptake in prison settings. Uptake of this programme is a key policy in reducing the risk of cardiovascular disease and death in these settings. METHOD Semi-structured focus groups were conducted with groups of prisoners (attendees and non-attendees to the health check), prison healthcare staff, custodial staff and ex-prisoners (n = 50). Participants were asked about their awareness and experiences of the NHS Health Check Programme in prison. RESULTS All groups highlighted barriers for not attending a health check appointment, such as poor accessibility to the healthcare department, stigma and fear. The majority of participants expressed a lack of awareness and discussed common misconceptions regarding the health check programme. Methods of increasing the uptake of health checks through group-based approaches and accessibility to healthcare were suggested. CONCLUSIONS This study reports on prisoner, staff and ex-prisoner perspectives on the implementation of NHS Health Checks within a restrictive prison environment. These findings have potentially substantial implications for successful delivery of care within offender healthcare services.
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Affiliation(s)
- Marie Williams
- Nottinghamshire Healthcare NHS Trust, Nottingham NG6 3AA, UK
| | - Louise Thomson
- Centre for Organizational Health and Development, University of Nottingham, Nottingham NG8 1BB, UK
| | | | - Richard Morriss
- Institute of Mental Health, University of Nottingham, Nottingham NG7 2TU, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
| | - Chris Packham
- Nottinghamshire Healthcare NHS Trust, Nottingham NG6 3AA, UK
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29
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Alzubaidi H, Namara KM, Saidawi W, Hasan S, Krass I. Pharmacists' experiences and views on providing screening services: An international comparison. Res Social Adm Pharm 2020; 16:1558-1568. [DOI: 10.1016/j.sapharm.2020.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/18/2020] [Accepted: 07/19/2020] [Indexed: 01/16/2023]
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30
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Correr CJ, Coura-Vital W, Frade JCQP, Nascimento RCRM, Nascimento LG, Pinheiro EB, Ferreira WM, Reis JS, Melo KFS, Pontarolo R, Lenzi MSA, Almeida JV, Pedrosa HC, João WSJ. Prevalence of people at risk of developing type 2 diabetes mellitus and the involvement of community pharmacies in a national screening campaign: a pioneer action in Brazil. Diabetol Metab Syndr 2020; 12:89. [PMID: 33062060 PMCID: PMC7545923 DOI: 10.1186/s13098-020-00593-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/23/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Brazil is one of top 10 countries with the highest number of people with diabetes mellitus (DM), affecting 16.8 million peoples. It is estimated that 7.7 million people (20-79 years) in the country have not yet been diagnosed, representing an under-diagnosis rate of 46.0%. Herein we aimed to screen people for high blood glucose or risk for developing type 2 DM (T2DM) through community pharmacies in Brazil. METHODS A cross-sectional study was carried out in November 2018, involving 977 pharmacists from 345 municipalities in Brazil. The study evaluated people between 20 and 79 years old without a previous diagnosis of DM. Glycemia was considered high when its value was ≥ 100 mg/dL fasting and ≥ 140 mg/dL in a casual feeding state. The FINDRISC (Finnish Diabetes Risk Score) was used to estimate the risk for developing T2DM. The prevalence of high blood glucose was estimated and the associated factors were obtained using Poisson's multivariate analysis with robust variance. RESULTS During the national screening campaign, 17,580 people were tested with the majority of the consultations (78.2%) being carried out in private pharmacies. The population was composed mainly of women (59.5%) and people aged between 20 and 45 years (47.9%). The frequency of participants with high blood glucose was 18.4% (95% CI 17.9-19.0). Considering the FINDRISC, 22.7% of people had a high or very high risk for T2DM. The risk factors associated with high blood glucose were: Body Mass Index > 25 kg/m2, abdominal circumference > 94 cm for men and > 80 cm for women; education level below 15 years of study, no daily intake of vegetables and fruits; previous diagnosis of arterial hypertension; history of high blood glucose and family history of DM. CONCLUSIONS This is the largest screening study that evaluated the frequency of high blood glucose and its associated factors in a population without a previous diagnosis ever performed in community pharmacies in Brazil. These results may help to improve public health policies and reinforce the role of pharmacists in screening and education actions aimed at this undiagnosed population in a continent-size country such as Brazil.
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Affiliation(s)
- Cassyano J. Correr
- Departamento de Farmácia, Universidade Federal do Paraná, Curitiba, Paraná Brazil
| | - Wendel Coura-Vital
- Programa de Pós Graduação em Ciências Farmacêuticas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais Brazil
| | | | - Renata C. R. M. Nascimento
- Programa de Pós Graduação em Ciências Farmacêuticas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais Brazil
| | - Lúbia G. Nascimento
- Programa de Pós Graduação em Ciências Farmacêuticas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais Brazil
| | | | | | - Janice S. Reis
- Sociedade Brasileira de Diabetes, Ensino e Pesquisa da Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais Brazil
| | - Karla F. S. Melo
- Sociedade Brasileira de Diabetes, Equipe de Diabetes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Roberto Pontarolo
- Departamento de Farmácia, Universidade Federal do Paraná, Curitiba, Paraná Brazil
| | | | - José V. Almeida
- Conselho Federal de Farmácia, Brasília, Distrito Federal Brazil
| | - Hermelinda C. Pedrosa
- Sociedade Brasileira de Diabetes, São Paulo, Brazil
- Secretaria de Estado da Saúde, Polo de Pesquisa da Unidade de Endocrinologia FEPECS-HRT, Brasília, Distrito Federal Brazil
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Prevalence of Undiagnosed Diabetes and Prediabetes in the Dental Setting: A Systematic Review and Meta-Analysis. Int J Dent 2020; 2020:2964020. [PMID: 32908510 PMCID: PMC7468655 DOI: 10.1155/2020/2964020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 06/23/2020] [Accepted: 07/07/2020] [Indexed: 02/06/2023] Open
Abstract
Background With the close link between diabetes mellitus (DM) and periodontal disease (PD), dentists have an unrealized opportunity to make a chance discovery of a patient's medical condition. Unlike in the medical setting, information on the point of care (PoC) and opportunistic screening for DM in the dental setting is limited. To make a reliable estimate on the prevalence of undiagnosed type 2 diabetes mellitus (T2DM) and prediabetes among dental patients in the dental setting and to assist healthcare planners in making an informed decision, information on the disease frequency and strategies employed to address this issue is of paramount importance. Objectives To summarize the data on the prevalence of undiagnosed T2DM and prediabetes amongst dental patients and further explore the effectiveness of the PoC screening and its implication for use in the dental setting. Methods A MEDLINE-PubMed, EMBASE, Web of Science, and Cochrane Library search was conducted with no time specification. Information on study characteristics and diagnostic parameters was retrieved for meta-analysis. All the studies were assessed for methodological quality using the QUADAS-2 tool. Proportions were presented in tables and forest plots. All statistical analysis was performed using the MedCalc software. Results Nine studies met the inclusion criteria. The proportion of dental patients identified to be at a risk of hyperglycaemia with the PoC screening using random blood glucose (RBG) and HbA1 was 32.47% and 40.10%, whilst the estimated proportion with undiagnosed T2DM and prediabetes was identified as 11.23% and 47.38%. Conclusion A significant proportion of dental patients can be identified as undiagnosed T2DM and prediabetes. Targeted opportunistic screening is a feasible approach and can help reduce the prevalence of undiagnosed T2DM and prediabetes.
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Dzingirai B, Matyanga CMJ, Mudzviti T, Siyawamwaya M, Tagwireyi D. Risks to the community pharmacists and pharmacy personnel during COVID-19 pandemic: perspectives from a low-income country. J Pharm Policy Pract 2020; 13:42. [PMID: 32724658 PMCID: PMC7360895 DOI: 10.1186/s40545-020-00250-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/08/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an infectious disease that has become a global pandemic. COVID-19 is spreading in Africa, and Zimbabwe has not been spared. The cases in Zimbabwe are mainly from imported cases due to high volume of travellers from the COVID-19 hotspots. In Zimbabwe, local transmission is also anticipated due to inter- and intracity travelling. Frontline health workers are at risk of infection due to contact with infected people as they discharge their duties. In this setting, the risk to community pharmacists and pharmacy personnel is poorly understood and characterised. This paper looked at the risks of infection that are peculiar to community pharmacy personnel and suggested some recommendations to reduce the risk to COVID-19 infection.
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Affiliation(s)
- B. Dzingirai
- School of Pharmacy, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- Institute of Science in Healthy Aging & Healthcare (SHARE), University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - C. M. J. Matyanga
- School of Pharmacy, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- Clinical Pharmacology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - T. Mudzviti
- School of Pharmacy, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- Newlands Clinic, Harare, Zimbabwe
| | - M. Siyawamwaya
- School of Pharmacy, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - D. Tagwireyi
- School of Pharmacy, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Antoine Sedrak, Glewis S, Alexander M, Lingaratnam MS, Cherie Chiang, Luetsch K. Cancer patients' perspectives on participating in a community pharmacy-based hyperglycaemia screening service - A qualitative exploration of enablers and barriers. Res Social Adm Pharm 2020; 17:613-618. [PMID: 32563743 DOI: 10.1016/j.sapharm.2020.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Patients diagnosed with cancer are often treated with high dose glucocorticosteroids, increasing their risk of developing hyperglycaemia or steroid-induced diabetes, which can be reduced by regular monitoring of blood glucose levels. Community pharmacies can provide easily accessible monitoring services to patients, but may not be convenient or acceptable for people with a cancer diagnosis. OBJECTIVES To explore patients' motivations, perceptions of benefits and barriers influencing their decisions to participate in a novel community pharmacy-based hyperglycaemia screening and monitoring program. METHODS Patients initiated on high-dose-glucocorticosteroids at a quaternary cancer centre, who were meeting risk factor-based inclusion criteria and offered participation in a community-based blood glucose monitoring program, were purposively recruited to semi-structured interviews. Interview transcripts were analysed using content analysis and the Framework Method. RESULTS Twenty-four patients participated in the interviews, of whom eighteen enrolled into the monitoring program and six declined participation. Interview analysis identified themes of motivators and barriers which were interpreted within the Health Belief Model. Patients individually balanced perceptions of risk and susceptibility to hyperglycaemia with the illness and treatment burden of a cancer diagnosis and the ability to access the program. Health concerns, accessibility of the community pharmacy, trust in healthcare professionals and altruism of patients (giving back) were identified as enablers to enrol. Barriers were inaccessibility of the community pharmacy, extra burden to deal with monitoring appointments, and initial misunderstandings about the screening and monitoring program. CONCLUSION Ascertaining individual tipping points based on motivators or enablers and barriers with subsequent tailoring of supportive care programs will be more likely to meet patients' individual needs and may increase the likelihood of delivering appropriate care via community pharmacies.
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Affiliation(s)
- Antoine Sedrak
- Department of Pharmacy, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia.
| | - Sarah Glewis
- Department of Pharmacy, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia.
| | - Marliese Alexander
- Department of Pharmacy, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia.
| | - Mr Senthil Lingaratnam
- Department of Pharmacy, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia.
| | - Cherie Chiang
- The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, 3050, Australia.
| | - Karen Luetsch
- School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, Qld, 4102, Australia.
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Chinnasamy A, Moodie M. Diabetes Related Knowledge, Attitudes and Practice - A Survey Among Oral Health Professionals in Victoria, Australia. Clin Cosmet Investig Dent 2020; 12:111-121. [PMID: 32308495 PMCID: PMC7138629 DOI: 10.2147/ccide.s240212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/29/2020] [Indexed: 01/29/2023] Open
Abstract
Purpose Until now, little is known as to how well the evidence supporting the link between periodontal disease and diabetes is incorporated in the dental practice, in Australia. This study aims to explore Oral health Professionals (OHP) knowledge, attitudes, and practice (KAP) towards diabetes screening in the dental setting. Methods The survey questionnaire consisted of sociodemographic, practice characteristics and Likert scaled questions categorised in different domains of KAP and one additional domain as barriers. A Mann–Whitney and Kruskal–Wallis test was performed to determine differences in the OHP response. To predict if practice behavior was influenced by knowledge and attitudes, a multiple linear regression was conducted. Results A total of 197 respondents were included in the analysis of the results. General dentists constituted 64.6% of the response. For chairside screening of diabetes, 58% felt it was essential and 70% felt it was appropriate. More public sector OHP (79%) felt it is important to conduct chairside screening for T2DM. Patient willingness was identified as the most important and insurance coverage as the least important (43%) consideration for T2DM screening. Conclusion Overall, knowledge, attitude and practice towards DM were positive, but a significant proportion of the OHP felt chairside screening may not be appropriate or important.
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Affiliation(s)
- Alagesan Chinnasamy
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC, Australia
| | - Marjory Moodie
- Deakin Health Economics, Deakin University, Geelong, VIC, Australia
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Pizarro Â, Martins M, Simões J. Expanding Primary Care to Pharmaceutical Patient Care in Diabetes Mellitus Type 2 through the European Union’s Community Pharmacies, between 2008 and 2018: A Systematic Review. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2020. [DOI: 10.1159/000506261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Tesfaye ZT, Yismaw MB. Community's extent of use and approval of extended pharmacy services in community pharmacies in Southwest Ethiopia. PLoS One 2020; 15:e0230863. [PMID: 32241021 PMCID: PMC7117944 DOI: 10.1371/journal.pone.0230863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 03/10/2020] [Indexed: 11/18/2022] Open
Abstract
Background The emergence of chronic diseases as major causes of disability and death has necessitated the introduction of new strategies to effectively address the ever-changing nature of public health problems. As a result, the role of community pharmacies in promoting public health is growing in recent years through the provision of extended pharmacy services. This study was conducted with the aim of assessing community’s extent of use and approval of extended pharmacy services at community pharmacies in Bonga town, Southwest Ethiopia. Materials and methods Community based cross-sectional study was conducted in Bonga town, Southwest Ethiopia, on households selected by systematic random sampling. Data was collected using semi-structured questionnaire. Data was collected by personally delivering questionnaires to respondents in selected households. Results of the study were described by frequency, mean and standard deviation (SD). Binary logistic analysis was performed to identify potential associations between dependent and independent variables. Results Out of 356 individuals included in the study, 58.4% recalled visiting community pharmacy premises during the previous six months. Out of these, 34.6% visited the community pharmacies to get extended pharmacy services. College educated participants were 19.4 times more likely to have used extended pharmacy services as compared to illiterate individuals whereas those who earn monthly income more than 5000 Ethiopian Birr were 3.6 times more likely than those with monthly income of 2000 Ethiopian Birr or less. Of the total participants, 91.3% approved the provision of extended pharmacy services in community pharmacies. Conclusion The extent of community’s use of extended pharmacy services at community pharmacies was found to be low. Nevertheless, majority of the study subjects approved the provision of extended pharmacy services at community pharmacies. Efforts to improve the practice of extended pharmacy service provision at community pharmacies should be made by all stake holders.
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Affiliation(s)
- Zelalem Tilahun Tesfaye
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Malede Berihun Yismaw
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Gnavi R, Sciannameo V, Baratta F, Scarinzi C, Parente M, Mana M, Giaccone M, Cavallo Perin P, Costa G, Spadea T, Brusa P. Opportunistic screening for type 2 diabetes in community pharmacies. Results from a region-wide experience in Italy. PLoS One 2020; 15:e0229842. [PMID: 32187210 PMCID: PMC7080237 DOI: 10.1371/journal.pone.0229842] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/15/2020] [Indexed: 11/18/2022] Open
Abstract
Background and aims Given the paucity of symptoms in the early stages of type 2 diabetes, its diagnosis is often made when complications have already arisen. Although systematic population-based screening is not recommended, there is room to experience new strategies for improving early diagnosis of the disease in high risk subjects. We report the results of an opportunistic screening for diabetes, implemented in the setting of community pharmacies. Methods and results To identify people at high risk to develop diabetes, pharmacists were trained to administer FINDRISC questionnaire to overweight, diabetes-free customers aged 45 or more. Each interviewee was followed for 365 days, searching in the administrative database whether he/she had a glycaemic or HbA1c test, or a diabetologists consultation, and to detect any new diagnosis of diabetes defined by either a prescription of any anti-hyperglycaemic drug, or the enrolment in the register of patients, or a hospital discharge with a diagnosis of diabetes. Out of 5977 interviewees, 53% were at risk of developing diabetes. An elevated FINDRISC score was associated with higher age, lower education, and living alone. Excluding the number of cases expected, based on the incidence rate of diabetes in the population, 51 new cases were identified, one every 117 interviews. FINDRISC score, being a male and living alone were significantly associated with the diagnosis. Conclusions The implementation of a community pharmacy-based screening programme can contribute to reduce the burden of the disease, particularly focusing on people at higher risk, such as the elderly and the socially vulnerable.
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Affiliation(s)
- Roberto Gnavi
- Epidemiology Unit, ASL TO3, Grugliasco (TO), Italy
- * E-mail:
| | | | - Francesca Baratta
- Department of Drug Science and Technology, University of Torino, Torino TO, Italy
| | | | - Marco Parente
- Department of Drug Science and Technology, University of Torino, Torino TO, Italy
| | | | | | | | - Giuseppe Costa
- Epidemiology Unit, ASL TO3, Grugliasco (TO), Italy
- Department of Clinical and Biological Sciences, University of Torino, Torino TO, Italy
| | | | - Paola Brusa
- Department of Drug Science and Technology, University of Torino, Torino TO, Italy
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Almansour HA, Aloudah NM, Alhawassi TM, Chaar B, Krass I, Saini B. Health consumer engagement in developing novel preventive health community pharmacy roles in cardiovascular disease in Saudi Arabia: A qualitative analysis. Saudi Pharm J 2020; 28:529-537. [PMID: 32435133 PMCID: PMC7229330 DOI: 10.1016/j.jsps.2020.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 03/08/2020] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Hadi A Almansour
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nouf M Aloudah
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Tariq M Alhawassi
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Betty Chaar
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ines Krass
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Bandana Saini
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Whittaker PJ. Uptake of cardiovascular health checks in community pharmacy versus general practice. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2019. [DOI: 10.1002/jppr.1568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Paula J. Whittaker
- Division of Population Health Health Services Research and Primary Care School of Health Sciences University of Manchester Manchester UK
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Pappaccogli M, Ravetto Enri L, Perlo E, Di Monaco S, Pignata I, Baratta F, Rabbia F, Mana M, Veglio F, Brusa P. Assessment of a non-physician screening program for hypertension and cardiovascular risk in community pharmacies. Nutr Metab Cardiovasc Dis 2019; 29:1316-1322. [PMID: 31383504 DOI: 10.1016/j.numecd.2019.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 06/30/2019] [Accepted: 07/11/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS The strategic role of prevention in hypertension setting is well known but, with the only exception of annually events promoted by international scientific societies, no other screening campaigns are available. Aim of this study was to assess the feasibility of a non-physician pharmacy-based screening program and to describe the cardiovascular risk and the BP status of participating subjects. METHODS AND RESULTS 2731 costumers participated to the screening program, answering to a questionnaire about personal cardiovascular risk and measuring their BP with an Omron HEM 1040-E. Since no threshold for hypertension diagnosis is currently available for community pharmacies BP measurements, we assessed high BP prevalence according to 3 different cut-offs (≥140/90, ≥135/85 and ≥ 130/80 mmHg) and compared normotensives and hypertensives on major cardiovascular risk factors. According to the proposed cut-offs, prevalence of hypertension was respectively of 31%, 45% and 59.5%, and it increased among younger subjects (31-65 y) when the lowest cut-offs were applied. High BP was found in a large percentage of subjects self-declared on-/not on-treatment (uncontrolled hypertensives) or normotensives (presumptive hypertensives) and among those not aware of their own BP values (presumptive hypertensives). Prevalence of CV risk factors was higher in hypertensives than in normotensives. CONCLUSIONS Our findings demonstrated that a community pharmacy-based screening is feasible and attracts the interests of many subjects, improving awareness on their BP status. The screening was also showed to be useful in order to detect potentially uncontrolled and/or suspected new hypertensives, especially among young adults, to refer to general practitioners for confirmatory diagnosis or further evaluation.
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Affiliation(s)
- Marco Pappaccogli
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Italy.
| | | | - Elisa Perlo
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Italy
| | - Silvia Di Monaco
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Italy
| | - Irene Pignata
- Department of Drug Science and Technology, University of Turin, Italy
| | - Francesca Baratta
- Department of Drug Science and Technology, University of Turin, Italy
| | - Franco Rabbia
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Italy
| | | | - Franco Veglio
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Italy
| | - Paola Brusa
- Department of Drug Science and Technology, University of Turin, Italy
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Alzubaidi HT, Chandir S, Hasan S, McNamara K, Cox R, Krass I. Diabetes and cardiovascular disease risk screening model in community pharmacies in a developing primary healthcare system: a feasibility study. BMJ Open 2019; 9:e031246. [PMID: 31712336 PMCID: PMC6858145 DOI: 10.1136/bmjopen-2019-031246] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES This study aimed to develop an evidence-based community pharmacist-delivered screening model for diabetes and cardiovascular disease (CVD), and assess its feasibility to identify and refer patients with elevated risk. DESIGN A feasibility study. SETTING A purposive sample of 12 community pharmacies in three cities in the United Arab Emirates (UAE). PARTICIPANTS Adults 40 years of age and above who have not been previously diagnosed with either diabetes or CVD. INTERVENTION Pharmacist screening of adults visiting pharmacies involved history, demographics, anthropometric measurements, blood pressure and point-of-care testing including glycated haemoglobin (HbA1c) levels and lipid panel. Participants with a 10-year CVD risk ≥7.5%, HbA1c level ≥5.7% or American Diabetes Association (ADA) risk score ≥5 points were advised to visit their physician. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcomes were (1) development of UAE pharmacist-delivered screening model, (2) the proportion of screened participants identified as having high CVD risk (atherosclerotic CVD 10-year risk defined as ≥7.5%) and (3) the proportion of participants identified as having elevated blood glucose (high HbA1c level ≥5.7% (38.8 mmol/mol)) or high self-reported diabetes risk (ADA risk score ≥5 points). Secondary outcome is participants' satisfaction with the screening. RESULTS The first UAE pharmacist-delivered screening model was developed and implemented. A total of 115 participants were screened, and 92.3% of the entire screening process was completed during a single visit to pharmacy. The mean duration of the complete screening process was 27 min. At-risk individuals (57.4%) were referred to their physicians for further testing, while 94.5% of participants were at least satisfied with their screening experience. CONCLUSIONS The community pharmacist-delivered screening of diabetes and CVD risk is feasible in the UAE. The model offers a platform to increase screening capacity within primary care and provides an opportunity for early detection and treatment. However, pathways for the integration of the pharmacist-delivered screening service with physicians in primary care are yet to be explored.
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Affiliation(s)
- Hamzah Tareq Alzubaidi
- Pharmacy Practice & Pharmacotherapy, University of Sharjah, College of Pharmacy, Sharjah, United Arab Emirates
| | - Subhash Chandir
- Center for Global Health Delivery-Dubai, Harvard Medical School, Dubai, United Arab Emirates
| | - Sanah Hasan
- Ajman University of Science and Technology College of Pharmacy and Health Science, Ajman, United Arab Emirates
| | - Kevin McNamara
- Deakin Rural Health, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Institute for Healthcare Transformation, Deakin University, Geelong, Victoria, Australia
| | - Rachele Cox
- Center for Global Health Delivery-Dubai, Harvard Medical School, Dubai, United Arab Emirates
| | - Ines Krass
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
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Alexander S. Ohio Community Pharmacist Provision of Clinical Preventive Services. Innov Pharm 2019; 10:10.24926/iip.v10i1.1347. [PMID: 34007532 PMCID: PMC7643704 DOI: 10.24926/iip.v10i1.1347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The primary objective of this study was to assess whether Ohio community pharmacists currently provide certain evidencebased clinical preventive services. Secondary objectives were to explore whether there were any differences in provision of services based on respondent education, position, employment status, location, practice setting, or years in practice and to gather information on how pharmacists provide specific services, barriers to providing specific services, pharmacists' perceptions on specific services needed in their patient population, and pharmacists' interests in providing services if not already doing so. METHODS A random sample of 500 community pharmacists licensed in Ohio received a Qualtrics survey via email assessing current practices and perspectives regarding clinical preventive services. The U.S. Preventive Services Task Force (USPSTF) "A" and "B" recommended services that can be provided in a community pharmacy served as the framework for the survey questions. Reminders were sent every 3-4 days; data collection continued for a month. The study was IRB-approved. RESULTS Ninety-three responses were included in the final analysis (18.9% response rate). Approximately 63% of respondents were female; 51.6% held a Doctor of Pharmacy degree. Only 21.5% of respondents were familiar with the USPSTF. However, many respondents were providing clinical preventive services in their pharmacy; the most common were blood pressure screening (51.6%), tobacco use screening or counseling (43%), and diet and/or physical activity counseling (22.6%). These services were provided in varied ways including patient counseling, medication therapy management sessions, screening events, and health fairs. Those who are not currently providing services showed interest in developing them. Pharmacists reported barriers such as lack of time, staff, and reimbursement by patients or third-party payers. CONCLUSION Many surveyed community pharmacists in Ohio reported providing clinical preventive services in a variety of ways. Many pharmacists who did not provide these services indicated an interest developing such services. Staffing concerns, time constraints, and a lack of reimbursement by patients and third-party payers were reported as barriers by community pharmacists in providing these services. As many respondents reported being unfamiliar with USPSTF recommendations, the opportunity to educate pharmacist on these recommendations and potentially increase their activity in these prevention activities exists.
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Alexander SJ, Mager NAD. Ohio Community Pharmacist Interest and Participation in Community-Clinical Linkages. Innov Pharm 2019; 10:10.24926/iip.v10i2.1760. [PMID: 34007542 PMCID: PMC7592858 DOI: 10.24926/iip.v10i2.1760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Community-clinical linkages have been promoted as a means to improve population health. The community pharmacy is an ideal location for these partnerships to occur due to the expertise of the community pharmacist. While the need for these partnerships exists, there are limited data regarding community pharmacists' current participation in such programs. OBJECTIVE The purpose of this analysis was to assess Ohio community pharmacists' involvement and interest in community-clinical linkages. METHODS An electronic survey tool containing 26 questions was developed to assess Ohio community pharmacists' participation in community-clinical linkages and interest to develop such partnerships. The tool was sent via email to a random sample of 500 pharmacists registered in Ohio and practicing in a community setting. Chi-square or Fisher exact nonparametric statistical tests were used as appropriate to identify whether there were any significant differences in current partnership or interest to partner with a prescriber who refers patients to their community pharmacy based on education (Bachelor of Science or Doctor of Pharmacy degree) or pharmacy location (urban, suburban, or rural). RESULTS Nine emails were undeliverable, leaving a sample of 491 pharmacists. Ninety-three (19%) responded to the survey. Sixteen respondents (17%) indicated that they currently partner with a prescriber who refers patients to their pharmacy for assistance with medications or chronic disease state management; this practice was more often reported in urban settings (p=0.022). Of those not currently participating in such a partnership, 53 (57%) were interested in developing one. Thirty-two respondents (34%) reported providing referrals for at least 1 type of screening or counseling service. For some types of services, pharmacists reported that they provide the service in the pharmacy and/or were interested to develop the service in the pharmacy rather than provide a referral. However, for any given service there were a number of pharmacists who expressed interest in providing referrals although they were not currently doing so. CONCLUSION This sample of Ohio community pharmacists reported limited participation in community-clinical linkages but interest to develop them. Further studies should explore the pharmacists' role and impact in such programs.
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Moving opioid misuse prevention upstream: A pilot study of community pharmacists screening for opioid misuse risk. Res Social Adm Pharm 2019; 15:1032-1036. [DOI: 10.1016/j.sapharm.2018.07.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 01/08/2023]
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Haider I, Luetsch K. Pharmacists' advice and clinical reasoning in relation to cardiovascular disease risk factors - A vignette case study. Res Social Adm Pharm 2019; 16:568-573. [PMID: 31383600 DOI: 10.1016/j.sapharm.2019.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/22/2019] [Accepted: 08/01/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pharmacists are increasingly providing public health services like the screening and monitoring for cardiovascular disease risk factors. Information on risk factors should be integrated into an assessment of absolute cardiovascular disease risk. Limited information is available on how pharmacists interpret test results and information related to cardiovascular disease risk factors. OBJECTIVE To investigate the potential advice to clients featured in vignette case studies and reasoning of pharmacists in relation to multiple cardiovascular disease risk factors. METHODS Three vignette case studies representing clients with varying degrees of absolute cardiovascular disease risk who requested blood pressure and cholesterol level testing and related advice were designed and distributed to practicing pharmacists. Vignettes contained all necessary information for absolute cardiovascular disease risk assessment. Two open ended questions asked what advice pharmacists would provide and what influenced their decisions to give specific advice. Responses were analysed using content analysis and assessed for appropriateness in relation to cardiovascular guidelines. RESULTS Replies of twenty-nine pharmacists were analysed. Advice to hypothetical clients was mainly appropriate when it concentrated on lifestyle modifications. Pharmacists' reasoning indicated a focus on individual risk factors in their decision making on advice rather than consideration of absolute cardiovascular disease risk, which resulted in inappropriate recommendations of referral and follow up. CONCLUSION Advice provided in relation to case studies and underlying clinical reasoning indicate potential knowledge gaps, anchoring bias and a framing effect in how pharmacists interpret multiple cardiovascular disease risk factors.
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Affiliation(s)
- Ibrahim Haider
- School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, Qld, 4102, Australia.
| | - Karen Luetsch
- School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, Qld, 4102, Australia.
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Hattingh L, Sim TF, Sunderland B, Czarniak P. Successful implementation and provision of enhanced and extended pharmacy services. Res Social Adm Pharm 2019; 16:464-474. [PMID: 31272922 DOI: 10.1016/j.sapharm.2019.06.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Careful planning is important for successful implementation and ongoing provision of enhanced and extended pharmacy services. OBJECTIVE To explore the factors that contributed to the successful implementation and ongoing provision of enhanced and extended services in Western Australian community pharmacies. METHODS In-depth semi-structured telephone interviews were conducted with purposively selected pharmacists from various practice settings. Interviews explored experiences and perspectives on the provision of enhanced and extended professional services and continued until saturation was achieved. Analysis focused on prior investigation before implementation of services, perceptions of the impact of the services and factors to be considered. The COM-B (Capability, Opportunity, Motivation and Behaviour) model was applied post hoc to the thematic analysis to explore whether there was an overlap between themes and the model. RESULTS In total 26 pharmacists (16 males, 10 females) participated in semi-structured interviews during October 2017 and February 2018. They classified as 20 community, 13 accredited and 7 specialist pharmacists and 11 pharmacist immunisers (some classified as more than one). Interview duration was 55 min (minimum 22, maximum 91 min). Responses regarding prior investigation/research conducted varied in approach followed and level of enquiry. Opinions about services were overall positive such as enhanced collaboration with other healthcare professionals, positive patient outcomes, increased staff satisfaction and acceptance of pharmacists as primary care providers. New services did not always provide direct financial benefit. Three major themes emerged as factors that impacted on provision of services: 1) pharmacist characteristics, 2) local needs, structures and support, and 3) an enabling practice framework. CONCLUSIONS Pharmacists who were successful in the implementation and maintenance of new professional services were familiar with local needs. Both pharmacy and pharmacist aspects should be considered during implementation and maintenance of new professional services. An enabling practice framework is crucial in facilitating new pharmacy services.
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Affiliation(s)
- Laetitia Hattingh
- Gold Coast Health, Gold Coast, Queensland, 4215, Australia; School of Pharmacy and Pharmacology, Griffith University, Gold Coast, Queensland 4222, Australia.
| | - Tin Fei Sim
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, 6102, Australia.
| | - Bruce Sunderland
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, 6102, Australia.
| | - Petra Czarniak
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, 6102, Australia.
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Adje DU, Williams FE, Oparah AC. Outcome of cardiovascular risk assessment among rural community dwellers in ezionum, Nigeria-implications for public health. Afr Health Sci 2019; 19:2112-2120. [PMID: 31656495 PMCID: PMC6794530 DOI: 10.4314/ahs.v19i2.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Cardiovascular disease is a major cause of mortality worldwide. Risk assessment has been shown to reduce cardiovascular morbidity and mortality. In view of their proximity and accessibility, community pharmacies could be a suitable site for cardiovascular risk assessment and other preventive health activities especially in rural underserved populations. The objective of this study was to assess outcome of cardiovascular risk assessment among rural community dwellers. Materials and methods Five hundred and five community dwellers aged 40 to 80 years were recruited for the study. Cardiovascular risk assessment was performed using the region specific WHO/ISH risk assessment charts. Blood pressure, diabetes status, total non- fasting cholesterol, and age were used to estimate risk category. Demographic variables and clinical characteristics were expressed as frequency and percentage. Regression analysis was done to identify predictors of high risk category. Results More than 30% of subjects were hypertensive. Nearly 30% were overweight and had abnormal cholesterol levels. The proportion of subjects in the high risk category was 8.9%. Systolic blood pressure, random blood sugar and advancing age were the highest predictors of high risk category. Conclusion Accessibility, proximity and availability are unique characteristics of community pharmacies that could be exploited to support community based screening services.
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Affiliation(s)
- David U Adje
- Department of Clinical Pharmacy and Pharmacy Administration, Delta State University, Abraka, Nigeria.
| | - Felicia E Williams
- Department of Clinical Pharmacy and Pharmacy Practice, University of Ilorin, Nigeria.
| | - Azuka C Oparah
- Department of Clinical Pharmacy and Pharmacy Practice, University of Benin, Benin city, Nigeria.
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Mc Namara KP, Krass I, Peterson GM, Alzubaidi H, Grenfell R, Freedman B, Dunbar JA. Implementing screening interventions in community pharmacy to promote interprofessional coordination of primary care - A mixed methods evaluation. Res Social Adm Pharm 2019; 16:160-167. [PMID: 31088777 DOI: 10.1016/j.sapharm.2019.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 04/04/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Screening is a critical component of efforts to reduce the population burden of cardiovascular disease (CVD), by facilitating early use of cost-effective prevention and treatment strategies. While international evidence suggests that screening in community pharmacies improves screening access and identifies at-risk individuals, concerns from medical organisations about the absence of interdisciplinary coordination and related lack of continuity of care with general practice have significantly contributed to reluctance from some stakeholders to endorse, and engage with, pharmacy-based screening initiatives. The Cardiovascular Absolute Risk Screening (CARS) study was designed to address these challenges and promote an interprofessional approach to screening for cardiovascular disease risk by pharmacists. This study describes the impact of the CARS implementation model on interdisciplinary coordination and continuity of care. METHODS In addition to clinical training, pharmacists at eleven participating pharmacies were provided with implementation training, resources and support to promote interprofessional coordination. Completion of training and pharmacy implementation plans, both of which highlighted GP engagement strategies, were pre-requisites for screening commencement. Using mixed methods approaches, data were analyzed from screening records (n = 388), researcher interviews with patients at 6-10 weeks post-screening (n = 248, 64%), and pharmacist interviews (n = 10). RESULTS Screening records suggested that 94% of screened individuals were advised to seek formal GP assessment, and 98% consented to sharing of results. Among interviewed participants, 81% recalled direct pharmacist action to facilitate GP engagement. Among interviewees who had seen their GP already (n = 70), 79% reported that their GP was aware of the results (another 16% were uncertain). Pharmacists reported positive GP feedback stemming from efforts at early engagement, but an absence of ongoing collaboration. CONCLUSIONS Use of implementation planning by pharmacists, alongside clinical training, can effectively promote an interdisciplinary coordination focus by pharmacists.
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Affiliation(s)
- Kevin P Mc Namara
- School of Medicine, Deakin University, Geelong, Victoria, Australia; Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia; Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia.
| | - Ines Krass
- School of Pharmacy, The University of Sydney, Camperdown, New South Wales, Australia
| | - Gregory M Peterson
- School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Hamzah Alzubaidi
- University of Sharjah, Sharjah Institute for Medical Research and College of Pharmacy, Sharjah, United Arab Emirates
| | - Rob Grenfell
- CSIRO Health and Biosecurity, Parkville, Victoria, Australia
| | - Ben Freedman
- Heart Research Institute/Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia; Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - James A Dunbar
- Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
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Aly P, Tempremant G, Houppermans S, Maes-Patinier F, Vanbockstael V, Lemdani M. [Experimentation of targeted cardio-neurovascular risk screening in pharmacies]. SANTE PUBLIQUE 2019; 30:777-783. [PMID: 30990266 DOI: 10.3917/spub.187.0777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Pharmacists' involvement in the screening of cardio-neurovascular diseases could enhance the prevention of cardio-neurovascular risk factors. This research-action assesses the pertinence of targeted screening for cardio-neurovascular risk in pharmacies. METHODS This study was carried out within Lens-Hénin over the course of four months. The model included: the tracking of patients, excluding those with known cardio-neurovascular disease, with risk factors according to their age, sex, weight, family history of cardio-neurovascular diseases, smoking status; Screening for cardio-neurovascular risk with blood pressure measuring, blood total cholesterol, HDL cholesterol and the glycaemia by capillary blood sampling as well as the abdominal perimeter and the BMI. Patients were oriented according to results of screening. RESULTS 471 patients were screened, 218 (46%) had at least two risks, 236 (50%) had a cholesterol value greater than or equal 2 g/L, 176 (37.4%) had a blood pressure greater than or equal to limit value l, 104 (22%) patients had a BMI value greater than or equal to 30 kg/m2, 217 (46%) had an abdominal perimeter value greater than or equal to limit value and 17 (5.3%) patients had impaired fasting blood glucose. 373 (79%) patients were moved toward their general practitioner and at least 68 (18%) consulted. CONCLUSION This research-action of targeted screening for cardiovascular risk in pharmacies proves to be relevant. The reproduction of a similar study in other territories is under consideration.
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Cardiovascular disease risk screening by pharmacists: a behavior change wheel guided qualitative analysis. Res Social Adm Pharm 2019; 16:149-159. [PMID: 31027964 DOI: 10.1016/j.sapharm.2019.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND In common with many developed countries, Saudi Arabia is currently experiencing an increasing cardiovascular disease (CVD) burden. However, systematic screening programs for early identification and minimization of CVD risk within community or general clinical settings are limited. Globally, research suggests that pharmacists can play an effective role in identifying, assessing, managing and referring people at risk of CVD in the community as well as in the hospital setting. This role is not yet developed in Saudi Arabia. OBJECTIVES This study aimed to explore the perspectives of hospital and community pharmacists in Saudi Arabia about potential roles in CVD risk screening. The purpose of the study was to propose potential interventions to facilitate the development of pharmacist delivered models for CVD risk prevention and management services in Saudi Arabia. METHODS A qualitative study was conducted using semi-structured in-depth interviews and focus group discussions with a purposive convenience sample of hospital and community pharmacists in Saudi Arabia. Data collection continued until saturation was achieved. All interviews were audio recorded, transcribed verbatim and thematically analyzed. RESULTS A total of 50 pharmacists (26 hospital and 24 community pharmacists) participated in this study. Twenty hospital and eight community pharmacists were interviewed individually, while the remaining participants contributed to three focus groups discussions. Currently, it appears that CVD risk prevention services are rarely provided, and when offered involved provision of discrete elements only such as blood pressure measurement, rather than a consolidated evidence based approach to risk assessment. Participating pharmacists did not appear to have a clear understanding of how to assess CVD risk. Four key themes were identified: pharmacists' perception about their current roles in CVD, proposed future clinical and service roles, impeding factors and enabling factors. Subthemes were mainly related to determinants likely to influence future CVD services. These subthemes included public perception of pharmacists' roles, pharmacist-physician collaboration, legislative restrictions, systemic issues, sociocultural barriers, organizational pharmacy issues, lack of professional motivation, government and organizational support and professional pharmacy support frameworks. These influencing factors need to be addressed at micro, meso and macro systems level in order to facilitate development of new pharmacist delivered cognitive services in Saudi Arabia. CONCLUSIONS Pharmacists in Saudi Arabia are willing to expand their role and offer pharmacy-based services, but influencing determinants have to be addressed at the individual, professional and health system levels. Further work is needed to clarify and develop practical and appropriate protocols for pharmacist CVD prevention and management services within the Saudi public and health care system. Such work should be guided by implementation science frameworks rather than embarking on conventional research trial pipelines where public benefit of generated evidence is delayed or limited.
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