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Alhomoud IS, Cook E, Patel D, Brown RE, Dixon DL. Effect of pharmacist interventions on the management of overweight and obesity: A systematic review. J Am Pharm Assoc (2003) 2024; 64:102058. [PMID: 38417740 DOI: 10.1016/j.japh.2024.102058] [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: 12/20/2023] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Pharmacists are underused healthcare professionals who are well positioned to provide weight management interventions; however, a systematic review of the literature supporting the role of pharmacists in weight management is lacking. OBJECTIVES To conduct a systematic review to assess the body of evidence supporting the role of pharmacists in the management of obesity. METHODS A literature search of OVID MEDLINE, Embase, Web of Science, and CINAHL was conducted from inception through February 23, 2023, to identify studies involving pharmacist interventions for weight management. Included studies were retrospective or prospective studies reporting a change in body weight, body mass index (BMI), or waist circumference as a primary endpoint; and a weight management intervention involving a pharmacist. Studies were excluded if they did not report the desired outcomes, involved pediatric populations, or lacked a pharmacist in the intervention. RESULTS Twenty-nine studies met the eligibility criteria. A total of 6,423 study participants were enrolled with a mean BMI of 27 to 46 kg/m2. The included studies were conducted across 8 different countries with 15 from the United States. The primary approach was a prepost/quasi-experimental study design, typically conducted in community pharmacies. The pharmacists' role varied widely but mainly involved educational counseling as the pharmacist made medication recommendations in only 5 studies. Multidisciplinary collaboration was infrequent. All but 3 studies reported a significant improvement in the weight loss outcome of interest, although most study durations were less than 6 months. A critical appraisal of the 29 studies found the overall quality of the available studies to be relatively poor. CONCLUSION Pharmacist interventions for weight management were mostly effective in reducing body weight; however, more robust clinical trials with a comparator group and for longer duration are warranted. The pharmacist's role in managing weight loss medications also requires further study.
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Motlohi NF, Wiafe E, Mensah KB, Padayachee N, Petrus R, Bangalee V. A systematic review of the role of community pharmacists in the prevention and control of cardiovascular diseases: the perceptions of patients. Syst Rev 2023; 12:160. [PMID: 37705090 PMCID: PMC10500864 DOI: 10.1186/s13643-023-02338-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 08/28/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Cardiovascular diseases are a leading cause of mortality globally. The modifiable risk factors can be measured and identified early at primary healthcare facilities. Community pharmacists present an opportunity for improved management of cardiovascular diseases and health outcomes. The systematic review aims to identify the roles of community pharmacists in preventing and controlling cardiovascular diseases and patients' perceptions towards such functions. METHODS A systematic review of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The team searched MEDLINE, CINAHL via EBSCOhost, and Web of Science from January 2001 to December 2021 with a focus on studies reporting the role of community pharmacists in preventing and controlling cardiovascular diseases, and patients' perceptions of such roles. Search terms included were ''interventions,'' ''community pharmacists,'' ''patients,'' ''cardiovascular diseases,'' ''risk factors,'' and "perceptions". The quality of studies was appraised using the Joanne Briggs Institute checklist. RESULTS A total of 45 studies met the inclusion criteria: 35 (78%) and 10 (22%) reported community pharmacists' preventive and control roles, respectively. Generally, drug therapy monitoring, medicine and lifestyle counselling, and health education were most common roles, with pharmacist-initiated prescribing and social support least common. A total of 11 (24%) studies reported patients' perceptions of community pharmacists' contribution in preventing (73%, n = 8) and controlling (27%, n = 3) cardiovascular diseases. Patients were satisfied with community pharmacists' services in 10 of 11 studies. CONCLUSIONS The findings highlight community pharmacists' capability of providing primary healthcare services in preventing and controlling cardiovascular diseases and provide evidence for their inclusion in primary healthcare frameworks. Future research should assess the effectiveness of these roles and provide a comprehensive evaluation of clinical, humanistic, and economic outcomes. SYSTEMATIC REVIEW REGISTRATION Open Science Framework (OSF) registration https://doi.org/10.17605/OSF.IO/WGFXT .
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Affiliation(s)
| | - Ebenezer Wiafe
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa
- Ho Teaching Hospital, Ho, Ghana
| | - Kofi Boamah Mensah
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa
- Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Neelaveni Padayachee
- Department of Pharmacy and Pharmacology, University of Witwatersrand, Johannesburg, South Africa
| | - Ruwayda Petrus
- Discipline of Psychology, University of KwaZulu-Natal, Durban, South Africa
| | - Varsha Bangalee
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa
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Kapanen AI, Conklin AI, Gobis B, Leung L, Yuen J, Zed PJ. Pharmacist-led cardiovascular risk prevention in Western Canada: a qualitative study. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:45-54. [PMID: 32779329 DOI: 10.1111/ijpp.12658] [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: 12/17/2019] [Revised: 06/26/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Preventing cardiovascular diseases (CVD) is a public health and policy priority, including for employers. A novel CVD risk management programme that included medication management was delivered by pharmacists to employees of a Canadian university. This qualitative study describes the experiences and perceptions of participants who received individual health consultations in this programme. METHODS A qualitative study design using free-text responses was adopted. Data (5658 words) came from evaluation surveys completed by 119 programme participants were iteratively coded and thematically analysed. KEY FINDINGS We identified four themes characterising participant experiences of pharmacist-led CVD prevention. Theme one was labelled self-efficacy because personalised health information and advice on CVD risk factor management empowered participants to make improvements for their health. Participants expressed a range of positive responses about the longer consultations, supportive communication and safe setting of their pharmacist-led encounters; hence, Theme two is labelled pharmacists' interpersonal skills. The wider context of the programme included a number of enabling factors (Theme three) that either supported or limited participant engagement in the programme. A number of changes to behaviour and health measures were identified and participant suggestions to expand and continue the programme further contributed to perceptions of positive programme impact (Theme four). CONCLUSIONS This study raises questions about how external resources and broader determinants might enable, or hinder, future programme success and sustainability. It also highlights the need for greater understanding and communication of the importance of primary prevention and the role of pharmacists in CVD risk reduction and workplace health promotion.
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Affiliation(s)
- Anita I Kapanen
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Annalijn I Conklin
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Providence Healthcare Research Institute, St. Paul's Hospital, Vancouver, BC, Canada
| | - Barbara Gobis
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Larry Leung
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Jamie Yuen
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Peter J Zed
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada.,Department of Emergency Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
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Abstract
PURPOSE OF REVIEW The burden of cardiovascular disease (CVD) in the USA remains unacceptably high. The associated morbidity and mortality of CVD has important implications on our healthcare system and society. With much of CVD considered preventable an increase emphasis on primary prevention is important. To review the evidence for pharmacists providing CVD primary prevention, particularly as a part of employer-based programs. RECENT FINDINGS A recent study evaluated the impact of a pharmacist-led 12-month preventative health program in 178 at-risk employees at University of British Columbia (UBC). Cardiovascular Assessment and Medication Management by Pharmacists at UBC (CAMMPUS) resulted in improved Framingham risk scores (FRS) from 11.7 to 10.7 (p = 0.0017), improvement in quality of life (p = 0.023), and medication adherence (p = 0.019). Findings are consistent with improvements observed in other pharmacist-led intervention trials but offer the unique perspective as an employer-based intervention. Pharmacists-led interventions prevent CVD through improvement in health markers and medication adherence. The ability of pharmacists to provide these as part of an employer-sponsored benefit might be favorable as other billing models for pharmacist can be challenging to be justified in a fee-for-service payment structure; further, there is incentive for employers to lower healthcare cost and improve productivity. Future studies defining the impact of pharmacists in this and other settings may have important public health implications.
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Meng L, Wolff MB, Mattick KA, DeJoy DM, Wilson MG, Smith ML. Strategies for Worksite Health Interventions to Employees with Elevated Risk of Chronic Diseases. Saf Health Work 2017; 8:117-129. [PMID: 28593067 PMCID: PMC5447415 DOI: 10.1016/j.shaw.2016.11.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 10/20/2016] [Accepted: 11/07/2016] [Indexed: 10/27/2022] Open
Abstract
Chronic disease rates have become more prevalent in the modern American workforce, which has negative implications for workplace productivity and healthcare costs. Offering workplace health interventions is recognized as an effective strategy to reduce chronic disease progression, absenteeism, and healthcare costs as well as improve population health. This review documents intervention and evaluation strategies used for health promotion programs delivered in workplaces. Using predetermined search terms in five online databases, we identified 1,131 published items from 1995 to 2014. Of these items, 27 peer-reviewed articles met the inclusion criteria; reporting data from completed United States-based workplace interventions that recruited at-risk employees based on their disease or disease-related risk factors. A content rubric was developed and used to catalogue these 27 published field studies. Selected workplace interventions targeted obesity (n = 13), cardiovascular diseases (n = 8), and diabetes (n = 6). Intervention strategies included instructional education/counseling (n = 20), workplace environmental change (n = 6), physical activity (n = 10), use of technology (n = 10), and incentives (n = 13). Self-reported data (n = 21), anthropometric measurements (n = 17), and laboratory tests (n = 14) were used most often in studies with outcome evaluation. This is the first literature review to focus on interventions for employees with elevated risk for chronic diseases. The review has the potential to inform future workplace health interventions by presenting strategies related to implementation and evaluation strategies in workplace settings. These strategies can help determine optimal worksite health programs based on the unique characteristics of work settings and the health risk factors of their employee populations.
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Affiliation(s)
- Lu Meng
- Workplace Health Group, Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA, USA
| | - Marilyn B. Wolff
- Workplace Health Group, Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA, USA
| | - Kelly A. Mattick
- Workplace Health Group, Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA, USA
| | - David M. DeJoy
- Workplace Health Group, Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA, USA
| | - Mark G. Wilson
- Workplace Health Group, Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA, USA
| | - Matthew Lee Smith
- Workplace Health Group, Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA, USA
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M Health Science Center, College Station, TX, USA
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El Hajj MS, Mahfoud ZR, Al Suwaidi J, Alkhiyami D, Alasmar AR. Role of pharmacist in cardiovascular disease-related health promotion and in hypertension and dyslipidemia management: a cross-sectional study in the State of Qatar. J Eval Clin Pract 2016; 22:329-40. [PMID: 26552842 DOI: 10.1111/jep.12477] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES In Qatar, cardiovascular diseases (CVD) have recently become the leading cause of morbidity and mortality. Prevention, detection and management of CVD risk factors reduce CVD chance. The study objectives were to assess Qatar pharmacists' involvement in CVD health promotion, to identify the activities that they currently provide to patients with CVD risk factors, to describe their attitudes towards their involvement in CVD prevention and to assess their perceived barriers for provision of CVD prevention services METHOD We conducted a cross-sectional survey of community and ambulatory pharmacists in Qatar. Pharmacist characteristics, involvement in CVD-related activities along with their attitudes and perceived barriers were analysed using frequency distributions. Bivariate linear regression models were used to test for associations between CVD health promotion activity score and each variable. Variables with a P-value of 0.20 or less were included in the multivariate model. RESULTS A total of 141 pharmacists completed the survey (response rate 60%). More than 70% responded with rarely or never to 6 out of the 10 CVD health promotion activities. Eighty-four per cent and 68% always or often describe to patients the appropriate time to take antihypertensive medications and the common medication adverse effects, respectively. Yet, 50% rarely or never review the medication refill history or provide adherence interventions. Lack of CVD educational materials was the top perceived barrier (55%) in addition to lack of having private counselling area (44.6%), and lack of time (38.3%). Females and community pharmacists were more involved in CVD health promotion (P = 0.046 and P = 0.017, respectively) than their counterparts. Health promotion practice increased with increasing attitudes score and decreased with increased barriers score (P = 0.012 and P = 0.001). CONCLUSION The scope of pharmacy practice in CVD prevention is limited in Qatar. Efforts need to be exerted to increase pharmacists' involvement in CVD prevention.
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Affiliation(s)
- Maguy Saffouh El Hajj
- Clinical Pharmacy and Practice Section, College of Pharmacy, Qatar University, Doha, Qatar
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7
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Krass I. Quasi experimental designs in pharmacist intervention research. Int J Clin Pharm 2016; 38:647-54. [PMID: 26825756 DOI: 10.1007/s11096-016-0256-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 01/17/2016] [Indexed: 12/01/2022]
Abstract
Background In the field of pharmacist intervention research it is often difficult to conform to the rigorous requirements of the "true experimental" models, especially the requirement of randomization. When randomization is not feasible, a practice based researcher can choose from a range of "quasi-experimental designs" i.e., non-randomised and at time non controlled. Objective The aim of this article was to provide an overview of quasi-experimental designs, discuss their strengths and weaknesses and to investigate their application in pharmacist intervention research over the previous decade. Results In the literature quasi experimental studies may be classified into five broad categories: quasi-experimental design without control groups; quasi-experimental design that use control groups with no pre-test; quasi-experimental design that use control groups and pre-tests; interrupted time series and stepped wedge designs. Quasi-experimental study design has consistently featured in the evolution of pharmacist intervention research. The most commonly applied of all quasi experimental designs in the practice based research literature are the one group pre-post-test design and the non-equivalent control group design i.e., (untreated control group with dependent pre-tests and post-tests) and have been used to test the impact of pharmacist interventions in general medications management as well as in specific disease states. Conclusion Quasi experimental studies have a role to play as proof of concept, in the pilot phases of interventions when testing different intervention components, especially in complex interventions. They serve to develop an understanding of possible intervention effects: while in isolation they yield weak evidence of clinical efficacy, taken collectively, they help build a body of evidence in support of the value of pharmacist interventions across different practice settings and countries. However, when a traditional RCT is not feasible for logistical and/or ethical reasons researchers should endeavour to use the more robust of the quasi experimental designs.
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Affiliation(s)
- Ines Krass
- Faculty of Pharmacy, A15, University of Sydney, Camperdown, NSW, 2006, Australia.
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Jordan MA, Harmon J. Pharmacist interventions for obesity: improving treatment adherence and patient outcomes. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2015; 4:79-89. [PMID: 29354522 PMCID: PMC5741031 DOI: 10.2147/iprp.s72206] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Obesity is currently a worldwide pandemic, with overweight (body mass index [BMI] ≥25 kg/m2) and obesity (BMI ≥30 kg/m2) estimated at 35% and 12% of the global adult population, respectively. According to data collected from the United States National Health and Nutrition Examination Survey, approximately 68.8% of US adults are overweight or obese. Additionally, a large burden of health care costs can be attributed directly to obesity as well as multiple, potentially preventable, comorbidities such as cancer, cardiovascular disease, and diabetes. As a result, national and international organizations, such as the US Centers for Disease Control and World Health Organization, have made halting the rise of the obesity epidemic a top priority. Pharmacists, commonly considered one of the most trustworthy and accessible health care professionals, are ideally situated to provide counseling for weight and lifestyle management. This review presents examples of pharmacist-led as well as collaborative practices that have been somewhat successful in educating and monitoring patient progress in attaining weight-loss goals. Common barriers and potential solutions to administration of lifestyle counseling and monitoring programs, such as limited pharmacist time and resources, lack of expertise and/or confidence in program administration, and patient perception and awareness, are also discussed.
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Affiliation(s)
- Melanie A Jordan
- College of Pharmacy – Glendale, Midwestern University, Glendale, AZ, USA
| | - Jonathan Harmon
- College of Pharmacy – Glendale, Midwestern University, Glendale, AZ, USA
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Todd A, Moore HJ, Husband AK, Bambra C, Kasim A, Sniehotta FF, Steed L, Summerbell CD. Community pharmacy interventions for public health priorities: protocol for a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions. Syst Rev 2014; 3:93. [PMID: 25145710 PMCID: PMC4145162 DOI: 10.1186/2046-4053-3-93] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/14/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Community pharmacists can deliver health care advice at an opportunistic level, related to prescription or non-prescription medicines and as part of focused services designed to reduce specific risks to health. Obesity, smoking and excessive alcohol intake are three of the most significant modifiable risk factors for morbidity and mortality in the UK, and interventions led by community pharmacists, aimed at these three risk factors, have been identified by the government as public health priorities. In 2008, the Department of Health for England stated that 'a sound evidence base that demonstrates how pharmacy delivers effective, high quality and value for money services is needed'; this systematic review aims to respond to this requirement. METHODS/DESIGN We will search the databases MEDLINE, Embase, CINAHL, PsycINFO, Social Sciences Citation Index, ASSIA, IBSS, Sociological Abstracts, Scopus and NHS Economic Evaluation Database for studies that have evaluated interventions based on community pharmacies that aim to target weight management, smoking cessation and alcohol misuse. We will include all randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after studies (CBAs) and interrupted time series (ITS) and repeated measures studies. Data from included studies will be extracted by two independent reviewers and will include study details methods, results, intervention implementation/costs and methodological quality. Meta-analysis will be conducted if appropriate; if not, the synthesis will be restricted to a narrative overview of individual studies looking at the same question. DISCUSSION The review aims to summarise the evidence base on the effectiveness of community pharmacy interventions on health and health behaviours in relation to weight management, smoking cessation and alcohol misuse. It will also explore if, and how, socio-economic status, gender, ethnicity and age moderate the effect of the interventions and will describe how the interventions included in the review have been organised, implemented and delivered, since context is an important factor governing the success of public health interventions. The findings from this review will have an impact on the commissioning of public health services aiming to promote healthy weight, smoking cessation and prevent excessive alcohol consumption. SYSTEMATIC REVIEW REGISTRATION The review has been registered with PROSPERO (registration no. CRD42013005943). Available at: http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42013005943.
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Affiliation(s)
- Adam Todd
- School for Medicine, Pharmacy and Health, Durham University, Durham TS17 6BH, UK
- FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle NE2 4AX, UK
- Wolfson Research Institute for Health and Wellbeing, Durham University, Durham TS17 6BH, UK
| | - Helen J Moore
- School for Medicine, Pharmacy and Health, Durham University, Durham TS17 6BH, UK
- FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle NE2 4AX, UK
- Wolfson Research Institute for Health and Wellbeing, Durham University, Durham TS17 6BH, UK
| | - Andrew K Husband
- School for Medicine, Pharmacy and Health, Durham University, Durham TS17 6BH, UK
- FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle NE2 4AX, UK
- Wolfson Research Institute for Health and Wellbeing, Durham University, Durham TS17 6BH, UK
| | - Clare Bambra
- FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle NE2 4AX, UK
- Wolfson Research Institute for Health and Wellbeing, Durham University, Durham TS17 6BH, UK
- Department of Geography, Durham University, Durham DH1 3LE, UK
| | - Adetayo Kasim
- Wolfson Research Institute for Health and Wellbeing, Durham University, Durham TS17 6BH, UK
| | - Falko F Sniehotta
- FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle NE2 4AX, UK
- Institute of Health & Society, Newcastle University, Newcastle NE2 4AX, UK
| | - Liz Steed
- Blizard Institute, Barts and The London School of Medicine and Dentistry, London E1 2AT, UK
| | - Carolyn D Summerbell
- School for Medicine, Pharmacy and Health, Durham University, Durham TS17 6BH, UK
- FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle NE2 4AX, UK
- Wolfson Research Institute for Health and Wellbeing, Durham University, Durham TS17 6BH, UK
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Landy DC, Gorin MA, Rudock RJ, O'Connell MT. Increasing access to cholesterol screening in rural communities catalyzes cardiovascular disease prevention. J Rural Health 2013; 29:360-7. [PMID: 24088210 DOI: 10.1111/jrh.12002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Despite increasing frequency, little evidence guides cholesterol screening in less traditional health care settings, such as rural health fairs. METHODS The Miller School of Medicine Department of Community Service (DOCS) is a student-run organization providing free basic health care to underserved South Florida communities. We retrospectively reviewed all new patients seen at 2007 DOCS rural fairs to describe their low-density lipoprotein (LDL) and high-density lipoprotein (HDL) values. In addition, we assessed if patient characteristics were associated with cholesterol abnormalities and whether patients with abnormalities who returned to a subsequent fair in 2008 or 2009 improved their cholesterol. FINDINGS Of 252 patients, 145 (58%) had an LDL cholesterol over 129 mg/dL and 61 (24%) had an HDL cholesterol below 40 mg/dL or 50 mg/dL for males and females, respectively. Baseline LDL cholesterol was not associated with body-mass index (BMI), age over 60 years, gender, healthy lifestyle habits, or insurance status. Of 36 patients with elevated LDL cholesterol and a follow-up screening, 24 (67%) reduced their LDL cholesterol by at least 16 mg/dL though reductions were not associated with BMI reduction, and 22 (61%) increased their HDL cholesterol by at least 5 mg/dL, trending with BMI reduction. CONCLUSIONS Cholesterol screening at rural fairs can identify a high proportion of patients with abnormal cholesterol, including those who might not be considered at high risk. Although this may catalyze favorable cholesterol changes, the lack of an association with weight loss suggests patients seek additional medical care, which should be considered before offering cholesterol screening at fairs.
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Affiliation(s)
- David C Landy
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida
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Yakiwchuk EM, Jorgenson D, Mansell K, Laubscher T, Lebras M, Blackburn DF. Collaborative Cardiovascular Risk Reduction in Primary Care II (CCARP II): Implementation of a systematic case-finding process for patients with uncontrolled risk factors. Can Pharm J (Ott) 2013; 146:284-92. [PMID: 24093040 PMCID: PMC3785192 DOI: 10.1177/1715163513499303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous pharmacist interventions to reduce cardiovascular (CV) risk have been limited by low patient enrolment. The primary aim of this study was to implement a collaborative pharmacist intervention that used a systematic case-finding procedure to identify and manage patients with uncontrolled CV risk factors. METHODS This was an uncontrolled, program implementation study. We implemented a collaborative pharmacist intervention in a primary care clinic. All adults presenting for an appointment with a participating physician were systematically screened and assessed for CV risk factor control by the pharmacist. Recommendations for risk factor management were communicated on a standardized form, and the level of pharmacist follow-up was determined on a case-by-case basis. We recorded the proportion of adults exhibiting a moderate to high Framingham risk score and at least 1 uncontrolled risk factor. In addition, we assessed before-after changes in CV risk factors. RESULTS Of the 566 patients who were screened prior to visiting a participating physician, 186 (32.9%) exhibited moderate or high CV risk along with at least 1 uncontrolled risk factor. Physicians requested pharmacist follow-up for 60.8% (113/186) of these patients. Of the patients receiving the pharmacist intervention, 65.5% (74/113) were at least 50% closer to 1 or more of their risk factor targets by the end of the study period. Significant risk factor improvements from baseline were also observed. DISCUSSION Through implementation of a systematic case-finding approach that was carried out by the pharmacist on behalf of the clinic team, a large number of patients with uncontrolled risk factors were identified, assessed and managed with a collaborative intervention. CONCLUSION Systematic case finding appears to be an important part of a successful intervention to identify and manage individuals exhibiting uncontrolled CV risk factors in a primary care setting.
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Affiliation(s)
- Erin M Yakiwchuk
- College of Pharmacy & Nutrition (Yakiwchuk, LeBras, Jorgenson, Mansell, Blackburn), University of Saskatchewan, Saskatoon, Saskatchewan
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Blalock SJ, Roberts AW, Lauffenburger JC, Thompson T, O'Connor SK. The effect of community pharmacy-based interventions on patient health outcomes: a systematic review. Med Care Res Rev 2013; 70:235-66. [PMID: 23035056 PMCID: PMC4958406 DOI: 10.1177/1077558712459215] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Many studies have demonstrated the beneficial effects that pharmacist-provided patient care services can have on patient health outcomes. However, the effectiveness of patient care services delivered by pharmacists in community pharmacy settings, where organizational barriers may affect service implementation or limit effectiveness, remains unclear. The authors systematically reviewed the literature on the effectiveness of pharmacist-delivered patient care services in community pharmacy settings in the United States. Of the 749 articles retrieved, 21 were eligible for inclusion in the review. Information concerning 134 outcomes was extracted from the included articles. Of these, 50 (37.3%) demonstrated statistically significant, beneficial intervention effects. The percentage of studies reporting favorable findings ranged from 50% for blood pressure to 0% for lipids, safety outcomes, and quality of life. Our findings suggest that evidence supporting the effectiveness of pharmacist-provided direct patient care services delivered in the community pharmacy setting is more limited than in other settings.
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Affiliation(s)
- Susan J Blalock
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7573, USA.
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Taylor J, Krska J, Mackridge A. A community pharmacy-based cardiovascular screening service: views of service users and the public. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2012; 20:277-84. [PMID: 22953766 DOI: 10.1111/j.2042-7174.2012.00190.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine whether pharmacy-based cardiovascular disease (CVD) screening reached the desired population, the local population's awareness of pharmacy screening and the views of service users and the general public about CVD screening. METHODS Pharmacy staff, located in one English Primary Care Trust providing a CVD screening service, issued questionnaires to service users who had undergone screening. Face-to-face street surveys were conducted with members of the general public within the vicinity of each participating pharmacy. KEY FINDINGS A total of 259 people were screened within the first 6 months of service provision, 97 of whom (37.4%) completed the evaluation questionnaire. In addition, 261 non-service users participated in street surveys. Most respondents among both service users and non-users had at least one risk factor for cardiovascular disease, including smoking and lack of exercise. Responses to statements regarding CVD screening showed a high level of agreement with the need for screening in both groups. However, significantly more service users (90.7%) agreed that a pharmacy was a good place for screening compared to the non-users (77.4%; P < 0.005). Likewise significantly fewer service users agreed that screening should be only carried out by doctors (10.3 compared to 25.3% of non-users; P < 0.005). The overall majority of service users 96 (99.7%) had a positive experience of the screening service, agreeing that they were given enough time and pharmacists made them feel at ease. Only 9% of non-users were aware of the pharmacy service and, although the majority (78.4%) were willing to be screened at a pharmacy, this was significantly lower among males than females (69.9 compared to 82.7%; P < 0.005). Perceived concerns about confidentiality and lack of privacy were among barriers identified to taking up screening. CONCLUSION Pharmacy-based CVD screening is acceptable to the public. Its uptake could be improved through increased awareness of the service and by addressing concerns about privacy and confidentiality in promotional activities.
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Affiliation(s)
- Julia Taylor
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
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Backman D, Gonzaga G, Sugerman S, Francis D, Cook S. Effect of fresh fruit availability at worksites on the fruit and vegetable consumption of low-wage employees. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2011; 43:S113-S121. [PMID: 21683280 DOI: 10.1016/j.jneb.2011.04.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 03/28/2011] [Accepted: 04/18/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To examine the impact of fresh fruit availability at worksites on the fruit and vegetable consumption and related psychosocial determinants of low-wage employees. DESIGN A prospective, randomized block experimental design. SETTING Seven apparel manufacturing and 2 food processing worksites. PARTICIPANTS A convenience sample of 391 low-wage employees in 6 intervention worksites and 137 low-wage employees in 3 control worksites in Los Angeles, CA. INTERVENTION Fresh fruit deliveries with enough for 1 serving per employee, 3 days a week for 12 consecutive weeks. The control worksites did not receive the fruit deliveries. MAIN OUTCOME MEASURES Participants' fruit and vegetable consumption, fruit and vegetable purchasing habits, self-efficacy, job satisfaction, and overall health were measured at baseline, weeks 4 and 8, and following the 12-week intervention. ANALYSIS Descriptive statistics and growth curve analysis using hierarchical linear modeling were employed to analyze the data. RESULTS Participants in the intervention worksites showed a significant increase in fruit, vegetable, and total fruit and vegetable consumption, purchasing of fruit, family purchasing of vegetables, and self-efficacy toward eating 2 servings of fruit each day compared to the control worksites. CONCLUSIONS AND IMPLICATIONS Improving access to fruit during the workday can improve fruit and vegetable consumption, purchasing habits, and self-efficacy of low-income employees.
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Affiliation(s)
- Desiree Backman
- Network for a Healthy California, California Department of Public Health and Public Health Institute, Sacramento, CA, USA.
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Blenkinsopp A, Anderson C, Armstrong M. Community pharmacy's contribution to improving the public's health: the case of weight management. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/ijpp.16.3.0001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Liu Y, McDonough RP, Carruthers KM, Doucette WR. Identifying patients at risk of cardiovascular disease: a pharmacist-managed screening event for union workers and their dependents. J Am Pharm Assoc (2003) 2009; 49:549-53. [PMID: 19589768 DOI: 10.1331/japha.2009.08024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe a pharmacist-managed health screening as a tool to identify patients who were at risk for cardiovascular disease (CVD). DESIGN Descriptive nonexperimental study. SETTING A community pharmacy, a health benefit consulting company, and two local unions of plumbers and electricians in the Quad Cities area (Mid-Mississippi Valley) in fall 2006. PATIENTS Union members and their dependents who received any one of the following pharmacist-managed screening services: systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, and high-density lipoprotein (HDL). INTERVENTION Pharmacist-managed CVD risk screening program coordinated by a health benefit consulting company. MAIN OUTCOME MEASURES Risk levels of CVD according to SBP, DBP, total cholesterol, and HDL. RESULTS 452 patients 20 years of age or older were screened. A total of 137 participants (45.2%) had an SBP of 140 mm Hg or more and 73 (24.1%) a DBP of 90 mm Hg or more. Among patients who checked their total cholesterol or HDL, 81 (24.0%) had high total cholesterol and 55 (16.4%) low HDL. CONCLUSION A pharmacist-managed health screening program was a tool to identify patients at risk of CVD. At-risk individuals could be potential participants in a cardiovascular risk management service.
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Affiliation(s)
- Yifei Liu
- Division of Pharmacy Practice and Administration, University of Missouri-Kansas City, USA
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Divine H, Nicholas A, Johnson CL, Perrier DG, Steinke DT, Blumenschein K. PharmacistCARE: description of a pharmacist care service and lessons learned along the way. J Am Pharm Assoc (2003) 2009; 48:793-802. [PMID: 19019810 DOI: 10.1331/japha.2008.07132] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To describe the PharmacistCARE program, an innovative pharmacy practice model implemented within a self-insured employer and to describe lessons learned by the authors in implementing and maintaining the program. SETTING University of Kentucky (UK), March 2003 to present. PRACTICE DESCRIPTION A free-standing pharmacist clinic located within an ambulatory care facility owned by UK HealthCare. PRACTICE INNOVATION PharmacistCARE, a pharmacist-provided patient care service for UK Health Plan members that includes comprehensive disease and medication therapy management. MAIN OUTCOME MEASURES Various lessons learned by the authors during development, implementation, and maintenance of the program. RESULTS The program has been recognized by the university as a positive contribution to health plan service enhancement and cost savings and has documented enhanced patient care outcomes. CONCLUSION The PharmacistCARE program is a unique pharmacist-provided service delivered in a free-standing pharmacist clinic that enhances health outcomes for adult members in a self-insured employer group.
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Affiliation(s)
- Holly Divine
- College of Pharmacy, University of Kentucky, Lexington, KY 40536-0082, USA.
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Chiu CC, Wu SS, Lee PY, Huang YC, Tan TY, Chang KC. Control of modifiable risk factors in ischemic stroke outpatients by pharmacist intervention: an equal allocation stratified randomized study. J Clin Pharm Ther 2009; 33:529-35. [PMID: 18834368 DOI: 10.1111/j.1365-2710.2008.00940.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the adequacy of management of modifiable risk factors (MRF) in a group of ischemic stroke outpatients and the value of pharmacist intervention in a randomized controlled study in a tertiary referral hospital. METHODS 160 ischemic stroke outpatients from the same catchment area and with the same financial arrangements for healthcare, went through a 6-month equal allocation stratified randomized study. Routine practice was not altered except for a monthly 1-hour pharmacist-intervention education programme. We evaluated the differences in blood pressure (BP), blood glucose and lipid profiles before and after study. The proportion of patients with adequate management of MRF was studied. RESULTS There were no differences in the demographic characteristics, MRF and medications prescribed throughout the study. Before the study, the proportions of adequate control of BP in the control and intervention groups were 43% vs. 40% (P = 0.64), lipid 27% vs. 13% (P = 0.09) and glucose 36% vs. 21% (P = 0.15) . At the end of the study, the corresponding proportions were for BP 43% vs. 83% (P = 0.00), lipid 27% vs. 40% (P = 0.16) and glucose 46% vs. 35% (P = 0.40). CONCLUSION Pharmacist intervention was associated with improved BP control but not with the other MRF. Earlier initiation and longer duration of intervention may improve the outcome further, and whether targeting of high-risk subjects may be particularly rewarding is worthy of investigation.
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Affiliation(s)
- Chun-Chi Chiu
- Department of Pharmacy, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Brooks JM, Unni EJ, Klepser DG, Urmie JM, Farris KB, Doucette WR. Factors affecting demand among older adults for medication therapy management services. Res Social Adm Pharm 2008; 4:309-19. [DOI: 10.1016/j.sapharm.2007.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Revised: 11/20/2007] [Accepted: 11/29/2007] [Indexed: 10/21/2022]
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Pérez-Escamilla R, Hromi-Fiedler A, Vega-López S, Bermúdez-Millán A, Segura-Pérez S. Impact of peer nutrition education on dietary behaviors and health outcomes among Latinos: a systematic literature review. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2008; 40:208-25. [PMID: 18565462 PMCID: PMC2746903 DOI: 10.1016/j.jneb.2008.03.011] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 03/13/2008] [Accepted: 03/19/2008] [Indexed: 05/12/2023]
Abstract
OBJECTIVE This systematic review assesses the impact of peer education/counseling on nutrition and health outcomes among Latinos and identifies future research needs. DESIGN A systematic literature search was conducted by: (1) searching Internet databases; (2) conducting backward searches from reference lists of articles of interest; (3) manually reviewing the archives of the Center for Eliminating Health Disparities among Latinos; (4) searching the Journal of Nutrition Education and Behavior; and (5) directly contacting researchers in the field. The authors reviewed 22 articles derived from experimental or quasi-experimental studies. OUTCOME MEASURES Type 2 diabetes behavioral and metabolic outcomes, breastfeeding, nutrition knowledge, attitudes and behaviors. RESULTS Peer nutrition education has a positive influence on diabetes self-management and breastfeeding outcomes, as well as on general nutrition knowledge and dietary intake behaviors among Latinos. CONCLUSIONS AND IMPLICATIONS There is a need for longitudinal randomized trials testing the impact of peer nutrition education interventions grounded on goal setting and culturally appropriate behavioral change theories. Inclusion of reliable scales and the construct of acculturation are needed to further advance knowledge in this promising field. Operational research is also needed to identify the optimal peer educator characteristics, the type of training that they should receive, the client loads and dosage (ie, frequency and amount of contact needed between peer educator and client), and the best educational approaches and delivery settings.
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Affiliation(s)
- Rafael Pérez-Escamilla
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT
- Connecticut Center for Eliminating Health Disparities among Latinos
| | - Amber Hromi-Fiedler
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT
- Connecticut Center for Eliminating Health Disparities among Latinos
| | - Sonia Vega-López
- Hispanic Health Council, Hartford CT
- Connecticut Center for Eliminating Health Disparities among Latinos
| | - Angela Bermúdez-Millán
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT
- Hispanic Health Council, Hartford CT
- Connecticut Center for Eliminating Health Disparities among Latinos
| | - Sofia Segura-Pérez
- Hispanic Health Council, Hartford CT
- Connecticut Center for Eliminating Health Disparities among Latinos
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