1
|
Jairoun AA, Al-Himyari SS, Shahwan M, Al Ani M, Habeb M, Jairoun M, Zyoud SH, Alkhanani MF, Alhasani RH, Hakami AY, Ainousah BA, Alshehri FS, Alorfi NM, Suliman A. Community pharmacists' perspectives on cardiovascular disease pharmaceutical care in the United Arab Emirates: a questionnaire survey-based analysis. Front Pharmacol 2023; 14:1237717. [PMID: 37736347 PMCID: PMC10509554 DOI: 10.3389/fphar.2023.1237717] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/24/2023] [Indexed: 09/23/2023] Open
Abstract
Background: Community pharmacists play an intermediary role between prescribing physicians and patients in the United Arab Emirates (UAE) and thus are responsible for ensuring that patients receive optimal cardiovascular disease (CVD) pharmaceutical care. Methods: we used a cross-sectional design to assess the perceptions and practices of community pharmacists concerning pharmaceutical care for patients with CVD. A trained researcher visited randomly selected community pharmacies and used a structured questionnaire to conduct in-person interviews with pharmacists. The questionnaire collected demographic data and information on perceptions and practices regarding CVD pharmaceutical care. Results: Five hundred and fifty-one participants were recruited. The average participant age (mean ± SD) was 35 ± 2.7 years. The average perception score regarding CVD prevention and management was 75.6% (95% confidence interval [CI] 77.1%-74.2%), and the average practice score for CVD prevention and management was 87.1% (95% CI 76.5%-79.6%). Bivariate analysis revealed that gender (p = 0.001), education level (p < 0.001), pharmacy position (p = 0.004), work experience (p < 0.001), number of patients served per day (p < 0.001) and being trained on CVD prevention and management (p < 0.001) were significantly associated with perceptions about the prevention and management of CVD. Better practice scores were seen among older participants (OR 1.01; 95% CI 1-1.019), postgraduates (OR 1.77; 95% CI 1.66-1.89), workers at chain pharmacies (OR 1.24; 95% CI 1.11-1.39), pharmacists in charge (OR 1.22; 95% CI 1.01-1.47), pharmacists with >10 years of experience (OR 11.3; 95% CI 6.01-15.62), pharmacists with 6-10 years of experience (OR 4.42; 95% CI 3.90-5) and pharmacists trained on CVD prevention and management (OR 1.29; 95% CI 1.15-1.46). Conclusion: Pharmacy practitioners working in community pharmacies in the UAE actively engage in delivering pharmaceutical care to patients, playing a role in CVD management and prevention. However, they showed low levels of involvement in other healthcare services, specifically in screening and measuring patients' weight, glucose levels, and blood pressure, monitoring treatment responses, maintaining medical records, and reviewing medication refill histories. Activities such as educating patients, providing medication counseling, offering support for treatment adherence, and fostering collaborative relationships with other healthcare providers should be encouraged among UAE community pharmacists to ensure the provision of high-quality patient care.
Collapse
Affiliation(s)
- Ammar Abdulrahman Jairoun
- Health and Safety Department, Dubai Municipality, Dubai, United Arab Emirates
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University of Science Malaysia (USM), Pulau Pinang, Malaysia
| | - Sabaa Saleh Al-Himyari
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University of Science Malaysia (USM), Pulau Pinang, Malaysia
- Pharmacy Department, Emirates Health Services, Dubai, United Arab Emirates
| | - Moyad Shahwan
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Mina Al Ani
- Department of Developmental Biology and Cancer, Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | | | - Maimona Jairoun
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Sa’ed H. Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- Clinical Research Centre, An-Najah National University Hospital, Nablus, Palestine
| | - Mustfa Faisal Alkhanani
- Department of Biology, College of Science, University of Hafr Al Batin, Hafr Al-Batin, Saudi Arabia
| | | | - Alqassem Y. Hakami
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Bayan A. Ainousah
- Pharmaceutical Chemistry Department, College of Pharmacy, Umm Al Qura University, Makkah, Saudi Arabia
| | - Fahad S. Alshehri
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al Qura University, Mecca, Saudi Arabia
| | - Nasser M. Alorfi
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al Qura University, Mecca, Saudi Arabia
| | - Abdulhaq Suliman
- College of Dentistry, Ajman University, Ajman, United Arab Emirates
| |
Collapse
|
2
|
Sendekie AK, Tadesse YB, Kasahun AE, Belachew EA. Determine the perceived level of involvement and factors affecting diabetes management by community pharmacy professionals at drug retails in northwestern amhara region, Ethiopia. Heliyon 2023; 9:e20091. [PMID: 37810015 PMCID: PMC10559852 DOI: 10.1016/j.heliyon.2023.e20091] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
Background Pharmacists in community drug retail outlets (CDROs) have significant involvement in diabetes prevention and management by providing more direct interventions in medication education, preventive measures, and disease management. This study examined the perceived level of involvement of community pharmacy professionals (CPPs) in diabetes management at CDROs in Northwest Ethiopia. Methods A multicenter cross-sectional study was conducted among CPPs in Northwest Ethiopia between September 1 and 30, 2022. The Statistical Package for Social Science (SPSS) version 26 was used to analyzed the data, which had been gathered using a self-administered structured questionnaire. An independent sample t-test and one-way ANOVA were used to examine the mean perceived involvement score difference between CPPs. The association between CPPs' involvement and other sociodemographic variables was examined using linear regression analysis. At a 95% confidence interval (CI), a p-value <0.05 was considered statistically significant. Results The study included 184 (94.3%) of 195 CPPs approached. The overall mean perceived involvement score of CPPs in diabetes management was 3.80 ± 0.63 out of 5. CPPs with a bachelor's degree or higher [β = 3.065, 95% CI: 2.704, 3.641; p < 0.001], CPPs with a higher monthly income (≥5000 ETB) [β = 0.242, 95% CI: 0.112, 0.596; p = 0.034], and those who provided more than 8 hours of service per day [β = 0.163, 95% CI: 0.051, 0.332; p = 0.043] had higher perceived involvement in the management of diabetes compared with their counterparts. Conclusions This study found that most CPPs had a high level of perceived involvement in diabetes management. Higher educational backgrounds, a higher monthly salary, and working longer hours were associated with an increased level of perceived involvement. Promoting the educational background of CPPs may be crucial to enhance their active involvement in the management of diabetes.
Collapse
Affiliation(s)
- Ashenafi Kibret Sendekie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar; Gondar, Ethiopia
| | - Yabibal Berie Tadesse
- Department of Pharmaceutical Chemistry, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar; Gondar, Ethiopia
| | - Asmamaw Emagn Kasahun
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar; Gondar, Ethiopia
| | - Eyayaw Ashete Belachew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar; Gondar, Ethiopia
| |
Collapse
|
3
|
Sendekie AK, Dagnaw AD, Dagnew EM. Pharmacists' involvements and barriers in the provision of health promotion services towards noncommunicable diseases: Community-based cross-sectional study in Northwest Ethiopia. Arch Public Health 2023; 81:31. [PMID: 36841787 PMCID: PMC9968412 DOI: 10.1186/s13690-023-01038-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/07/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Community drug retail outlets (CDROs) are among the initial healthcare facilities where pharmacists play a crucial role in preventing and managing noncommunicable diseases (NCDs). Therefore, this study assessed pharmacists' level of involvement and barriers in the provision of health promotion for noncommunicable diseases at CDROs in Northwest Ethiopia. METHODS A community-based multicenter cross-sectional study was conducted among community pharmacists in Northwest Ethiopia from April to June 2022. Data was collected using a self-administered structured questionnaire, and analyzed using the Statistical Package for Social Science (SPSS) version 26. The level of involvement mean score difference among pharmacists was investigated using an independent samples t-test and a one-way ANOVA. Logistic regression analysis was used to examine the association between pharmacists' level of involvement and other variables. A p-value < 0.05 at a 95% confidence interval (CI) was considered statistically significant. RESULTS A total of 285 (94.4%) participants participated in the study out of 302 approached samples. Overall, more than half (58.9%) of the participants showed a high level of involvement in health promotion. Pharmacists who had a degree and/or above (AOR = 0.03, 95% CI: 0.01-0.63; p < 0.001) and served a lower number of clients per day (AOR = 0.19, 95% CI: 0.04-94; p = 0.042) were less likely to have low involvement in health promotion services. Pharmacists who worked fewer hours per day (AOR = 3.65, 95% CI: 1.79-7.48; p = 0.005) were more likely to have low involvement. Lack of an appropriate area in the CDROs (52.1%) and lack of coordination with other healthcare providers (43.6%) were the most reported barriers to the provision of health promotion. CONCLUSION Most pharmacists were found to have a high level of involvement in health promotion activities. A lack of an appropriate area in the CDROs and a lack of coordination with other healthcare providers were among the most reported barriers. Pharmacists might benefit from training to increase their educational backgrounds, and barriers could be addressed to enhance the pharmacist involvement.
Collapse
Affiliation(s)
- Ashenafi Kibret Sendekie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Abera Dessie Dagnaw
- grid.59547.3a0000 0000 8539 4635Department of Pharmaceutical Chemistry, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ephrem Mebratu Dagnew
- grid.449044.90000 0004 0480 6730Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| |
Collapse
|
4
|
Awareness of Cardiovascular Disease Risk Factors by Community Pharmacists in Saudi Arabia. Healthcare (Basel) 2023; 11:healthcare11020151. [PMID: 36673520 PMCID: PMC9859281 DOI: 10.3390/healthcare11020151] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/29/2022] [Accepted: 12/31/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Pharmacists in community settings are recognized as highly accessible healthcare practitioners and demonstrate a crucial role in the primary prevention of cardiovascular disease. Evidence indicates that community pharmacists can make a significant impact on controlling cardiovascular disease risk factors, particularly on hypertension. OBJECTIVES We aimed to assess the knowledge of community pharmacists in Saudi Arabia regarding cardiovascular disease risk factors. METHODS A cross-sectional study involving community pharmacists was conducted. The knowledge of cardiovascular disease risk factors was assessed with the Heart Disease Fact Questionnaire (HDFQ). A web link for an anonymous questionnaire was shared with the licensed community pharmacists in Saudi Arabia using the "Seha" platform of the Ministry of Health. Data analysis was performed with R version 4.0.5. RESULTS Three hundred seventy-four community pharmacists responded to the questionnaire. Many community pharmacists (94.4%) had satisfactory awareness of cardiovascular disease risk factors. The odds of having satisfactory HDFQ knowledge for community pharmacists seeing more than 20 individuals with diabetes per month were 20 times (AOR = 19.9, 95% CI: 1.73-260, and p = 0.019) more compared to those seeing fewer than 10 individuals with diabetes per month. The age of the community pharmacists and the average number of individuals with diabetes seen per month were found to be factors associated with satisfactory HDFQ knowledge. CONCLUSION The practicing pharmacists had a substantial understanding of cardiovascular disease risk factors. In line with counseling and education, the implementation of community pharmacy models for improving the knowledge of pharmacists, particularly the young pharmacists, is needed to effectively assist patients with cardiovascular disease.
Collapse
|
5
|
AlAhmad MM, ZainAlAbdin S, AlAhmad K, AlAhmad I, AbuRuz S. Value of the clinical pharmacist interventions in the application of the American College of Cardiology (ACC/AHA) 2018 guideline for cholesterol management. PLoS One 2023; 18:e0283369. [PMID: 36972252 PMCID: PMC10042341 DOI: 10.1371/journal.pone.0283369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVES The study aims to examine the extent to which the updated ACC/AHA management of blood cholesterol guideline (2018) is implemented in practice and to assess the value of the clinical pharmacist interventions in improving physicians' adherence the guidelines recommendations. METHODS We utilized in this study an interventional before-after design. The study was conducted on 272 adult patients who visited the study site internal medicine clinics and were candidates for statin therapy based on the 2018 ACC/AHA guidelines for cholesterol management. Adherence to guideline recommendations was measured before and after clinical pharmacists' interventions by calculating the percentage of patients receiving statin therapy as per guideline recommendation, the type and intensity (moderate or high intensity) of statin therapy used, and the need for additional non-statin therapy. RESULTS Adherence with guideline recommendations was significantly improved from 60.3% to 92.6% (X2 = 79.1, p = 0.0001) after clinical pharmacist interventions. Among patients who were on statin therapy, the percentage of those who were on proper statin intensity increased significantly from 47.6% to 94.4% (X2 = 72.5, p = 0.0001). The combination of statins with non-statin therapies such as ezetimibe and PCSK9 inhibitors increased from 8.5% to 30.6% (X2 = 95, p<0.0001) and from 0.0% to 1.6% (X2 = 6, p = 0.014), respectively. The use of other lipid-lowering agents was diminished from 14.6% to 3.2% (X2 = 19.2, p<0.0001). CONCLUSION Collaboration between physicians and clinical pharmacists is a crucial strategy to improve patients' treatment and hence, achieve better health outcomes among patients suffering from dyslipidemia.
Collapse
Affiliation(s)
- Mohammad M AlAhmad
- Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, Al Ain, United Arab Emirates
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Sham ZainAlAbdin
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | - Iqbal AlAhmad
- Czech Rehabilitation Hospital, Al Ain, United Arab Emirates
| | - Salah AbuRuz
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, University of Jordan, Amman, Jordan
| |
Collapse
|
6
|
Birarra MK, Baye E, Tesfa W, Kifle ZD. Knowledge of cardiovascular disease risk factors, practice, and barriers of community pharmacists on cardiovascular disease prevention in North West Ethiopia. Metabol Open 2022; 16:100219. [DOI: 10.1016/j.metop.2022.100219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/01/2022] [Accepted: 11/19/2022] [Indexed: 11/23/2022] Open
|
7
|
Henneh AH, Teg-Nefaah Tabong P. Community pharmacists perception and role in the prevention and management of cardiovascular disease conditions: Evidence from Ghana. Int J Health Plann Manage 2022; 37:2794-2808. [PMID: 35607292 DOI: 10.1002/hpm.3504] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 04/28/2022] [Accepted: 05/11/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Globally, Cardiovascular Diseases (CVDs) are the leading non-communicable diseases with a high mortality if not detected and managed early. The study assessed community pharmacists' perception and determined their role in CVDs prevention and management. METHOD A cross-sectional study was conducted among 103 registered community pharmacists in the Ahafo, Bono and Bono East regions of Ghana. Data was collected using validated questionnaires through an online and in-person surveys. The data was analysed using Microsoft Excel and STATA 14.1. RESULTS Community Pharmacists had knowledge on the concept of pharmaceutical care (n = 93, 92.2%). The roles that Pharmacists played in CVD management and control included educating clients on their conditions and drug therapy, checking for possible drug interactions and screening for risk factors. The barriers to CV health promotion were increase of the pharmacist's workload (n = 96, 93.2%), lack of time (n = 91, 88.4%) and lack of CVD educational materials and clinical tools (n = 56, 54.4%). CONCLUSION Community pharmacists have a positive perception of their role in CVDs and performed various activities to reduce the burden of CVDs. However, cardiovascular health promotion in community pharmacies is hindered by increase of the pharmacist's workload, lack of time and lack of CVD educational materials.
Collapse
Affiliation(s)
| | - Philip Teg-Nefaah Tabong
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Legon-Accra, Ghana
| |
Collapse
|
8
|
Hammad EA, Al-Aqeel S, Elayah E, Jaber D. Assessing content and factors influencing responses to information requests in community pharmacies in Jordan: A simulated patients study. PLoS One 2022; 17:e0264224. [PMID: 35180273 PMCID: PMC8856514 DOI: 10.1371/journal.pone.0264224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/06/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives To assess the management of requests for information about a prescription only medicine (simvastatin for treatment of dyslipidemia) by pharmacy staff in community settings and explore the factors influencing the information content. Methods A cross sectional study conducted using the stimulated patient (SP) method between November 2018 and May 2019. The SP conveyed the request at the beginning of the encounter in a standardized way based on predetermined plots and was instructed to ask the pharmacy staff directly if information was not discussed spontaneously. After the visit, the SP provided written feedback including information about the scenario and a copy of individualized feedback. The study was reported according to the checklist for reporting research using simulated patient methodology (CRiSP). Factors influencing information content with or without information demand were investigated. Results A total of 55 visits were analyzed. The average content score for the information discussed spontaneously was 16.2% with the standard deviation (SD) equal to15.6. The score improved significantly after information was demanded by the SP; the average total information content score became 34.4% (SD = 16) with p < 0.001. The score of information discussed spontaneously was higher for male pharmacy staff, older age, more experience, and a Pharm D degree. When the SP prompted or demanded for information, older pharmacy staff with more experience and with a college degree scored higher. Independent pharmacies, longer visit durations, and less distraction were associated significantly with higher information scores Pharmacy staff aged 35–39 and those with 6–10 years of experience were significant contributors to spontaneous discussion of information with p values = 0.003 and 0.013, respectively. After the SP demanded information, pharmacy staff with less than 5 years of experience and greater confidence as well as longer visits were positively predicting higher information scores with p values of 0.049, 0.04, and 0.04, respectively. Conclusions Information provided by community pharmacists responding to information requests about prescription only medications was found to be suboptimal. Patient requests for information were found to be a positive driver for better information content. Further research of mixed methodologies is required to clarify the factors and motivators enabling information exchange in community settings and to outline true training needs.
Collapse
Affiliation(s)
- Eman A. Hammad
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, University of Jordan, Amman, Jordan
- * E-mail:
| | - Sinaa Al-Aqeel
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Eman Elayah
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, University of Jordan, Amman, Jordan
| | - Deema Jaber
- Department of Clinical Pharmacy, Faculty of Pharmacy, Zarqa University, Zarqa, Jordan
| |
Collapse
|
9
|
Sendekie AK, Netere AK. Multicenter Cross-Sectional Study on Perceptions and Roles of Community Pharmacists in the Prevention and Management of Cardiovascular Disorders in Northwest Ethiopia. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2022; 11:21-31. [PMID: 35083130 PMCID: PMC8784253 DOI: 10.2147/iprp.s348260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 12/25/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Community pharmacy professionals are among the initial healthcare providers and could play crucial roles in preventing and managing cardiovascular disorders. This study aimed to assess perceptions and involvements of community pharmacy professionals in the prevention and management of cardiovascular disorders in Gondar city and nearby rural towns, Northwest Ethiopia. METHODS A multi-centered cross-sectional survey was conducted on community pharmacy professionals in Gondar city and the nearby rural towns from June to July 2021. Independent sample t-test and one-way ANOVA were used to show mean score differences of pharmacists towards the prevention and management of cardiovascular diseases. A 95% confidence interval with a P-value of < 0.05 in the tests was considered statistically significant. RESULTS Of the 223 initial samples, 210 completed the survey and resulted in a 94.2% response rate. The average perception and involvement scores of the community pharmacy professionals towards the prevention and treatment of the cardiovascular syndromes were 4.1 and 3.8, respectively. Numerous professionals (>86%) agreed on weight reductions, alcohol consumption restrictions and physical exercises to decrease cardiovascular risks. Pharmacy professionals recruited from Gondar city had significantly higher mean scores compared with pharmacy professionals involved from rural towns (P < 0.001). A significant difference in mean involvement score was also noted in regarding the numbers of clients serving/day (P = 0.026). CONCLUSION Community pharmacy professionals had good perceptions on prevention and management of cardiovascular diseases. However, their level of involvement in measuring weight, blood pressure and glucose level, dispensing equipment for home blood pressure and glucose monitoring and keeping records of patients needs to be encouraged. Professionals might benefit from enhanced training to increase their knowledge and confidence.
Collapse
Affiliation(s)
- Ashenafi Kibret Sendekie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adeladlew Kassie Netere
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
10
|
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.
Collapse
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).
| |
Collapse
|
11
|
Al-Arkee S, Mason J, Lane DA, Fabritz L, Chua W, Haque MS, Jalal Z. Mobile Apps to Improve Medication Adherence in Cardiovascular Disease: Systematic Review and Meta-analysis. J Med Internet Res 2021; 23:e24190. [PMID: 34032583 PMCID: PMC8188316 DOI: 10.2196/24190] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/08/2021] [Accepted: 04/11/2021] [Indexed: 01/07/2023] Open
Abstract
Background Adherence rates of preventative medication for cardiovascular disease (CVD) have been reported as 57%, and approximately 9% of all CVD events in Europe are attributable to poor medication adherence. Mobile health technologies, particularly mobile apps, have the potential to improve medication adherence and clinical outcomes. Objective The objective of this study is to assess the effects of mobile health care apps on medication adherence and health-related outcomes in patients with CVD. This study also evaluates apps’ functionality and usability and the involvement of health care professionals in their use. Methods Electronic databases (MEDLINE [Ovid], PubMed Central, Cochrane Library, CINAHL Plus, PsycINFO [Ovid], Embase [Ovid], and Google Scholar) were searched for randomized controlled trials (RCTs) to investigate app-based interventions aimed at improving medication adherence in patients with CVD. RCTs published in English from inception to January 2020 were reviewed. The Cochrane risk of bias tool was used to assess the included studies. Meta-analysis was performed for clinical outcomes and medication adherence, with meta-regression analysis used to evaluate the impact of app intervention duration on medication adherence. Results This study included 16 RCTs published within the last 6 years. In total, 12 RCTs reported medication adherence as the primary outcome, which is the most commonly self-reported adherence. The duration of the interventions ranged from 1 to 12 months, and sample sizes ranged from 24 to 412. Medication adherence rates showed statistically significant improvements in 9 RCTs when compared with the control, and meta-analysis of the 6 RCTs reporting continuous data showed a significant overall effect in favor of the app intervention (mean difference 0.90, 95% CI 0.03-1.78) with a high statistical heterogeneity (I2=93.32%). Moreover, 9 RCTs assessed clinical outcomes and reported an improvement in systolic blood pressure, diastolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol levels in the intervention arm. Meta-analysis of these clinical outcomes from 6 RCTs favored app interventions, but none were significant. In the 7 trials evaluating app usability, all were found to be acceptable. There was a great variation in the app characteristics. A total of 10 RCTs involved health care professionals, mainly physicians and nurses, in the app-based interventions. The apps had mixed functionality: 2 used education, 7 delivered reminders, and 7 provided reminders in combination with educational support. Conclusions Apps tended to increase medication adherence, but interventions varied widely in design, content, and delivery. Apps have an acceptable degree of usability; yet the app characteristics conferring usability and effectiveness are ill-defined. Future large-scale studies should focus on identifying the essential active components of successful apps. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42019121385; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=121385
Collapse
Affiliation(s)
- Shahd Al-Arkee
- Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Julie Mason
- Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Winnie Chua
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - M Sayeed Haque
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Zahraa Jalal
- Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
12
|
Lopez T, Nuffer W. Impact and Sustainability of a 10-year Community Pharmacy Disease Management Service. Innov Pharm 2021; 12:10.24926/iip.v12i1.3630. [PMID: 34007665 PMCID: PMC8102957 DOI: 10.24926/iip.v12i1.3630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Community pharmacy practice needs to demonstrate services beyond traditional dispensing roles to continue to function in a changing marketplace. Pharmacists have established themselves as being capable of improving patient outcomes and saving healthcare dollars by providing disease management services to patients. This paper describes a sustained community pharmacy-run disease management program that continued after a grassroots grant-funding effort in 2007. METHODS The city of Colorado Springs recognized the successes shown by the pharmacy during the Ten City Challenge funded project, and decided to financially support pharmacy diabetes care services. Partnering with the local School of Pharmacy, the pharmacist obtained advanced training and continued to deliver individualized counseling and management to approximately 100 patients per year for the past 14 years. Objective lab measurements (systolic and diastolic blood pressures, A1C values, total lipid profiles) were obtained or performed, and clinical goals were set based on national guidelines. Patients received a series of appointments to learn how to control their diabetes, and later their cardiovascular disease. Financial estimates were calculated using 2008 baseline numbers and adding estimated inflation based on published Segal rates. RESULTS The pharmacy services successfully maintained participation of approximately 100 patients annually each year since its inception. Average lab value markers for disease control were at or close to clinical guideline recommendations for the population. Services were associated with estimated cost savings for the health system. Positive results led to expansion in services to include cardiovascular disease in 2017. CONCLUSIONS A community pharmacy has successfully sustained a disease management program for patients for over 14 years, demonstrating high patient enrollment, health outcomes at or near clinical guidelines for control, and positive financial outcomes associated with the program.
Collapse
Affiliation(s)
- Tammy Lopez
- City Employee Pharmacy, Colorado Springs; Maxor National Pharmacy Services, LLC
| | - Wesley Nuffer
- University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences
| |
Collapse
|
13
|
Opportunistic screening of cardiovascular disease risk factors in community pharmacies in Nigeria: a cross-sectional study. Int J Clin Pharm 2020; 42:1469-1479. [PMID: 32960427 DOI: 10.1007/s11096-020-01112-2] [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: 06/22/2019] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
Background Early identification and treatment of cardiovascular disease (CVD) risk factors through screening are crucial in the primary prevention of CVD and reduction in healthcare-related costs. Use of Non-Physician Healthcare-workers including Community Pharmacists has been advocated as an effective and cost-efficient model of healthcare delivery. In Nigeria the use of community pharmacists for mass screening of CVD risk factors has not been explored. Objective We sought to investigate the possibility of mass CVD risk factor screening in community pharmacies by pharmacists. Setting Lagos, Nigeria. Methods Between October and December 2018 eight hundred and eighty-nine apparently healthy participants were screened for obesity, hypertension, diabetes and hypercholesterolaemia in ten community pharmacies. Diabetes and hypercholesterolaemia were screened for using point-of-care testing modalities. A structured questionnaire was used to obtain the socio-demographic data of the participants. Main outcome measures Prevalence of overweight/obesity, hypertension, diabetes, hypercholesterolaemia, smoking and alcohol intake. Results Mean age of the subjects was 56.8 ± 21.1 years. Majority (57.4%) were females. Prevalence of smoking and alcohol intake were 4.3% and 26.7% respectively. 59.7% and 71.5% of males and females were either overweight (BMI ≥ 25 kg/m2) or obese (BMI ≥ 30 kg/m2) respectively. Prevalence of hypertension was 28.2% in all subjects, 30.9% in males and 26.3% in females, p < 0.001. Using BP > 130/80 mmHg prevalence of hypertension was 55.1%. Diabetes was detected in 3% of the subjects while 45.3% had hypercholesterolaemia. In total, 64.1% of the subjects were diagnosed with CVD risk factors for the first time. Conclusion Opportunistic screening for CVD risk factors is possible in community pharmacies and has the ability to detect previously undiagnosed risk factors. This community pharmacy based model could serve as a cost-effective approach to primary prevention of CVD.
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Brewster S, Holt R, Portlock J, Price H. The role of community pharmacists and their position in the delivery of diabetes care: an update for medical professionals. Postgrad Med J 2020; 96:473-479. [PMID: 32217748 DOI: 10.1136/postgradmedj-2020-137511] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/03/2020] [Accepted: 03/06/2020] [Indexed: 11/04/2022]
Abstract
Pharmacists are the third largest group of healthcare professionals worldwide, but are underused in the delivery of diabetes care. The aim of this narrative was to describe how integration of community pharmacy services into existing healthcare models may improve diabetes care. Relevant literature exploring pharmacy-led interventions for diabetes were identified from a search of Medline, Embase and Cinahl online databases. This review highlights that community pharmacists are accessible, experts in medicine management, trusted by the public and able to achieve financial savings. They are poorly integrated into existing healthcare models, and commissioning arrangements can be poorly perceived by the public and those working in primary care. Community pharmacy interventions in type 2 diabetes have similar, if not greater effects compared to those delivered by other healthcare professionals. It was concluded that community pharmacy interventions in diabetes are feasible, acceptable and deliver improved health outcomes. Future work should build public recognition of pharmacists and improve communication between them and other healthcare professionals.
Collapse
Affiliation(s)
- Sarah Brewster
- Research and Development, Southern Health NHS Foundation Trust, Southampton, UK
| | - Richard Holt
- Division of Human Development and Health, University of Southampton, Southampton, UK
| | - Jane Portlock
- School of Life Sciences, University of Sussex, Brighton, UK
| | - Hermione Price
- Research and Development, Southern Health NHS Foundation Trust, Southampton, UK
| |
Collapse
|
16
|
Amadi CE, Lawal FO, Mbakwem AC, Ajuluchukwu JN, Oke DA. Knowledge of cardiovascular disease risk factors and practice of primary prevention of cardiovascular disease by Community Pharmacists in Nigeria: a cross-sectional study. Int J Clin Pharm 2018; 40:1587-1595. [PMID: 30474770 PMCID: PMC6280866 DOI: 10.1007/s11096-018-0744-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/22/2018] [Indexed: 01/21/2023]
Abstract
Background Studies in international literature have shown that Community Pharmacists can make considerable impact in controlling cardiovascular disease risk factors, especially hypertension. In Nigeria, there are no studies on the knowledge of CVD risk factors by Community Pharmacists and their practice of primary prevention. Objective To assess the knowledge of CVD risk factors and practice of primary prevention of CVD amongst Nigerian community pharmacists. Setting Community Pharmacists in Lagos, Nigeria. Methods This cross-sectional study involved 168 Community Pharmacists. Their knowledge of CVD risk factors was assessed with the Heart Disease Fact Questionnaire. Their opportunistic screening practices for CVD risk factors (primary prevention) were also assessed. Main outcome measures Knowledge of CVD risk factors and practice of primary CVD prevention. Results The mean age of the participating pharmacists was 41.7 (± 11.2) years and 87 (51.8%) of them were males. The median number of years of practice was 9.0 (3-15) years. Mean knowledge score was 22.1 (± 3.0) with 154 (91.7%) of the subjects scoring above 70%. An average of 95.5% of the participants correctly identified hypertension, smoking, dyslipidaemia, obesity, physical inactivity and diabetes as CVD risk factors. Eighty-one (48.2%) had good practice of primary CVD prevention. Conclusion: This study shows that Community Pharmacists in Nigeria have very good knowledge level of CVD risk factors and almost 50% of them practised primary prevention of CVD.
Collapse
Affiliation(s)
- Casmir E Amadi
- Department of Medicine, College of Medicine, University of Lagos, Nigeria, Lagos, Nigeria.
| | | | - Amam C Mbakwem
- Department of Medicine, College of Medicine, University of Lagos, Nigeria, Lagos, Nigeria
| | - Jayne N Ajuluchukwu
- Department of Medicine, College of Medicine, University of Lagos, Nigeria, Lagos, Nigeria
| | - David A Oke
- Department of Medicine, College of Medicine, University of Lagos, Nigeria, Lagos, Nigeria
| |
Collapse
|
17
|
Nuffer W, Trujillo T, Harmon C, Thompson M. Engaging with In-need Rural Patient Populations through Public Health Partnerships. Innov Pharm 2018; 9. [PMID: 31750008 DOI: 10.24926/iip.v9i2.1055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A public health partnership was established between a state Medicare Regional Care Collaborative Organization (RCCO), the state health department, a pharmacy school and three community pharmacies located in rural Colorado to optimize the utilization of a free public health service provided through each pharmacy. Fourth-year pharmacy students were allocated year-round by the University of Colorado to support disease management and medication therapy management (MTM) services offered to patients in three rural towns served by the RCCO. Faculty from the school of pharmacy reviewed data provided by the RCCO to identify patients who could benefit from MTM or disease state management (DSM) services. These patients were contacted and encouraged to take advantage of these free pharmacy-based services. Additionally, a number of targeted interventions were performed within these populations to optimize their health. Concerted efforts were made to improve information flow and communication between these pharmacy sites and partnering medical offices. Additionally, pharmacy students were successfully integrated in to medical offices to work alongside medical providers in these communities. This manuscript describes the implementation and coordination of this project as well as the impact these pharmacies had on the communities they served.
Collapse
Affiliation(s)
- Wes Nuffer
- University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences
| | - Tara Trujillo
- Colorado Department of Public Health and Environment
| | - Christy Harmon
- University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences
| | - Megan Thompson
- University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences
| |
Collapse
|
18
|
Zolezzi M, Abdallah O, Kheir N, Abdelsalam AG. Evaluation of community pharmacists' preparedness for the provision of cardiovascular disease risk assessment and management services: A study with simulated patients. Res Social Adm Pharm 2018; 15:252-259. [PMID: 29753643 DOI: 10.1016/j.sapharm.2018.04.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/22/2018] [Accepted: 04/26/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Individuals who suffer from major cardiovascular events every year have one or more risk factors. Cardiovascular disease (CVD) risk assessment is an important strategy for the early identification of modifiable risk factors and their management. There is substantial evidence that shifting the focus from treatment to primary prevention reduces the burden of CVD. OBJECTIVES To evaluate the preparedness of community pharmacists in Qatar for the provision of CVD risk assessment and management services; and to explore the pharmacists' views on the provision of these services. METHODS A cross-sectional study using simulated-client methodology. Using standardized scenarios, community pharmacists were approached for consultation on two medicines (Aspirin® and Crestor®) used for managing specific CVD risk factors. Pharmacists' competency to assess CVD risk was the primary outcome evaluated. Scores for each outcome were obtained based on the number of predefined statements addressed during the consultation. RESULTS The mean cumulative score for all the competency outcomes assessed was 11.7 (SD 3.7) out of a possible score of 31. There were no differences for the majority of the competencies tested between the two scenarios used. Significantly more pharmacists exposed to the Aspirin® scenario than to the Crestor® scenario addressed hypertension as one of the risk factors needed to assess CVD risk (22% versus 11%, p = 0.03); whereas significantly more pharmacists in the Crestor® scenario compared to the Aspirin® scenario, addressed dyslipidemia as one of the risk factors needed to assess CVD risk (30% versus 7%, p = 0.02). Significantly more pharmacists exposed to the Aspirin® scenario provided explanation about CVD risk than those exposed to the Crestor® scenario 36% versus 8%, p < 0.01). CONCLUSION The results suggest that many community pharmacists in Qatar are not displaying competencies that are necessary for the provision of CVD prevention services.
Collapse
Affiliation(s)
| | | | - Nadir Kheir
- College of Pharmacy Qatar University, Doha, Qatar.
| | | |
Collapse
|
19
|
Doggrell SA. A review of interventions ≥ 6 months by pharmacists on adherence to medicines in cardiovascular disease: Characteristics of what works and what doesn't. Res Social Adm Pharm 2018; 15:119-129. [PMID: 29656935 DOI: 10.1016/j.sapharm.2018.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 03/11/2018] [Accepted: 04/04/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Nonadherence to cardiovascular medicines occurs in 60% of subjects with chronic cardiovascular disease and leads to poor outcomes. In an attempt to improve adherence and cardiovascular outcomes, interventions are often used. Interventions may involve a pharmacist, but it is not always clear whether these are effective. OBJECTIVES The primary objective of this review is to determine whether interventions by pharmacists, alone, discussing adherence to medicines, improve adherence to medicines for cardiovascular disease. Subsequently, the review links the characteristics of the individual studies with effectiveness or lack of effect. The second objective of this review is to consider whether any improvement in adherence with interventions by pharmacist is associated with better clinical outcomes. METHODS A literature search of PubMed and CINAHL for 'pharmacist', 'medicine' with 'adherence' or 'compliance' or 'persistence' was undertaken. To be included in this review, papers had to be of a pharmacist working alone and in person in an intervention of subjects with hypertension, hyperlipidemia (prior to or after a coronary artery event) or heart failure. The paper had to be published in a peer review journal, with a measure of adherence to medicines. The effectiveness of the intervention had to be evaluated after ≥6 months. RESULTS Only 3 out of 8 interventions by pharmacists in hypertension, and 5 out of 12 interventions in subjects with hyperlipidemia led to improved adherence to medicines. In contrast, all 6 interventions by a pharmacist in subjects with heart failure were successful in improving adherence. One characteristic of successful interventions by pharmacists to improve adherence to cardiovascular medicines is that they must be more than brief/single interventions. A second characteristic is that the intervention should not involve subjects who are already highly adherent, as it is unlikely adherence can be improved in this population. Only 2 of 3 successful interventions in hypertension were associated with small reductions in blood pressure, and only one intervention in hyperlipidemia was shown to decrease LDL-cholesterol to a small extent. In subjects with heart failure, 5 of the 6 successful studies of the successful interventions by pharmacists to increase adherence also showed improved clinical outcomes. CONCLUSIONS When planning an intervention to improve adherence to medicines and cardiovascular outcomes in subjects with hypertension or hyperlipidemic, by a pharmacist alone, or as part of a multi-faceted interventions, it is essential to use an intervention that has been shown to be effective, as most interventions are not effective at improving adherence or only improve adherence and clinical outcomes to a small extent. In heart failure, there is well documented evidence of interventions by pharmacists that do improve clinical outcomes, which should be adopted widely.
Collapse
Affiliation(s)
- Sheila Anne Doggrell
- Faculty of Health, Queensland University of Technology, Brisbane, GPO 2343, QLD, 4002, Australia.
| |
Collapse
|
20
|
Train-the-trainer program on cardiovascular health for community pharmacists in Malaysia. Int J Clin Pharm 2017; 39:1166-1170. [DOI: 10.1007/s11096-017-0540-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 09/23/2017] [Indexed: 10/18/2022]
|
21
|
Franco-Trigo L, Hossain L, Durks D, Fam D, Inglis S, Benrimoj S, Sabater-Hernández D. Stakeholder analysis for the development of a community pharmacy service aimed at preventing cardiovascular disease. Res Social Adm Pharm 2017; 13:539-552. [DOI: 10.1016/j.sapharm.2016.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/16/2016] [Accepted: 06/19/2016] [Indexed: 10/21/2022]
|
22
|
Sabater-Hernández D, Sabater-Galindo M, Fernandez-Llimos F, Rotta I, Hossain LN, Durks D, Franco-Trigo L, Lopes LA, Correr CJ, Benrimoj SI. A Systematic Review of Evidence-Based Community Pharmacy Services Aimed at the Prevention of Cardiovascular Disease. J Manag Care Spec Pharm 2017; 22:699-713. [PMID: 27231797 PMCID: PMC10398089 DOI: 10.18553/jmcp.2016.22.6.699] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death worldwide and has a substantial impact on people's health and quality of life. CVD also causes an increased use of health care resources and services, representing a significant proportion of health care expenditure. Integrating evidence-based community pharmacy services is seen as an asset to reduce the burden of CVD on individuals and the health care system. OBJECTIVES To (a) identify community pharmacy evidence-based services designed to help prevent CVD and (b) provide fundamental information that is needed to assess their potential adaptation to other community pharmacy settings. METHODS This review used the DEPICT database, which includes 488 randomized controlled trials (RCT) that address the evaluation of pharmacy services. Articles reviewing these RCTs were identified for the DEPICT database through a systematic search of the following databases: MEDLINE, Scopus, SciELO (Scientific Electronic Library Online), and DOAJ (Directory of Open Access Journals). The DEPICT database was reviewed to identify evidence-based services delivered in the community pharmacy setting with the purpose of preventing CVD. An evidence-based service was defined as a service that has been shown to have a positive effect (compared with usual care) in a high-quality RCT. From each evidence-based service, fundamental information was retrieved to facilitate adaptation to other community pharmacy settings. RESULTS From the DEPICT database, 14 evidence-based community pharmacy services that addressed the prevention of CVD were identified. All services, except 1, targeted populations with a mean age above 60 years. Pharmacy services encompassed a wide range of practical applications or techniques that can be classified into 3 groups: activities directed at patients, activities directed at health care professionals, and assessments to gather patient-related information in order to support the previous activities. CONCLUSIONS This review provides pharmacy service planners and policymakers with a comprehensive list of evidence-based services that have the potential to be adapted to different settings from which they were originally implemented and evaluated in order to reduce the burden of CVD. DISCLOSURES Funding for this review was provided by the University of Technology Sydney Chancellor's Postdoctoral Fellowship awarded to Sabater-Hernández. No other potential conflict of interest was declared. Study concept and design were contributed by Sabater-Hernández, Fernandez-Llimos, Rotta, and Correr. Sabater-Galindo and Sabater-Hernández took the lead in data collection, along with Franco-Trigo and Rotta. Data interpretation was performed by Sabater-Hernández, Durks, and Lopes. The manuscript was written primarily by Sabater-Hernández, along with Hossain, and revised by Fernandez-Llimos, Rotta, and Benrimoj, with assistance from Durks, Sabater-Galindo, Franco-Trigo, and Correr.
Collapse
Affiliation(s)
- Daniel Sabater-Hernández
- 1 Graduate School of Health (UTS: Pharmacy), University of Technology Sydney, Sydney, Australia, and Academic Centre in Pharmaceutical Care, University of Granada, Granada, Spain
| | | | - Fernando Fernandez-Llimos
- 3 Research Institute for Medicines (iMed.ULisboa), Department of Social Pharmacy, Faculty of Pharmacy, University of Lisboa, Lisbon, Portugal
| | - Inajara Rotta
- 4 PostGraduate Program of Pharmaceutical Sciences, Federal University of Parana
| | - Lutfun N Hossain
- 7 Graduate School of Health (UTS: Pharmacy), University of Technology Sydney, Sydney, Australia
| | - Desire Durks
- 8 Graduate School of Health (UTS: Pharmacy), University of Technology Sydney, Sydney, Australia
| | - Lucia Franco-Trigo
- 9 School of Health (UTS: Pharmacy), University of Technology Sydney, Sydney, Australia
| | - Livia A Lopes
- 5 Post-Graduate Program of Pharmaceutical Sciences, Federal University of Parana
| | - Cassyano J Correr
- 6 Department of Pharmacy, Federal University of Parana, Curitiba, Brazil
| | - Shalom I Benrimoj
- 10 School of Health University of Technology Sydney, Sydney, Australia
| |
Collapse
|
23
|
Jahangard-Rafsanjani Z, Hakimzadeh N, Sarayani A, Najafi S, Heidari K, Javadi MR, Hadjibabaie M, Gholami K. A community pharmacy-based cardiovascular risk screening service implemented in Iran. Pharm Pract (Granada) 2017; 15:919. [PMID: 28690693 PMCID: PMC5499348 DOI: 10.18549/pharmpract.2017.02.919] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/11/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Cardiovascular disease is a major health concern around the world. OBJECTIVE To assess the outcomes and feasibility of a pharmacy-based cardiovascular screening in an urban referral community pharmacy in Iran. METHODS A cross sectional study was conducted in a referral community pharmacy. Subjects aged between 30-75 years without previous diagnose of cardiovascular disease or diabetes were screened. Measurement of all major cardiovascular risk factors, exercise habits, medical conditions, medications, and family history were investigated. Framingham risk score was calculated and high risk individuals were given a clinical summary sheet signed by a clinical pharmacist and were encouraged to follow up with their physician. Subjects were contacted one month after the recruitment period and their adherence to the follow up recommendation was recorded. RESULTS Data from 287 participants were analyzed and 146 were referred due to at least one abnormal laboratory test. The results showed 26 patients with cardiovascular disease risk greater than 20%, 32 high systolic blood pressure, 22 high diastolic blood pressures, 50 high total cholesterol levels, 108 low HDL-C levels, and 22 abnormal blood glucose levels. Approximately half of the individuals who received a follow up recommendation had made an appointment with their physician. Overall, 15.9% of the individuals received medications and 15.9% received appropriate advice for risk factor modification. Moreover, 7.5% were under evaluation by a physician. CONCLUSION A screening program in a community pharmacy has the potential to identify patients with elevated cardiovascular risk factor. A plan for increased patient adherence to follow up recommendations is required.
Collapse
Affiliation(s)
- Zahra Jahangard-Rafsanjani
- Assistant Professor of Clinical Pharmacy. Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences. Tehran (Iran).
| | - Negar Hakimzadeh
- PharmD. Faculty of Pharmacy, Tehran University of Medical Sciences. Tehran (Iran).
| | - Amir Sarayani
- PharmD. Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran (Iran).
| | - Sheyda Najafi
- PharmD. Department of Pharmaceutical Care, Faculty of Pharmacy, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex. Tehran (Iran).
| | - Kazem Heidari
- PhD (Epidemiol). School of Public Health, Tehran University of Medical Sciences. Tehran (Iran).
| | - Mohammad R Javadi
- Professor of Clinical Pharmacy. Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences. Tehran (Iran).
| | - Molouk Hadjibabaie
- Professor of Clinical Pharmacy. Research center for rational use of drugs and faculty of pharmacy, Tehran university of Medical sciences, Tehran (Iran).
| | - Kheirollah Gholami
- Professor of Clinical Pharmacy. Reseasrch Center for Rational Use of Drugs, Tehran, University of Medical Sciences. Tehran (Iran).
| |
Collapse
|
24
|
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.
Collapse
Affiliation(s)
- Maguy Saffouh El Hajj
- Clinical Pharmacy and Practice Section, College of Pharmacy, Qatar University, Doha, Qatar
| | | | | | | | | |
Collapse
|
25
|
Puspitasari HP, Costa DS, Aslani P, Krass I. An explanatory model of community pharmacists' support in the secondary prevention of cardiovascular disease. Res Social Adm Pharm 2016; 12:104-118. [DOI: 10.1016/j.sapharm.2015.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
|
26
|
Awad AI, Alsaleh FM. 10-year risk estimation for type 2 diabetes mellitus and coronary heart disease in Kuwait: a cross-sectional population-based study. PLoS One 2015; 10:e0116742. [PMID: 25629920 PMCID: PMC4309592 DOI: 10.1371/journal.pone.0116742] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 12/12/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM), coronary heart disease (CHD) and metabolic syndrome (MetS) are major healthcare problems in Kuwait. The present study was designed to determine the prevalence of MetS, and to estimate the 10-year risk for developing T2DM and CHD among the general population in Kuwait. METHODS A descriptive, cross-sectional survey was undertaken in 1800 individuals without diabetes or a history of cardiovascular disease (CVD). They were selected from six governorates using two stage convenience sampling. The questionnaire was developed using the Finnish Diabetes Risk Score (FINDRISK), Framingham Risk Score [FRS] and the 2009 Joint Statement criteria for diagnosis of MetS as a framework. Descriptive and multivariate logistic regression analyses were used. RESULTS The response rate was 89.4%. More than half (60.8%; 95% CI: 58.4-63.2) of responders were either overweight or obese. One hundred and ninety seven (12.2%) subjects had blood pressure (BP) ≥ 140/90 mm Hg. Almost three-in-ten (28.3%: 26.2-30.6) subjects had fasting plasma glucose (FPG) levels ≥ 5.6 mmol/l, of whom 86.0% and 14.0% had impaired fasting glucose (IFG) and screen detected T2DM, respectively. MetS was present in 512 (31.8%; 29.5-34.2) respondents. Just under one third (n = 481; 29.9%; 27.7-32.2) of participants were at moderate, high, or very high risk of developing T2DM, while 283 (17.6%: 15.8-19.6) were at moderate/high 10-year risk of developing CHD. Approximately one-in-ten (8.5%; 7.2-9.9) subjects were at moderate/high/very high 10-year risk of developing both T2DM/CHD. T2DM risk was higher for females compared to males (p < 0.001); however, the pattern was reversed in terms of the risk of developing CHD or T2DM/CHD. The risk of developing T2DM, CHD, or T2DM/CHD was greater among those aged ≥ 45 years, and those having MetS (p<0.001). CONCLUSIONS The current findings highlight the need for multifaceted interventions for prevention.
Collapse
|
27
|
Awad A, Al-Nafisi H. Public knowledge of cardiovascular disease and its risk factors in Kuwait: a cross-sectional survey. BMC Public Health 2014; 14:1131. [PMID: 25367768 PMCID: PMC4237772 DOI: 10.1186/1471-2458-14-1131] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 10/21/2014] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is estimated to cause 46% of all mortalities in Kuwait. To design effective primary and secondary prevention programs, an assessment of a population's prior CVD knowledge is of paramount importance. There is scarcity of data on the existing CVD knowledge among the general Kuwaiti population. Hence, this study was performed to assess the level of knowledge towards CVD types, warning symptoms of heart attack or stroke, and CVD risk factors. It also explored public views on the community pharmacists' role in CVD prevention and management. METHODS A descriptive cross-sectional survey was performed using a pretested self-administered questionnaire on a sample of 900 randomly selected Kuwaiti individuals. Descriptive and multivariate logistic regression analysis were used in data analysis. RESULTS The response rate was 90.7%. Respondents' knowledge about types of CVD, heart attack or stroke symptoms was low. Almost 60% of respondents did not know any type of CVD, and coronary heart disease was the commonest identified type (29.0%). Two-fifths of participants were not aware of any heart attack symptoms, and the most commonly known were chest pain (50.4%) and shortness of breath (48.0%). Approximately half of respondents did not recognize any stroke symptoms, and the most commonly recognized were 'confusion or trouble speaking' (36.4%) and 'numbness or weakness' (34.7%). Respondents' knowledge regarding CVD risk factors was moderate. The commonest factors identified by over four-fifths of participants were smoking, obesity, unhealthy diet and physical inactivity. In the multivariate logistic regression analysis, independent predictors of better level of CVD knowledge were females, age 50-59 years, high level of education, regular eating of healthy diet, and had a family history of CVD. Most of respondents only identified the role that pharmacists had to play is to help patients manage their medications, with a minimal role in other aspects of CVD prevention and management. CONCLUSIONS There are deficiencies in CVD knowledge among Kuwaiti population, which could turn into insufficient preventative behaviours and suboptimal patient outcomes. There is an apparent need to establish more wide-spread and effective educational interventions, which should be sensitive to the perceptions, attitudes, and abilities of targeted individuals.
Collapse
Affiliation(s)
- Abdelmoneim Awad
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, P.O. Box 24923, Safat, 13110 Kuwait
| | - Hala Al-Nafisi
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, P.O. Box 24923, Safat, 13110 Kuwait
| |
Collapse
|
28
|
Puspitasari HP, Aslani P, Krass I. Australian community pharmacists' awareness and practice in supporting secondary prevention of cardiovascular disease. Int J Clin Pharm 2013; 35:1218-28. [PMID: 24057435 DOI: 10.1007/s11096-013-9854-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 09/12/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pharmacists are well placed to identify, prevent and resolve medicine related problems as well as monitor the effectiveness of treatments in cardiovascular disease (CVD). Pharmacists' interventions in CVD secondary prevention have been shown to improve outcomes for clients with established CVD. OBJECTIVE To explore the scope of pharmacists' activities in supporting CVD secondary prevention. SETTING Community pharmacies in New South Wales, Australia. METHODS Twenty-one in-depth, semi-structured interviews with a range of community pharmacists were conducted. All interviews were audio-recorded and transcribed ad verbatim. Data were analyzed using a 'grounded-theory' approach by applying methods of constant comparison. MAIN OUTCOME MEASURE Community pharmacists' awareness and current practice in supporting secondary prevention of CVD. RESULTS Four key themes identified included 'awareness', 'patient counselling', 'patient monitoring', and 'perceptions of the role of pharmacists in CVD secondary prevention'. The pharmacists demonstrated a moderate understanding of CVD secondary prevention. There was considerable variability in the scope of practice among the participants, ranging from counselling only about medicines to providing continuity of care. A minority of pharmacists who had negative beliefs about their roles in CVD secondary prevention offered limited support to their clients. The majority of pharmacists, however, believed that they have an important role to play in supporting clients with established CVD. CONCLUSION Community pharmacists in Australia make a contribution to the care of clients with established CVD despite the gap in their knowledge and understanding of CVD secondary prevention. The scope of practice in CVD secondary prevention ranged from only counselling about medicines to offering continuity of care. The extent of pharmacists' involvement in offering disease management appears to be influenced by their beliefs regarding what is required within their scope of practice.
Collapse
|