Abstract

BackgroundAtrial fibrillation (AF) affects up to 10% of people aged ≥65 years, yet a third of all cases remain undetected. Practice-based pharmacists are in an ideal position to facilitate opportunistic AF screening, while increasing general practice capacity at a time of workforce crisis.AimTo explore the perspectives of three stakeholder groups involved in the ‘Pharmacists Detecting Atrial Fibrillation’ (PDAF) study to elucidate the facilitators and barriers to pharmacist-led AF screening in general practice.Design & settingA qualitative study took place, comprising homogeneous focus groups with stakeholders in Kent, UK.MethodThe stakeholder groups — patients, general practice staff (GPS), and clinical pharmacists (CPs) — were recruited using convenience sampling. Audio-recordings were transcribed verbatim and analysed using a deductive Theoretical Domains Framework (TDF) approach.ResultsTwenty-five patients, four pharmacists, and nine practice staff participated in six focus groups. Three main themes were identified: knowledge and awareness; prioritisation of resources; and environmental considerations. The public’s lack of awareness of AF-related risks and pharmacist-led screening services was highlighted. Practice-based pharmacists were perceived as an underutilised educational resource which, together with novel electrocardiogram devices, enabled convenient access to screening while reducing GPs’ workload. Participants agreed that AF screening should be incorporated into personalised health checks and at-risk groups should be prioritised, such as care home residents. Patients favoured the general practice environment over the community pharmacy where concerns of privacy, staffing, and commercialisation were raised.ConclusionThe findings of this study support the introduction of pharmacist-led AF screening programmes in general practice surgeries. Commissioners should consider the added value of utilising CPs and focus on the delivery of AF screening within an integrated service.

Highlights

  • Atrial fibrillation (AF) affects up to one in 10 people aged ≥65 years in England; 30% of all cases remain undiagnosed.[1]

  • Twenty-­five patients, four pharmacists, and nine practice staff participated in six focus groups

  • The findings of this study support the introduction of pharmacist-l­ed AF screening programmes in general practice surgeries

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Summary

Introduction

AF affects up to one in 10 people aged ≥65 years in England; 30% of all cases remain undiagnosed.[1] Individuals with untreated AF display a five-f­old greater risk of cardioembolic stroke, resulting in a preventable annual NHS bill of £2.2 billion.[2,3] Opportunistic AF screening is recommended by both international guidelines and a 2018 white paper,[4,5] but is not supported by UK national guidance.[6,7] Despite this discordance, the government has set a target to detect 85% of AF cases by 2029.8. Practice-­based pharmacists are in an ideal position to facilitate opportunistic AF screening, while increasing general practice capacity at a time of workforce crisis

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