Community Pharmacy-based Screening Research Articles

Cardiovascular risk assessment of the general population at a community pharmacy setting

Background: The increasing burden of cardiovascular diseases (CVDs) suggests the need for early detection of risks. This study assessed the outcomes of community pharmacy-based screening for CVD risks and the association of sociodemographic characteristics with health parameters. Methods: A cross-sectional study was conducted among healthy consumers of community pharmacy services aged 18 and above. Interventions included the measurement of blood pressure, waist-to-hip ratio, height/weight, visceral fat, and CVD risks. Study endpoints were outcomes of community pharmacy-based screenings and the association of sociodemographics with health parameters. Results: A high prevalence of elevated blood pressure 212 (53.1%), high visceral fat 167 (41.8%), high waist-to-hip ratio 176 (44.1%), and high body mass index (BMI) 251 (62.9%) were observed among the 400 study participants. Of the 152 (38.0%) with CVD risks, 84 (55.3%) had a medium risk. Age was statistically significant for CVD risks, blood pressure, heart rate, and BMI. Occupation was statistically significant for CVD risks and heart rate. Marital status was significantly associated with CVD risk. Conclusion: Several outcomes were observed, including a high prevalence of hypertension, high BMI, waist-to-hip ratio, and overall medium CVD risks. These findings suggest the need for increased and targeted educational interventions.

COMMUNITY PHARMACY-BASED HYPERTENSION SCREENING: MAY MEASUREMENT MONTH 2023 IN 3 CANADIAN PROVINCES

Objective: Elevated blood pressure (BP) is the largest contributing risk factor for premature death and disability. Approximately 50% of individuals with hypertension are unaware they have the condition; therefore, BP screening is essential. Canadian health professionals have previously participated in the annual global BP screening campaign, May Measurement Month (MMM); however this has never been completed in community pharmacies, which have the advantage of being highly accessible to the public. Our objective was to examine the prevalence of elevated (BP) in Alberta (AB), British Columbia (BC), Newfoundland and Labrador (NL) during MMM 2023. Design and method: This cross-sectional study enrolled consenting members of the general public 18 years of age, recruited through signage, media and social media. Data collection took place between May 1 and July 31, 2023 in 52 community pharmacies across AB, BC, and NL. Participants completed a questionnaire that included demographic information, medical history, and use of antihypertensives. Pharmacy personnel completed 3 blood pressure readings, with readings 2 and 3 used to estimate BP. We used an automated blood pressure device recommended by Hypertension Canada's Device Recommendation Program. Elevated BP was defined as >140/90mmHg or >130/80mmHg for individuals with diabetes. Results: We enrolled 736 participants. The mean age of participants was 52 (SD 18.6) years, 66% were female, 34% had a history of hypertension, and 14% had diabetes. Overall, 21% (152/733) had elevated BP. In subgroups of interest, elevated BP was found in 20% (96/480) of females, 35% (88/251) of those with a history of hypertension (13% (64/482) in those with no history of hypertension), and 52% (53/103) in those with diabetes. Conclusions: Identifying individuals with elevated BP is the starting point for better BP management. Community pharmacy screening of BP was effective in identifying individuals with elevated BP warranting further assessment. Our experiences from MMM 2023 will guide the future scale-up of a national community pharmacy-based screening program for MMM 2024.

Automated Signal Quality Assessment of Single-Lead ECG Recordings for Early Detection of Silent Atrial Fibrillation

Atrial fibrillation (AF) is an arrhythmic cardiac disorder with a high and increasing prevalence in aging societies, which is associated with a risk for stroke and heart failure. However, early detection of onset AF can become cumbersome since it often manifests in an asymptomatic and paroxysmal nature, also known as silent AF. Large-scale screenings can help identifying silent AF and allow for early treatment to prevent more severe implications. In this work, we present a machine learning-based algorithm for assessing signal quality of hand-held diagnostic ECG devices to prevent misclassification due to insufficient signal quality. A large-scale community pharmacy-based screening study was conducted on 7295 older subjects to investigate the performance of a single-lead ECG device to detect silent AF. Classification (normal sinus rhythm or AF) of the ECG recordings was initially performed automatically by an internal on-chip algorithm. The signal quality of each recording was assessed by clinical experts and used as a reference for the training process. Signal processing stages were explicitly adapted to the individual electrode characteristics of the ECG device since its recordings differ from conventional ECG tracings. With respect to the clinical expert ratings, the artificial intelligence-based signal quality assessment (AISQA) index yielded strong correlation of 0.75 during validation and high correlation of 0.60 during testing. Our results suggest that large-scale screenings of older subjects would greatly benefit from an automated signal quality assessment to repeat measurements if applicable, suggest additional human overread and reduce automated misclassifications.

Opportunistic screening for type 2 diabetes in community pharmacies. Results from a region-wide experience in Italy.

Given the paucity of symptoms in the early stages of type 2 diabetes, its diagnosis is often made when complications have already arisen. Although systematic population-based screening is not recommended, there is room to experience new strategies for improving early diagnosis of the disease in high risk subjects. We report the results of an opportunistic screening for diabetes, implemented in the setting of community pharmacies. To identify people at high risk to develop diabetes, pharmacists were trained to administer FINDRISC questionnaire to overweight, diabetes-free customers aged 45 or more. Each interviewee was followed for 365 days, searching in the administrative database whether he/she had a glycaemic or HbA1c test, or a diabetologists consultation, and to detect any new diagnosis of diabetes defined by either a prescription of any anti-hyperglycaemic drug, or the enrolment in the register of patients, or a hospital discharge with a diagnosis of diabetes. Out of 5977 interviewees, 53% were at risk of developing diabetes. An elevated FINDRISC score was associated with higher age, lower education, and living alone. Excluding the number of cases expected, based on the incidence rate of diabetes in the population, 51 new cases were identified, one every 117 interviews. FINDRISC score, being a male and living alone were significantly associated with the diagnosis. The implementation of a community pharmacy-based screening programme can contribute to reduce the burden of the disease, particularly focusing on people at higher risk, such as the elderly and the socially vulnerable.

Assessment of a non-physician screening program for hypertension and cardiovascular risk in community pharmacies

Background and aimsThe strategic role of prevention in hypertension setting is well known but, with the only exception of annually events promoted by international scientific societies, no other screening campaigns are available. Aim of this study was to assess the feasibility of a non-physician pharmacy-based screening program and to describe the cardiovascular risk and the BP status of participating subjects. Methods and results2731 costumers participated to the screening program, answering to a questionnaire about personal cardiovascular risk and measuring their BP with an Omron HEM 1040-E. Since no threshold for hypertension diagnosis is currently available for community pharmacies BP measurements, we assessed high BP prevalence according to 3 different cut-offs (≥140/90, ≥135/85 and ≥ 130/80 mmHg) and compared normotensives and hypertensives on major cardiovascular risk factors. According to the proposed cut-offs, prevalence of hypertension was respectively of 31%, 45% and 59.5%, and it increased among younger subjects (31–65 y) when the lowest cut-offs were applied. High BP was found in a large percentage of subjects self-declared on-/not on-treatment (uncontrolled hypertensives) or normotensives (presumptive hypertensives) and among those not aware of their own BP values (presumptive hypertensives). Prevalence of CV risk factors was higher in hypertensives than in normotensives. ConclusionsOur findings demonstrated that a community pharmacy-based screening is feasible and attracts the interests of many subjects, improving awareness on their BP status. The screening was also showed to be useful in order to detect potentially uncontrolled and/or suspected new hypertensives, especially among young adults, to refer to general practitioners for confirmatory diagnosis or further evaluation.

Evaluation of a Community Pharmacy-Based Screening Questionnaire to Identify Patients at Risk for Drug Therapy Problems.

To determine if a short screening questionnaire can identify patients at risk for drug therapy problems (DTPs) in a community pharmacy setting. Self-administered questionnaire. Three community pharmacies in Saskatoon, Canada. Forty-nine adults who were picking up a refill prescription for a medication that had remained stable over the past 6months (i.e., no changes to drug, dose, or regimen) during 4 consecutive weeks at each of the three pharmacies between November 2013 and February 2014. All patients completed a self-administered screening questionnaire and underwent a blinded comprehensive medication assessment with a clinical pharmacist. Agreement between the screening questionnaire responses and responses based on information from the medication assessment were assessed with Cohen's κ coefficient. The DTPs identified during the medication assessments were categorized in one of the eight standard DTP categories: unnecessary drug therapy, inappropriate drug, subtherapeutic dose, supratherapeutic dose, drug therapy required, adverse drug reaction, noncompliance, and other or unsure. The DTPs were also assigned a severity-mild, moderate, or severe-using adapted Schneider criteria. The number and severity of DTPs identified were compared among patients categorized as high versus low risk for DTPs as determined by the questionnaire responses. Of the 49 patients who completed the study, 18 (37%) were high risk and 31 (63%) low risk. The agreement between risk categorization based on the screening questionnaire and medication assessment was very good (κ=0.91, p<0.01). Also, patients identified as high risk on the screening questionnaire had a mean of 3.7 (p<0.01) more DTPs than low-risk patients. Seventeen (94%) of the 18 high-risk patients had at least one moderate or severe DTP compared with 15 (48%) of the 31 low-risk patients. The screening questionnaire was a reliable method for identifying patients in community pharmacies who have a large number of DTPs.

Screening for major diseases in community pharmacies: a systematic review†

The aim of this systematic review was to assess the published evidence about the feasibility and acceptability of community pharmacy-based screening for major diseases. Studies published between January 1990 and August 2012 involving community pharmacy-based screening interventions, published in the English language, were identified from electronic databases. Reference lists of included studies were also searched. Fifty studies (one randomised controlled trial, two cluster randomised studies, five non-randomised comparative studies and 42 uncontrolled studies) were included. The quality of most of these was assessed as poor. Screening was mostly opportunistic and screening tools included questionnaires or risk assessment forms, medical equipment to make physiological measurements, or a combination of both. Few studies assessed the accuracy of pharmacy-based screening tools. More than half of the screening interventions included an element of patient education. The proportion of screened individuals, identified with disease risk factors or the disease itself, ranged from 4% to 89%. Only 10 studies reported any economic information. Where assessed, patient satisfaction with pharmacy-based screening was high, but individuals who screened positive often did not follow pharmacist advice to seek further medical help. Available evidence suggests that screening for some diseases in community pharmacies is feasible. More studies are needed to compare effectiveness and cost-effectiveness of pharmacy-based screening with screening by other providers. Strategies to improve screening participants' adherence to pharmacist advice also need to be explored. This systematic review will help to inform future studies wishing to develop community pharmacy-based screening interventions.

The feasibility of providing community pharmacy-based services for alcohol misuse: A literature review

Abstract Objectives Excessive consumption of alcohol is a major public health concern. The use of community pharmacies and pharmacists as sources of public health information and services is gaining greater recognition. The objective of this review was to provide an overview of the evidence on the feasibility, effectiveness and acceptability of providing community pharmacy-based services to address the excessive consumption of alcohol. Methods Electronic databases were searched for the period 1996–2007 to identify relevant evidence. Searches were also conducted of relevant pharmacy and addiction journals. Information was sought from key contacts in pharmacy and alcohol research. Studies were included if they were conducted in a community pharmacy setting. Key findings The review comprised three feasibility studies which included 14 pharmacies and 500 customers. Non-significant reductions in alcohol consumption were reported with two studies following brief interventions by pharmacists. Between 30% and 53% of pharmacy customers were identified as having hazardous or harmful drinking behaviour. Customer opinion of the pharmacy-based alcohol services was not reported. Conclusions There has been little empirical evaluation of the effectiveness of community pharmacy-based services for alcohol misuse. The evidence presented in this review suggests that community pharmacy-based screening is feasible. Organisations and individuals involved with tackling excessive alcohol consumption should consider the inclusion of community pharmacies and pharmacists as part of their strategies to address this problem. Large-scale studies are needed to evaluate the short- and long-term effects and cost-effectiveness of community pharmacy-based interventions to reduce excessive alcohol consumption, as well as to explore the acceptability of the service to users.

The feasibility of providing community pharmacy-based services for alcohol misuse: a literature review

Excessive consumption of alcohol is a major public health concern. The use of community pharmacies and pharmacists as sources of public health information and services is gaining greater recognition. The objective of this review was to provide an overview of the evidence on the feasibility, effectiveness and acceptability of providing community pharmacy-based services to address the excessive consumption of alcohol. Electronic databases were searched for the period 1996-2007 to identify relevant evidence. Searches were also conducted of relevant pharmacy and addiction journals. Information was sought from key contacts in pharmacy and alcohol research. Studies were included if they were conducted in a community pharmacy setting. The review comprised three feasibility studies which included 14 pharmacies and 500 customers. Non-significant reductions in alcohol consumption were reported with two studies following brief interventions by pharmacists. Between 30% and 53% of pharmacy customers were identified as having hazardous or harmful drinking behaviour. Customer opinion of the pharmacy-based alcohol services was not reported. There has been little empirical evaluation of the effectiveness of community pharmacy-based services for alcohol misuse. The evidence presented in this review suggests that community pharmacy-based screening is feasible. Organisations and individuals involved with tackling excessive alcohol consumption should consider the inclusion of community pharmacies and pharmacists as part of their strategies to address this problem. Large-scale studies are needed to evaluate the short- and long-term effects and cost-effectiveness of community pharmacy-based interventions to reduce excessive alcohol consumption, as well as to explore the acceptability of the service to