An increased interest is observed in broadening community pharmacists' role in public health. To date, little information has been gathered in Canada on community pharmacists' perceptions of their role in health promotion and prevention; however, such data are essential to the development of public-health programs in community pharmacy. A cross-sectional study was therefore conducted to explore the perceptions of community pharmacists in urban and semi-urban areas regarding their ideal and actual levels of involvement in providing health-promotion and prevention services and the barriers to such involvement. Using a five-step modified Dillman's tailored design method, a questionnaire with 28 multiple-choice or open-ended questions (11 pages plus a cover letter) was mailed to a random sample of 1,250 pharmacists out of 1,887 community pharmacists practicing in Montreal (Quebec, Canada) and surrounding areas. It included questions on pharmacists' ideal level of involvement in providing health-promotion and preventive services; which services were actually offered in their pharmacy, the employees involved, the frequency, and duration of the services; the barriers to the provision of these services in community pharmacy; their opinion regarding the most appropriate health professionals to provide them; and the characteristics of pharmacists, pharmacies and their clientele. In all, 571 out of 1,234 (46.3%) eligible community pharmacists completed and returned the questionnaire. Most believed they should be very involved in health promotion and prevention, particularly in smoking cessation (84.3%); screening for hypertension (81.8%), diabetes (76.0%) and dyslipidemia (56.9%); and sexual health (61.7% to 89.1%); however, fewer respondents reported actually being very involved in providing such services (5.7% [lifestyle, including smoking cessation], 44.5%, 34.8%, 6.5% and 19.3%, respectively). The main barriers to the provision of these services in current practice were lack of: time (86.1%), coordination with other health care professionals (61.1%), staff or resources (57.2%), financial compensation (50.8%), and clinical tools (45.5%). Although community pharmacists think they should play a significant role in health promotion and prevention, they recognize a wide gap between their ideal and actual levels of involvement. The efficient integration of primary-care pharmacists and pharmacies into public health cannot be envisioned without addressing important organizational barriers.

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Ideal and actual involvement of community pharmacists in health promotion and prevention: a cross-sectional study in Quebec, Canada.

We describe results from a clinical program, which aimed at improving adherence to medications in children who had a liver transplant. We followed the medical outcomes of 23 children and adolescents who participated in a clinical adherence-improvement protocol during the years 2001-2002. The protocol included identification of non-adherent patients by examining tacrolimus blood levels and intervention by increasing the frequency of clinic visits for non-adherent patients. In the two-yr preintervention (1999-2000), there was no improvement in any of the outcomes. After the intervention, the number of patients with high alanine aminotransferase levels (100 and above) decreased significantly, from eight before the intervention to four afterwards. Other outcomes, including the number of rejection episodes (three before, none after) and the degree of adherence to tacrolimus, also improved, but the improvement did not reach statistical significance. Although non-adherent patients were called to clinic more often under the protocol, the intervention did not lead to increased outpatient costs. This adherence--improvement intervention appears to be promising in improving outcomes in pediatric liver transplant recipients. Larger, controlled studies are needed to establish the efficacy of this or other approaches.

Improving adherence to medications in pediatric liver transplant recipients.

Background Cardiovascular risk-based screening is proposed as a key intervention to reduce premature cardiovascular disease (CVD) in the UK and internationally. This study evaluated a targeted cardiovascular (CVD) assessment pilot in 23 community pharmacies in Birmingham, UK. Methods The CVD risk assessment service used near-patient testing and the Framingham risk equations administered by pharmacists to screen clients aged 40–70 without known CVD. Outcomes assessed included volume of activity, uptake by deprivation and ethnicity and onwards referral. Results Complete data were available for 1130 of 1141 clients; 679 (60%) male, 218 (19%) smokers and 124 (11%) had a family history of CVD. Overall, 792 (70%) of clients were referred to their general practice: 201 (18%) at CVD risk of 20% or more, remainder with individual risk factor(s). Greater representation from Black (7.4%) and Asian (24.8%) communities and from average and less deprived quintiles than the affluent and most deprived was observed. Conclusions Community pharmacies can provide a CVD risk assessment service in a UK urban setting that can attract males and provide access for deprived communities and Black and Asian communities. A pharmacy service can support GP practices in identifying and managing the workload of around 30% of clients.

Evaluation of a cardiovascular disease opportunistic risk assessment pilot ('Heart MOT' service) in community pharmacies.

Objectives

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.
Method

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.
Key findings

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.
Conclusion

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.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1111/ijpp.12041

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

Objectives To examine the effectiveness of collaborative physician–community pharmacist programs to treat influenza-like illness (ILI) with respect to clinical outcomes and health care utilization. Design Prospective multicenter cohort study. Setting Fifty-five pharmacies in Michigan, Minnesota, and Nebraska. Patients Adult patients presenting to the pharmacy with ILI during the 2013–14 influenza season (October 1, 2013 to May 30, 2014). Intervention Pharmacists screened adult patients presenting with ILI, completed a brief physical assessment, performed a point-of-care rapid influenza diagnostic test (RIDT), and provided appropriate referral or treatment per an established collaborative practice agreement (CPA) with a licensed prescriber. Pharmacists followed-up with patients 24 to 48 hours after the encounter to assess patient status and possible need for further intervention. Main outcome measures Number of patients screened, tested, and treated for influenza. Results Of the 121 patients screened, 45 (37%) were excluded and referred to their primary care provider or an urgent care facility for management. Of the 75 patients (62%) eligible for participation, 8 (11%) had a positive RIDT and were managed according to the CPA. Of the patients tested, 34.6% had no primary care physician and 38.7% visited the pharmacy outside of normal office hours. Only 3% of patients reported feeling worse at follow-up. Conclusion This study describes a physician-pharmacist collaborative model for treating ILI. Using an evidence-based CPA, pharmacists were able to provide timely treatment to patients with and without influenza.

https://www.japha.org/article/S1544-3191(15)00009-6/pdf

Effectiveness of a pharmacist-physician collaborative program to manage influenza-like illness

Objective To assess a model to screen minority, elderly, and at-risk individuals for diabetes, hypertension, and dyslipidemia in pharmacy and non–health care settings Design Multicenter, prospective, observational trial Setting 26 pharmacies and 4 non–health care settings Participants 888 individuals with one or more of the following risk factors: first-degree relative with diabetes, age 55 years or older, obesity, previous diagnosis of hypertension, or a previous diagnosis of dyslipidemia Intervention Measurement of plasma glucose, total cholesterol, high-density lipoprotein cholesterol (HDL-C), and blood pressure; risk assessment using a risk factor tool; referral of participants with abnormalities to physicians Main Outcome Measures Adherence with follow-up, physician recommendations, and new diagnoses of diabetes, hypertension, and dyslipidemia Results Pharmacists screened 888 participants in pharmacies and non–health care settings; 794 scored at least 10 on the risk factor tool and received further screenings Of these, 81% were referred for follow-up for at least one abnormality: 15% glucose, 68% blood pressure, 66% total cholesterol, and 26% HDL-C For those referred, the mean (± SD) fasting plasma glucose concentration was 179 ± 87 mg/dL, and the random glucose concentration was 234 ± 90 mg/dL Of participants completing follow-up, 16% received one or more new diagnoses as follows: diabetes, 8; hypertension, 9; and dyslipidemia, 29 Therapy changed for 42% of participants Participants who were elderly, of African American and Hispanic race/ethnicity, or those with elevated cholesterol values were at significantly greater risk for elevated glucose levels Screenings in community pharmacy settings had improved follow-up rates with physicians compared with screenings conducted in non–health care settings Conclusion Pharmacists identified individuals with elevated glucose, cholesterol, and blood pressure values through community-based screenings Pharmacists also identified individuals who could benefit from further control of previously diagnosed hypertension and hyperlipidemia

https://www.japha.org/article/S1544-3191(15)31535-1/pdf

Pharmacy- and Community-Based Screenings for Diabetes and Cardiovascular Conditions in High-Risk Individuals

OTC device: temporal scanner TAT-2000C.

Urinary incontinence is a prevalent, although often unreported, disease within the elderly population, with consequences spanning many aspects of the patient's life. Treatments differ for each subtype of urinary incontinence: urge incontinence, stress incontinence, and incontinence associated with bladder outlet obstruction and lower urinary tract symptoms in men. Limitations in current therapies have negatively affected care for each of these subtypes, particularly in the vulnerable elderly population. An emergence of new treatment options and strategies has created opportunities to optimize care for the general population. These include the use of trospium, darifenacin, solifenacin, and duloxetine as well as the strategic use of antimuscarinic agents in conjunction with alpha adrenergic blockade in men with bladder outlet obstruction. Yet, the literature regarding use of these agents and strategies in the elderly should be carefully evaluated to determine the benefits and the unique risks posed by their...

Ann E. Canales

Papers

Pharmacy- and Community-Based Screenings for Diabetes and Cardiovascular Conditions in High-Risk Individuals

OTC device: temporal scanner TAT-2000C.

New Options and Strategies for the Treatment of Urinary Incontinence