Diabetes and cardiovascular disease risk screening model in community pharmacies in a developing primary healthcare system: a feasibility study

• Published in: BMJ open Vol. 9; no. 11; p. e031246
• Main Authors: Alzubaidi, Hamzah Tareq, Chandir, Subhash, Hasan, Sanah, McNamara, Kevin, Cox, Rachele, Krass, Ines
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 10-11-2019; BMJ Publishing Group
• Subjects: Cardiovascular disease; Diabetes; Disease prevention; Drug stores; Expatriates; Feasibility studies; Medical screening; Mortality; Obesity; Physicians; Population; Primary care; Public Health; Risk assessment; Trends; United Arab Emirates; point-of-care testing; pharmacy; primary health care; screening; cardiovascular diseases; diabetes
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2019-031246

ObjectivesThis study aimed to develop an evidence-based community pharmacist-delivered screening model for diabetes and cardiovascular disease (CVD), and assess its feasibility to identify and refer patients with elevated risk.DesignA feasibility study.SettingA purposive sample of 12 community pharmacies in three cities in the United Arab Emirates (UAE).ParticipantsAdults 40 years of age and above who have not been previously diagnosed with either diabetes or CVD.InterventionPharmacist screening of adults visiting pharmacies involved history, demographics, anthropometric measurements, blood pressure and point-of-care testing including glycated haemoglobin (HbA1c) levels and lipid panel. Participants with a 10-year CVD risk ≥7.5%, HbA1c level ≥5.7% or American Diabetes Association (ADA) risk score ≥5 points were advised to visit their physician.Primary and secondary outcome measuresThe primary outcomes were (1) development of UAE pharmacist-delivered screening model, (2) the proportion of screened participants identified as having high CVD risk (atherosclerotic CVD 10-year risk defined as ≥7.5%) and (3) the proportion of participants identified as having elevated blood glucose (high HbA1c level ≥5.7% (38.8 mmol/mol)) or high self-reported diabetes risk (ADA risk score ≥5 points). Secondary outcome is participants’ satisfaction with the screening.ResultsThe first UAE pharmacist-delivered screening model was developed and implemented. A total of 115 participants were screened, and 92.3% of the entire screening process was completed during a single visit to pharmacy. The mean duration of the complete screening process was 27 min. At-risk individuals (57.4%) were referred to their physicians for further testing, while 94.5% of participants were at least satisfied with their screening experience.ConclusionsThe community pharmacist-delivered screening of diabetes and CVD risk is feasible in the UAE. The model offers a platform to increase screening capacity within primary care and provides an opportunity for early detection and treatment. However, pathways for the integration of the pharmacist-delivered screening service with physicians in primary care are yet to be explored.