Advertisement

Pharmacy World & Science

, Volume 32, Issue 3, pp 373–380 | Cite as

Cardiovascular risk screening program in Australian community pharmacies

  • Gregory M. PetersonEmail author
  • Kimbra D. Fitzmaurice
  • Helen Kruup
  • Shane L. Jackson
  • Rohan L. Rasiah
Research Article

Abstract

Objective To assess the suitability of Australian community pharmacies as cardiovascular disease risk profile screening centres and evaluate whether community pharmacists can play an important role in detecting, educating and referring screened individuals at high risk of cardiovascular disease. Setting 14 Australian community pharmacies. Method Opportunistic cardiovascular disease risk profiling for members of the public aged greater than 30 years with no existing cardiovascular diseases was performed. All major cardiovascular risk factors were measured. Exercise habits, existing conditions and therapy, and family history were also assessed. The results were used to calculate each subject’s 10-year risk of developing cardiovascular events, based on Framingham Risk Equations (New Zealand tables). Each subject’s knowledge of cardiovascular risk factors was assessed using a multiple-choice questionnaire. Written educational materials and verbal counselling were provided. Referral to a doctor for further assessment was recommended as appropriate. The screened individuals were followed up via mailed out questionnaire. A random sample of individuals at elevated risk was phoned to assess for outcomes of the screening and referral process. Main outcome measures Risk of developing cardiovascular disease and knowledge of cardiovascular risk factors. Results A total of 655 individuals (71.4% female) were screened for cardiovascular disease risk factors. Ages ranged from 30 to 90 years (median: 54 years) and 14.2% were smokers. Of the individuals screened, 28.1% had a 10-year risk of developing cardiovascular disease greater than 15%, including 6.9% who had a 10-year risk above 30%. The median calculated 10-year risk of developing cardiovascular disease was 9.5%. Approximately one-third of the individuals had elevated blood pressure, and almost two-thirds were either overweight or obese. The mean total serum cholesterol was 5.31 mmol/l, with 40% of individuals having a level above 5.5 mmol/l and 20% having a high-density lipoprotein cholesterol level below 1.0 mmol/l. There was a statistically significant improvement in the knowledge of cardiovascular disease risk factors at follow-up. Almost half of the contacted high-risk subjects reported lifestyle changes or started drug therapy following re-testing by their general practitioner. Conclusion A pharmacy-based cardiovascular disease risk profile screening and education program has the potential to identify and refer many undiagnosed individuals at high risk of cardiovascular events, and help contain the burden of heart disease.

Keywords

Australia Cardiovascular disease Detection Pharmacy Risk Screening 

Notes

Acknowledgements

We thank Madeleine Ball, Roger Rumble, Mark Naunton and Sue Owen for their contributions to this work.

Funding

This research was funded by the Australian Government Department of Health and Ageing through the Third Community Pharmacy Agreement Research and Development Program.

Conflicts of interest statement

None to declare

References

  1. 1.
    World Health Organization. Neglected global epidemics: three growing threats. The World Health Report—shaping the future. Geneva: World Health Organization; 2003. p. 83–102.Google Scholar
  2. 2.
    Australian Institute of Health and Welfare. Australia’s health 2006. AIHW cat. no. AUS 73. Canberra: AIHW. 2006.Google Scholar
  3. 3.
    National Heart Foundation of Australia. The shifting burden of cardiovascular disease. Report prepared by Access Economics 2005. Canberra: National Heart Foundation of Australia.Google Scholar
  4. 4.
    Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937–52. doi: 10.1016/S0140-6736(04)17018-9.CrossRefPubMedGoogle Scholar
  5. 5.
    Taylor R, Dobson A, Mirzaei M. Contribution of changes in risk factors to the decline of coronary heart disease mortality in Australia over three decades. Eur J Cardiovasc Prev Rehabil. 2006;13:760–8. doi: 10.1097/01.hjr.0000220581.42387.d4.CrossRefPubMedGoogle Scholar
  6. 6.
    Prepared by: British Cardiac Society; British Hypertension Society; Diabetes UK; HEART UK; Primary Care Cardiovascular Society. The Stroke Association. JBS 2: Joint British Societies’ guidelines on prevention of cardiovascular disease in clinical practice. Heart. 2005;91(Suppl 5):v1–52. doi: 10.1136/hrt.2005.079988.
  7. 7.
    Tonkin A, Barter P, Best J, et al. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: position statement on lipid management—2005. Heart Lung Circ. 2005;14:275–91. doi: 10.1016/j.hlc.2005.10.009.CrossRefPubMedGoogle Scholar
  8. 8.
    Joyce AW, Sunderland VB, Burrows S, et al. Community pharmacy’s role in promotion of healthy behaviours. J Pharm Pract Res. 2007;37:42–4.Google Scholar
  9. 9.
    Phillips S, Wyndham L, Shaw J, Walker S. How accurately does the Reflotron dry-chemistry system measure plasma total cholesterol levels when used as a community-screening device? Med J Aust. 1988;149:122–5.PubMedGoogle Scholar
  10. 10.
    Kinlay S. Comparison of Reflotron and laboratory cholesterol measurements. Med J Aust. 1988;149:126–9.PubMedGoogle Scholar
  11. 11.
    Ball MJ, Robertson IK, Woods M. Reflotron cholesterol measurement in general practice—accuracy and detection of errors. Ann Clin Biochem. 1994;31:556–60.PubMedGoogle Scholar
  12. 12.
    Gregory LC, Duh SH, Christenson RH. Eight compact analysis systems evaluated for measuring total cholesterol. Clin Chem. 1994;40:579–85.PubMedGoogle Scholar
  13. 13.
    Pearson JR, Dusenbury LJ, Bakes-Martin R, Loverde M, Johnson J, Byyny RL. Evaluation of a simple method for measuring blood cholesterol levels using non-laboratory observers. Am J Med. 1988;85:369–74. doi: 10.1016/0002-9343(88)90589-X.CrossRefPubMedGoogle Scholar
  14. 14.
    Thue G, Sandberg S, Bullock DG. Comparison of the use of a dry chemistry analyser in primary care in Norway and the United Kingdom. Br J Gen Pract. 1993;43:10–4.PubMedGoogle Scholar
  15. 15.
    Warnick GR, Boerma GJ, Assmann G, et al. Multicenter evaluation of Reflotron direct dry-chemistry assay of high-density lipoprotein cholesterol in venous and fingerstick specimens. Clin Chem. 1993;39:271–7.PubMedGoogle Scholar
  16. 16.
    New Zealand Guidelines Group. The assessment and management of cardiovascular risk, 2003. Available at: http://www.nzgg.org.nz. Accessed June 2007.
  17. 17.
    British Cardiac Society. Joint British recommendations on prevention of coronary heart disease in clinical practice: summary. BMJ. 2000;320:705–8. doi: 10.1136/bmj.320.7236.705.CrossRefGoogle Scholar
  18. 18.
    Teh R, Chen T, Krass I. Consumer perspectives of pharmacist delivered health information and screening services. Int J Pharm Pract. 2001;9:261–7.Google Scholar
  19. 19.
    Humphreys JS, Rolley F, Weinand HC. Evaluating the importance of information sources for preventive health care in rural Australia. Aust J Public Health. 1993;17:149–57.PubMedGoogle Scholar
  20. 20.
    Australian Government. Diabetes Pilot Program Questions and Answers. http://www.health.gov.au/internet/wcms/publishing.nsf/content/ppsac-qa-dpp. Accessed June 2007.
  21. 21.
    Korten AE, Jacomb PA, Jiao Z, Christensen H, et al. Predictors of GP service use: a community survey of an elderly Australian sample. Aust N Z J Public Health. 1998;22:609–15. doi: 10.1111/j.1467-842X.1998.tb01447.x.CrossRefPubMedGoogle Scholar
  22. 22.
    Parslow R, Jorm A, Christensen H, et al. Gender differences in factors affecting use of health services: an analysis of a community study of middle-aged and older Australians. Soc Sci Med. 2004;59:2121–9. doi: 10.1016/j.socscimed.2004.03.018.CrossRefPubMedGoogle Scholar
  23. 23.
    Tsuyuki RT, Johnson JA, Teo KK, et al. A randomized trial of the effect of community pharmacist intervention on cholesterol risk management: the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP). Arch Intern Med. 2002;162:1149–55. doi: 10.1001/archinte.162.10.1149.CrossRefPubMedGoogle Scholar
  24. 24.
    Chabot I, Moisan J, Gregoire JP, Milot A. Pharmacist intervention program for control of hypertension. Ann Pharmacother. 2003;37:1186–93. doi: 10.1345/aph.1C267.CrossRefPubMedGoogle Scholar
  25. 25.
    Sinclair HK, Bond CM, Stead LF. Community pharmacy personnel interventions for smoking cessation. Cochrane Database Syst Rev. 2004;CD003698.Google Scholar
  26. 26.
    Lee JK, Grace KA, Taylor AJ. Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: a randomized controlled trial. JAMA. 2006;296:2563–71. doi: 10.1001/jama.296.21.joc60162.CrossRefPubMedGoogle Scholar
  27. 27.
    Krass I, Armour CL, Mitchell B, et al. The Pharmacy Diabetes Care Program: assessment of a community pharmacy diabetes service model in Australia. Diabet Med. 2007;24:677–83. doi: 10.1111/j.1464-5491.2007.02143.x.CrossRefPubMedGoogle Scholar
  28. 28.
    Mangum SA, Kraenow KR, Narducci WA. Identifying at-risk patients through community pharmacy-based hypertension and stroke prevention screening projects. J Am Pharm Assoc. 2003;43(1):50–5. doi: 10.1331/10865800360467042.CrossRefGoogle Scholar
  29. 29.
    Snella KA, Canales AE, Irons BK, et al. Pharmacy- and community-based screenings for diabetes and cardiovascular conditions in high-risk individuals. J Am Pharm Assoc. 2006 May–Jun;46(3):370–7. doi: 10.1331/154434506777069598.

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Gregory M. Peterson
    • 1
    Email author
  • Kimbra D. Fitzmaurice
    • 1
  • Helen Kruup
    • 1
  • Shane L. Jackson
    • 1
  • Rohan L. Rasiah
    • 2
  1. 1.Unit for Medication Outcomes Research and Education, School of PharmacyUniversity of TasmaniaHobartAustralia
  2. 2.Pharmacy Discipline, School of Biomedical SciencesThe University of NewcastleNewcastleAustralia

Personalised recommendations