International Journal of Clinical Pharmacy

, Volume 35, Issue 6, pp 1218–1228 | Cite as

Australian community pharmacists’ awareness and practice in supporting secondary prevention of cardiovascular disease

  • Hanni Prihhastuti PuspitasariEmail author
  • Parisa Aslani
  • Ines Krass
Research Article


Background: Pharmacists are well placed to identify, prevent and resolve medicine related problems as well as monitor the effectiveness of treatments in cardiovascular disease (CVD). Pharmacists’ interventions in CVD secondary prevention have been shown to improve outcomes for clients with established CVD. Objective: To explore the scope of pharmacists’ activities in supporting CVD secondary prevention. Setting: Community pharmacies in New South Wales, Australia. Methods: Twenty-one in-depth, semi-structured interviews with a range of community pharmacists were conducted. All interviews were audio-recorded and transcribed ad verbatim. Data were analyzed using a ‘grounded-theory’ approach by applying methods of constant comparison. Main outcome measure: Community pharmacists’ awareness and current practice in supporting secondary prevention of CVD. Results: Four key themes identified included ‘awareness’, ‘patient counselling’, ‘patient monitoring’, and ‘perceptions of the role of pharmacists in CVD secondary prevention’. The pharmacists demonstrated a moderate understanding of CVD secondary prevention. There was considerable variability in the scope of practice among the participants, ranging from counselling only about medicines to providing continuity of care. A minority of pharmacists who had negative beliefs about their roles in CVD secondary prevention offered limited support to their clients. The majority of pharmacists, however, believed that they have an important role to play in supporting clients with established CVD. Conclusion: Community pharmacists in Australia make a contribution to the care of clients with established CVD despite the gap in their knowledge and understanding of CVD secondary prevention. The scope of practice in CVD secondary prevention ranged from only counselling about medicines to offering continuity of care. The extent of pharmacists’ involvement in offering disease management appears to be influenced by their beliefs regarding what is required within their scope of practice.


Australia Awareness Cardiovascular disease Community pharmacist Medication management Secondary prevention 



The researchers wish to thank the NSW community pharmacists for participating in the study.



Conflicts of interest

There are no conflicts of interest to report.


  1. 1.
    Australian Institute of Health and Welfare. Cardiovascular disease: Australian facts 2011. Cardiovascular disease series. Cat. no. CVD 53. Canberra: AIHW; 2011. ISBN 978-1-74249-130-1.Google Scholar
  2. 2.
    National Heart Foundation. Data and statistics (cited 2013 Mar 21). Available from:
  3. 3.
    National Health Priority Action Council. National chronic disease strategy. Canberra: Australian Government Department of Health and Ageing; 2006. ISBN 0-642-82869-5.Google Scholar
  4. 4.
    World Health Organization. Prevention of cardiovascular disease: pocket guidelines for assessment and management of cardiovascular risk. Geneva: WHO Press; 2007. ISBN 978-92-4-154726-µ0.Google Scholar
  5. 5.
    Ponniah A, Anderson B, Shakib S, Doecke CJ, Angley M. Pharmacists’ role in the post-discharge management of patients with heart failure: a literature review. J Clin Pharm Ther. 2007;32(4):343–52.PubMedCrossRefGoogle Scholar
  6. 6.
    Machado M, Bajcar J, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part I: systematic review and meta-analysis in diabetes management. Ann Pharmacother. 2007;41(10):1569–82.PubMedCrossRefGoogle Scholar
  7. 7.
    Machado M, Bajcar J, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part II: systematic review and meta-analysis in hypertension management. Ann Pharmacother. 2007;41(11):1770–81.PubMedCrossRefGoogle Scholar
  8. 8.
    Machado M, Nassor N, Bajcar J, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part III: systematic review and meta-analysis in hyperlipidemia management. Ann Pharmacother. 2008;42(9):1195–207.PubMedCrossRefGoogle Scholar
  9. 9.
    McConnell KJ, Denham AM, Olson KL. Pharmacist-led interventions for the management of cardiovascular disease: opportunities and obstacles. Dis Manag Health Outcomes. 2008;16(3):131–44.CrossRefGoogle Scholar
  10. 10.
    Evans CD, Watson E, Eurich DT, Taylor JG, Yakiwchuk EM, Shevchuk YM, et al. Diabetes and cardiovascular disease interventions by community pharmacists: a systematic review. Ann Pharmacother. 2011;45(5):615–28.PubMedCrossRefGoogle Scholar
  11. 11.
    Amariles P, Sabater-Hernandez D, Garcia-Jlmenez E, Rodriguez-Chamorro MA, Prats-Mas R, Marin-Magan F, et al. Effectiveness of dader method for pharmaceutical care on control of blood pressure and total cholesterol in outpatients with cardiovascular disease or cardiovascular risk: EMDADER-CV randomized controlled trial. J Manag Care Pharm. 2012;18(4):311–23.PubMedGoogle Scholar
  12. 12.
    George J, McNamara K, Stewart K. The roles of community pharmacists in cardiovascular disease prevention and management. Australas Med J. 2011;4(5):266–72.PubMedCrossRefGoogle Scholar
  13. 13.
    Pharmaceutical Society of Australia. Guidelines for pharmacists providing Home Medicines Review (HMR) services. Canberra: PSA; 2011 (cited 2013 Aug 18). Available from:
  14. 14.
    Sweeny K. The pharmaceutical industry in Australia: working paper no. 34. Pharmaceutical industry project working paper series. Melbourne: Centre for Strategic Economic Studies Victoria University of Technology; 2007 [cited 2013 Feb 1]. Available from:
  15. 15.
    Creswell JW. Qualitative inquiry and research design: choosing among five approaches. 3rd ed. Thousand Oaks: Sage Publications; 2013. ISBN 978-1-4129-9530-6.Google Scholar
  16. 16.
    Birk M, Mills J. Grounded theory: a practical guide. London: Sage Publications; 2010. ISBN 9781848609938.Google Scholar
  17. 17.
    Pharmaceutical Society of Australia. Guidelines for pharmacists providing medicines use review (MedsCheck) and diabetes medication management (Diabetes MedsCheck) services. Canberra: PSA; 2012 (cited 2013 Aug 18). Available from:
  18. 18.
    National Health and Medical Research Council. Strengthening cardiac rehabilitation and secondary prevention for Aboriginal and Torres Strait Islander people: a guide for health professionals. Canberra: Australian Government NHMRC; 2005. ISBN 1864962720.Google Scholar
  19. 19.
    National Stroke Foundation. Clinical guidelines for stroke management 2010. Melbourne: National Stroke Foundation of Australia; 2010. ISSBN0-978-0-9805933-3-4.Google Scholar
  20. 20.
    National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. Reducing risk in heart disease: an expert guide to clinical practice for secondary prevention of coronary heart disease. Melbourne: National Heart Foundation of Australia; 2012. ISBN 978-1-74345-016-1.Google Scholar
  21. 21.
    Fei G, Jiang X, Gui-lian W, Jia-hong W, Jin-song W, Jin-ming Y, et al. Community-wide survey of physicians’ knowledge of cholesterol management. Chin Med J. 2010;123(7):884–9.Google Scholar
  22. 22.
    Adams OP, Carter AO. Diabetes and hypertension guidelines and the primary health care practitioner in Barbados: knowledge, attitudes, practices and barriers—a focus group study. BMC Fam Pract. 2010;11(96):1.Google Scholar
  23. 23.
    Sacco RL, Adams R, Albers GW, Alberts MJ, Benavente O, Furie K, et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention. Stroke. 2006;37(2):577–617.PubMedCrossRefGoogle Scholar
  24. 24.
    Smith SC, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011;124:00–00 (cited 2011 Nov 30). Available from: Scholar
  25. 25.
    El Hajj MS, Al Nakeeb RR, Al-Qudah RA. Smoking cessation counseling in Qatar: community pharmacists’ attitudes, role perceptions and practices. Int J Clin Pharm. 2012;34(4):667–76.PubMedCrossRefGoogle Scholar
  26. 26.
    McCaig D, Fitzgerald N, Stewart D. Provision of advice on alcohol use in community pharmacy: a cross-sectional survey of pharmacists’ practice, knowledge, views and confidence. Int J Pharm Pract. 2011;19(3):171–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Grimes T, Duggan C, Gallagher P, Strawbridge J. Care of the stroke patient—communication between the community pharmacist and prescribers in the Republic of Ireland. Pharm World Sci. 2009;31(6):648–55.PubMedCrossRefGoogle Scholar
  28. 28.
    Puspitasari HP, Aslani P, Krass I. A review of counseling practices on prescription medicines in community pharmacies. Res Soc Adm Pharm. 2009;5(3):197–210.CrossRefGoogle Scholar
  29. 29.
    Guirguis LM. Mixed methods evaluation: pharmacists’ experiences and beliefs toward an interactive communication approach to patient interactions. Patient Educ Couns. 2011;83(3):432–42.PubMedCrossRefGoogle Scholar
  30. 30.
    Lenz TL, Stading JA. Lifestyle modification counseling of patients with dyslipidemias by pharmacists and other health professionals. J Am Pharm Assoc. 2005;45(6):709–13.Google Scholar
  31. 31.
    Hunt LM, Kreiner M, Brody H. The changing face of chronic illness management in primary care: a qualitative study of underlying influences and unintended outcomes. Ann Fam Med. 2012;10(5):452–60.PubMedCrossRefGoogle Scholar
  32. 32.
    Australian Government Department of Health and Ageing and the Pharmacy Guild of Australia. Pharmacy practice incentives: program specific guidelines. 2012. p. 10 (cited 2013 Mar 25). Available from:
  33. 33.
    Oladapo AO, Rascati KL. Review of survey articles regarding medication therapy management (MTM) services/programs in the United States. J Pharm Pract. 2012;25(4):457–70.PubMedCrossRefGoogle Scholar
  34. 34.
    Mak VS, Clark A, Poulsen JH, Udengaard KU, Gilbert AL. Pharmacists’ awareness of Australia’s health care reforms and their beliefs and attitudes about their current and future roles. Int J Pharm Pract. 2012;20(1):33–40.PubMedCrossRefGoogle Scholar
  35. 35.
    Rosenthal MM, Breault RR, Austin Z, Tsuyuki RT. Pharmacists’ self-perception of their professional role: insights into community pharmacy culture. J Am Pharm Assoc. 2011;51(3):363–7.Google Scholar
  36. 36.
    Al Hamarneh YN, Rosenthal M, McElnay JC, Tsuyuki RT. Pharmacists’ perceptions of their practice: a comparison between Alberta and Northern Ireland. Int J Pharm Pract. 2012;20:57–64.PubMedCrossRefGoogle Scholar
  37. 37.
    AbuRuz S, Al-Ghazawi M, Snyder A. Pharmaceutical care in a community-based practice setting in Jordan: where are we now with our attitudes and perceived barriers? Int J Pharm Pract. 2012;20(2):71–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Ibrahim A, Scott J. Community pharmacists in Khartoum State, Sudan: their current roles and perspectives on pharmaceutical care implementation. Int J Clin Pharm. 2012;35(2):236–43.PubMedCrossRefGoogle Scholar
  39. 39.
    Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533–43.PubMedGoogle Scholar
  40. 40.
    Pellegrino AN, Martin MT, Tilton JJ, Touchette DR. Medication therapy management services: definitions and outcomes. Drugs. 2009;69(4):393–406.PubMedCrossRefGoogle Scholar
  41. 41.
    National Health Service Employers and the Pharmaceutical Services Negotiating Committee. Guidance on the medicines use review service. London: NHS Employers and PSNC; 2012 (cited 2013 Mar 22). Available from:
  42. 42.
    Cipolle RJ, Strand LM, Morley PC, eds. Pharmaceutical care practice: the patient-centered approach to medication management services. New York: McGraw-Hill; 2012. ISBN 978-0-07-175638-9.Google Scholar
  43. 43.
    Gadkari AS, Mott DA, Kreling DH, Bonnarens JK. Pharmacy characteristics associated with the provision of drug therapy services in nonmetropolitan community pharmacies. J Rural Health. 2009;25(3):290–5.PubMedCrossRefGoogle Scholar
  44. 44.
    Haag JD, Stratton TP. Patient care services in rural Minnesota community pharmacies. J Am Pharm Assoc. 2010;50(4):508–16.Google Scholar
  45. 45.
    Xu KT, Borders TF. Characteristics of rural elderly people who bypass local pharmacies. J Rural Health. 2003;19(2):156–64.PubMedCrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013

Authors and Affiliations

  • Hanni Prihhastuti Puspitasari
    • 1
    • 2
    Email author
  • Parisa Aslani
    • 1
  • Ines Krass
    • 1
  1. 1.Faculty of PharmacyUniversity of SydneySydneyAustralia
  2. 2.Fakultas FarmasiUniversitas AirlanggaSurabayaIndonesia

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