Atrial fibrillation screening in pharmacies using an iPhone ECG: a qualitative review of implementation
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Background Atrial fibrillation guidelines advocate screening to identify undiagnosed atrial fibrillation. Community pharmacies may provide an opportunistic venue for such screening. Objective To explore the experience of implementing an atrial fibrillation screening service from the pharmacist’s perspective including: the process of study implementation; the perceived benefits; the barriers and enablers; and the challenges for future sustainability of atrial fibrillation screening within pharmacies. Setting Interviews were conducted face-to-face in the pharmacy or via telephone, according to pharmacist preference. Method The ‘SEARCH-AF study’ screened 1000 pharmacy customers aged ≥65 years using an iPhone electrocardiogram, identifying 1.5 % with undiagnosed atrial fibrillation. Nine pharmacists took part in semi-structured interviews. Interviews were transcribed in full and thematically analysed. Main outcome measure Qualitative analysis of the experience of implementing an AF screening service from the pharmacist’s perspective. Results Four broad themes relating to service provision were identified: (1) interest and engagement in atrial fibrillation screening by pharmacists, customers, and doctors with the novel, easy-to-use electrocardiogram technology serving as an incentive to undergo screening and an education tool for pharmacists to use with customers; (2) perceived benefits to the pharmacist including increased job satisfaction, improvement in customer relations and pharmacy profile by fostering enhanced customer care and the educational role of pharmacists; (3) implementation barriers including managing workflow, and enablers such as personal approaches for recruitment, and allocating time to discuss screening process and fears; and, (4) potential for sustainable future implementation including remuneration linked to government or pharmacy incentives, combined cardiovascular screening, and automating sections of risk-assessments using touch-screen technology. Conclusion Atrial fibrillation screening in pharmacies is well accepted by pharmacists and customers. Many pharmacists combined atrial fibrillation screening with other health screens reporting improved time-efficiency and greater customer satisfaction. Widespread implementation of atrial fibrillation screening requires longterm funding, which could be provided for a combined cardiovascular screening service. Further research could focus on feasibility and cost-effectiveness of combined cardiovascular screening in pharmacies.
KeywordsAtrial fibrillation Australia Barriers Enablers Implementation Pharmacist Screening
We thank the staff of the participating community pharmacies for their invaluable time conducting the screening and participating in the interviews.
This work was supported by a small investigator-initiated project award from Boehringer Ingelheim.
Conflicts of interest
The SEARCH-AF screening study was supported by an investigator-initiated grant from Bristol-Myers Squibb/Pfizer, and the associated cost-effectiveness analysis was supported by an investigator-initiated grant from Bayer. The funding sources had no role in study design; collection, analysis, or interpretation of data; writing of the report; or the decision to submit the article for publication. AliveCor provided ECG Heart Monitors for study purposes: the investigators are not affiliated with, nor have any financial or other interest in AliveCor. SBF reports grants, personal fees and non-financial support from Bayer Pharma AG outside the submitted work, grants and non-financial support from Boehringer Ingelheim outside the submitted work, grants and personal fees from BMS/Pfizer outside the submitted work; All other authors have nothing to disclose.
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