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

Alzubaidi, Hamzah; Chandir, Subhash; Hasan, Sanah; McNamara, Kevin; Cox, Rachele; Krass, Ines

doi:10.1136/bmjopen-2019-031246

Cited by 18 publications

(27 citation statements)

References 31 publications

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“…Alternatively, the 2013 PCE risk prediction model has been recommended for screening CVD risk in our population, 7 yet the 7.5% cardiovascular risk threshold to determine the need for lipid-lowering treatment in our study cohort appears to be too low, particularly in men. Therefore, this current American College of Cardiology/American Heart Association recommended cut-off threshold could potentially result in inappropriate lipid-lowering therapy in our population.…”

Section: Discussionmentioning

confidence: 84%

“…Open access clinical practice guidelines for risk assessment of developing CVD [6][7][8] : the 2008 Framingham risk model, 9 the 2008 office-based Framingham risk model, 9 and the 2013 American College of Cardiology/American Heart Association Pooled Cohort Risk Equation (PCE). 10 However, the Framingham models are based on individuals aged 30-74 years of predominantly European descent, whereas the PCE model was obtained from several US populationbased cohort studies that included Caucasian and African American individuals aged 40-79 years.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

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External validation and clinical usefulness of three commonly used cardiovascular risk prediction scores in an Emirati population: a retrospective longitudinal cohort study

2020

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ObjectivesCardiovascular disease (CVD) risk prediction models are useful tools for identifying those at high risk of cardiovascular events in a population. No studies have evaluated the performance of such risk models in an Arab population. Therefore, in this study, the accuracy and clinical usefulness of two commonly used Framingham-based risk models and the 2013 Pooled Cohort Risk Equation (PCE) were assessed in a United Arab Emirates (UAE) national population.DesignA 10-year retrospective cohort study.SettingOutpatient clinics at a tertiary care hospital, Al-Ain, UAE.ParticipantsThe study cohort included 1041 UAE nationals aged 30–79 who had no history of CVD at baseline. Patients were followed until 31 December 2019. Eligible patients were grouped into the PCE and the Framingham validation cohorts.ExposureThe 10-year predicted risk for CVD for each patient was calculated using the 2008 Framingham risk model, the 2008 office-based Framingham risk model, and the 2013 PCE model.Primary outcome measureThe discrimination, calibration and clinical usefulness of the three models for predicting 10-year cardiovascular risk were assessed.ResultsIn women, the 2013 PCE model showed marginally better discrimination (C-statistic: 0.77) than the 2008 Framingham models (C-statistic: 0.74–0.75), whereas all three models showed moderate discrimination in men (C-statistic: 0.69‒0.70). All three models overestimated CVD risk in both men and women, with higher levels of predicted risk. The 2008 Framingham risk model (high-risk threshold of 20%) classified only 46% of women who subsequently developed incident CVD within 10 years as high risk. The 2013 PCE risk model (high-risk threshold of 7.5%) classified 74% of men who did not develop a cardiovascular event as high risk.ConclusionsNone of the three models is accurate for predicting cardiovascular risk in UAE nationals. The performance of the models could potentially be improved by recalibration.

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Section: Discussionmentioning

confidence: 84%

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

External validation and clinical usefulness of three commonly used cardiovascular risk prediction scores in an Emirati population: a retrospective longitudinal cohort study

2020

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“…17 The process of local adaptation, implementation, and description of screening model have been published previously. 18…”

Section: Methodsmentioning

confidence: 99%

Outcomes of a novel pharmacy screening intervention to address the burden of type 2 diabetes and cardiovascular disease in an Arabic‐speaking country

et al. 2021

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Aims: Aim of this study is to evaluate the capacity of a pharmacist-delivered screening model for type 2 diabetes and cardiovascular disease (CVD) in identifying and referring individuals at risk. Method: A screening programme was implemented in 12 community pharmacies in three cities in the United Arab Emirates. Trained pharmacists screened adults (≥40 years) without a previous diagnosis of diabetes or CVD. Most participants were recruited during their visits to the pharmacies; pharmacy-based advertising and social media were also used. The screening included medical history, anthropometric measurements, point-of-care glycated haemoglobin (HbA 1c ) levels, and a lipid panel.High-risk individuals (HbA 1c ≥ 5.7% [39 mmol/mol], a high diabetes risk score, or a 10-year CVD risk ≥7.5%) were given a referral letter and advised to visit their physician. Risk factors for elevated HbA 1c were identified by logistic regression. Results: Of the 568 screened participants, 332/568 (58%) were identified to be at risk: HbA 1c levels were consistent with diabetes 67/560 (12%) or prediabetes 148/560 (26%), high diabetes risk score 243/566 (43%), CVD risk score > 7.5% 79/541 (15%).Obese people were more likely to have prediabetes or diabetes OR (95% CI): 3.2 (1.3, 7.5), as were those who spent more than 11 h/day sitting: 5.7 (1.8, 17.6). Of the 332 at-risk participants, 206 (62%) responded to a telephone follow-up at six weeks; onethird had discussed screening results with their physician. Conclusions: Community pharmacists detected and referred individuals at risk for diabetes or CVD, although participant follow-up with their physician could be improved. Pharmacy screening is feasible and will potentially improve outcomes.

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“…In order to effect this strategy, interprofessional practice where clear roles/goals, professional identity issues, shared responsibility, interdependence and team tasks are addressed, is important because of the impact on the process of collaboration and patient health outcomes [12]. For example, process evaluation of a feasibility trial of UAE pharmacist-led screening services for diabetes and cardiovascular disease (CVD) risks based in pharmacy, highlighted the need for better integration with primary care physicians to ensure continuity of care following referral of individuals at high risk of CVD or diabetes [13]. Clearly physician support and acceptance of pharmacy provided services is an essential steppingstone to developing such pharmacy service models.…”

Section: Introductionmentioning

confidence: 99%

Physicians Views on Cardiovascular Disease Risk Prevention Services by Pharmacists and Potential for Collaboration

Almansour

Aloudah

Alhawassi

et al. 2020

Preprint

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Background: Cardiovascular diseases (CVD) are the leading cause of mortality worldwide. Early identification and management of modifiable CVD risk factors is highly effective in preventing disease onset and/or improving outcomes in CVD. Pharmacists as highly accessible primary health professionals can assume a role in screening and risk factor management in collaboration with physicians, however such prevention services are not established practice in Saudi pharmacies. Therefore, the aim was to explore physicians’ perceptions about the utility of a role in CVD risk screening and management for Saudi pharmacists. Methods: Qualitative semi-structured interviews were conducted, audio-recorded and transcribed verbatim in Arabic or English. All transcripts were thematically analysed after translation into English if required. Results: A total of 26 physicians recruited from public hospitals and primary healthcare centres were interviewed. Most were unaware of pharmacists’ potential to undertake a role in CVD risk prevention. Although there was broad support for the concept, they recommended physician-pharmacist collaborative models, extensive provider pharmacist training and strict oversight by the Saudi Ministry of Health/other official authorities to ensure service quality and sustainability, should implementation occur. Healthcare system reform was considered key to expanding private sector (i.e. community pharmacy) involvement in healthcare as was incentivising providers and ‘marketing’ for patient acceptance. Conclusion: Physicians were positive about setting up a collaborative community pharmacist-physician CVD risk screening and management service model with the help of an authorised body within the Saudi Arabian healthcare system.

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

Cited by 18 publications

References 31 publications

External validation and clinical usefulness of three commonly used cardiovascular risk prediction scores in an Emirati population: a retrospective longitudinal cohort study

External validation and clinical usefulness of three commonly used cardiovascular risk prediction scores in an Emirati population: a retrospective longitudinal cohort study

Outcomes of a novel pharmacy screening intervention to address the burden of type 2 diabetes and cardiovascular disease in an Arabic‐speaking country

Physicians Views on Cardiovascular Disease Risk Prevention Services by Pharmacists and Potential for Collaboration

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