Reem Kayyali & Aliki Peletidi
Kingston University London, UK
Title: Contribution of pharmacists in cardiovascular disease prevention journey
Biography
Biography: Reem Kayyali & Aliki Peletidi
Abstract
Statement of the Problem: Cardiovascular disease (CVD) is the primary cause of death worldwide causing 29.6% in 2010. In the UK, CVD was the second cause of mortality, responsible for 27% deaths in 2014 and 48% of all deaths in Greece in 2012. CVD is a result of risk factors such as hypertension, dyslipidemia, overweight/obesity, stress, smoking, physical inactivity and diabetes. CVD prevention consists of two stages: Primary and secondary. Pharmacists, one of the most accessible healthcare professionals, do not have a clear role in the existing pathways. In our view, there are three prevention stages: Primary, secondary and tertiary. The primary prevention constitutes enhancing awareness and initial screening of the public for CVD risk factors (obesity, lack of exercise, alcohol misuse and tobacco use) in order to estimate their CVD risk. Pharmacists could offer services such as weight management, alcohol brief intervention, smoking cessation and health checks. Secondary prevention is the management of post-diagnosis risk conditions (diabetes, hypertension and dyslipidemia) in order to prevent the incidence of a CVD disease. At this stage, pharmacists could provide services with a view to optimize medicines to improve medication adherence and to offer lifestyle advice. Tertiary prevention is the linkage between prevention and treatment for those who already suffered a CVD episode with a view to decreasing the risk of a secondary episode or mortality.
Methodology & Theoretical Orientation: A qualitative study utilizing semi-structured interviews with UK and Greek pharmacists was undertaken to explore their current and future roles in CVD prevention. The conceptual framework used was based on the results of the literature search conducted on the pharmacist's role in CVD risk factors and conditions. The interview schedule, which included 28 questions in three sections, was designed based on the proposed CVD prevention pathway. Purposive sampling was used, obtaining 40 participants in total for both countries.
Results: The analysis identified the following themes; role recognition and priority services. Both UK and Greek pharmacists played a role in secondary prevention, after risk conditions have been diagnosed. They are eager to monitor patients’ blood pressure or blood glucose when necessary, and provide lifestyle advice when they dispense the prescribed medications to them. Furthermore, in Greece it was identified that pharmacists had an appetite to initiate CVD prevention services. Pharmacists were willing to start a weight management programme to help their clients to reduce their CVD risk. Therefore, a weight management service was designed and is currently being evaluated.
Conclusion & Significance: This study identified UK and Greek pharmacists’ perspectives on their role in CVD prevention. Pharmacists’ role is mainly focused in secondary and less in primary and tertiary CVD prevention. However, in Greece, pharmacists recognized a potential role in primary prevention and early screening of CVD. There is a need of more work targeted in tertiary prevention to reduce complications and the chance of a secondary or a third CVD episode as well as premature mortality.
References :
1. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380:2095–2128.
2. Townsend N, Bhatnagar P, Wilkins E, Wickramasinghe K, Rayner M. Cardiovascular disease statistics 2015, British Heart Foundation: London.
3. World Health Organization. Greece: Noncommunicable Diseases (NCD) Country Profiles. Available from: http://www.who.int/nmh/countries/grc_en.pdf [Accessed: 16th October 2016].
4. Peletidi A, Nabhani-Gebara S, Kayyali R. Smoking Cessation Support Services at Community Pharmacies in the UK: A Systematic Review. Hellenic Journal of Cardiology 2016; 57: 7-15.
5. Yusuf S, Hawken S, Ounpuu T, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case control study. The Lancet. 2004; 364: 937–52.
6.Hobbs F. Cardiovascular Disease: Different Strategies for Primary and Secondary Prevention?. Heart 2004; 90:1217–1223.