Evaluation of patient-centred services by community pharmacists in New Zealand: Focus on cardiovascular disease risk assessment

Abstract

Background: Cardiovascular disease (CVD) remains the leading cause of death and hospitalisation in New Zealand (NZ). Pharmacists are ideally positioned to have an influence on cardiovascular risk reduction. However, it is still unknown whether community pharmacists in NZ are well equipped to be involved in CVD preventive strategies that are effective and sustainable under the current healthcare environment. Aim: The overall aim of this thesis was to investigate the role of pharmacists in providing CVD risk assessment and management services in NZ community pharmacies; and to evaluate the readiness of the NZ primary healthcare environment for integrating community pharmacists into this role. Methods: A mixture of qualitative and quantitative research methods were used; including a postal questionnaire to examine the extent and role of community pharmacists in health screening and medication monitoring services; a systematic review of the literature, a set of qualitative studies to explore the views of general practitioners, community pharmacy consumers and community pharmacists in regard to the role of pharmacists in CVD risk prevention strategies; and a questionnaire to explore undergraduate pharmacy students’ perceived education, competency and future roles in CVD risk assessment and management. Results: The results of the national postal survey suggested that community pharmacists in NZ are currently involved in CVD prevention strategies, although most are related to screening patients for the presence of risk factors with minimal involvement in CVD absolute risk assessment or management. The research into the views of key stakeholders, in an effort to understand this poor uptake of pharmacists in CVD prevention strategies, revealed that time, remuneration and perceived lack of adequate training on the part of pharmacists were significant barriers. Despite these barriers, the three key stakeholders indicated that further involvement of community pharmacists in CVD risk reduction strategies would result in increased and wider access to cardiovascular primary health care services. The assessment of the current undergraduate pharmacy curriculum in NZ and the survey of pharmacy undergraduate students identified several weaknesses in preparing future pharmacists for delivering patient-centred care. Conclusions: Most community pharmacies in NZ continue to offer predominantly product-oriented services, following a business model, and have been generally unable to run an integrated or a parallel self-sustainable patient-centred service. CVD assessment and management by pharmacists is an example of a service which could deliver substantial population health benefits, but this will require clear leadership and commitment by the profession.