Peter Rivers

The Effectiveness of Screening for Diabetes and Cardiovascular Disease Risk Factors in a Community Pharmacy Setting

Risk factors for cardiovascular disease including diabetes have seen a large rise in prevalence in recent years. This has prompted interest in prevention through the identifying individuals at risk of both diabetes and cardiovascular disease and has seen increased investment in screening interventions taking place in primary care. Community pharmacies have become increasingly involved in the provision of such interventions and this systematic review and meta-analysis aims to gather and analyse the existing literature assessing community pharmacy based screening for risk factors for diabetes and those with a high cardiovascular disease risk. Methods We conducted systematic searches of electronic databases using MeSH and free text terms from 1950 to March 2012. For our analysis two outcomes were assessed. They were the percentage of those screened who were referred for further assessment by primary care and the uptake of this referral. Results Sixteen studies fulfilled our inclusion criteria comprising 108,414 participants screened. There was significant heterogeneity for all included outcomes. Consequently we have not presented summary statistics and present forest plots with I2 and p values to describe heterogeneity. We found that all included studies suffered from high rates of attrition between pharmacy screening and follow up. We have also identified a strong trend towards higher rates for referral in more recent studies. Conclusions Our results show that pharmacies are feasible sites for screening for diabetes and those at risk of cardiovascular disease. A significant number of previously unknown cases of cardiovascular disease risk factors such as hypertension, hypercholesterolemia and diabetes are identified, however a significant number of referred participants at high risk do not attend their practitioner for follow up. Research priorities should include methods of increasing uptake to follow up testing and early intervention, to maximise the efficacy of screening interventions based in community pharmacies.

Rethinking Packaging: How Electronic Packs for Pharmaceuticals Work with Mobile IT to Improve Patient Adherence to Medication Regimens

Indictments of waste, and distaste for the packaging of consumer goods, are widespread in modern life. Yet in England, at least, households account for less than a third of overall waste, and household waste—like the industrial and commercial kinds—is actually in decline. In addition, the potentialities of packaging as a force for progress are too often ignored. Electronic packaging could improve the way users of prescription drugs take their medicines. With an ageing population taking more and more varied kinds of drugs, patient adherence to medication regimens is a growing social and economic issue. Linked to mobile IT, electronic packaging can, in principle, do much to ensure that medical patients wind up taking the right drugs at the right times. The paper reviews four examples of electronic packaging, and goes on to situate them in the context of mobile health (mHealth)—mobile telephony applications that prompt patients, each time they take medicine, to report their symptoms very simply and, if necessary, receive advice back from doctors. Together, reporting adherence and symptoms can enable prescribers to build up a rich picture of the effectiveness of each prescription issued. Doses or medication can be changed, or medication withdrawn, using real intelligence about patients. The dual approach outlined here can also reduce the problems that arise with the use of multiple medications by a patient. Innovation in the way in which prescription drugs are packaged could do a lot for society. This paper explores the potential of linking the electronic packaging of medicines to mobile IT, as well as the attitudinal and likely regulatory barriers that could impede progress in this domain.