The RxEACH study was the first large randomized trial of CVD risk reduction by community pharmacists, demonstrating a significant reduction in risk for CVD events. Engagement of community pharmacists with an expanded scope of practice could have significant public health implications. (The Alberta Vascular Risk Reduction Community Pharmacy Project: RxEACH [RxEACH]; NCT01979471).

Primary health care is defined as a patient's first point of contact with the health care system. As such, pharmacists are an integral part of primary health care. Indeed, for many years, we have said that pharmacists see their patients more frequently than they see any other health care practitioner, including physicians. Let's review the evidence for that. To address this topic, we searched PubMed/MEDLINE, Scopus, EMBASE, Cochrane Library, Web of Science and CINAHL Plus from their inception to October 2017. The searches combined relevant keywords and subject headings relating to the concept of pharmacist visit frequency. The search terms used included pharmacist, pharmacy, visit, visit frequency, follow up frequency, physician, doctor and general practitioner. An additional search was conducted in Google for the phrase "pharmacists see patients more than physicians. " The results of these searches are shown in Table 1. Using Saskatchewan population data, Shiu et al. 2 demonstrated that pharmacists see patients with diabetes at least twice as frequently as general practitioners and 36% more than any physician. 2 These results did not change when stratified by the size of the urban centres. 2 McNamara et al. 1 reported that patients in rural Australia visit their general practitioners more frequently than they visit their pharmacists. However, when broken down by age groups, this finding appears to be driven by patients who are younger than 65 years of age (25-64 years, with over half of those being under 55 years). It is very plausible that younger patients might not have as many chronic conditions as older patients, and so they might visit their general practitioner more frequently (presumably for acute conditions). When looking at patients aged 65 years and older (65-84 years; 40% of patients), the visits to community pharmacists were more frequent. Jose et al. 3 did not include a comparator group but interestingly reported visit frequency numbers similar to those reported by Shiu et al. 2 and the older * No data or citation provided.

The present study reports that the general public in Jordan has limited knowledge and awareness of CVD. In planning to positively impact CVD prevention and management, community pharmacists must develop and promote effective and accessible services.

ObjectiveTo determine the effect of a community pharmacist prescribing intervention on glycaemic control in patients with poorly controlled type 2 diabetes.DesignPragmatic, before–after design.Setting12 community pharmacies in Alberta, Canada.ParticipantsType 2 diabetes receiving oral hypoglycaemic medications and with glycated haemoglobin (HbA1c) of 7.5–11%.InterventionPharmacists systematically identified potential candidates by inviting patients with type 2 diabetes to test their HbA1c using validated point-of-care technology. Pharmacists prescribed 10 units of insulin glargine at bedtime, adjusted by increments of 1 unit daily to achieve a morning fasting glucose of ≤5.5 mmol/L. The patients were followed up at 2, 4, 8, 14, 20 and 26 weeks.Primary outcomeChange in HbA1c from baseline to week 26.Secondary outcomesProportion of patients achieving target HbA1c, changes in oral hypoglycaemic agents, quality of life and patient satisfaction, persistence on insulin glargine, number of insulin dosage adjustments per patient and number of hypoglycaemic episodes.ResultsWe screened 365 patients of whom 111 were eligible. Of those, 100 (90%) were enrolled in the study; all 11 patients who did not consent refused to use insulin. Average age was 64 years (SD 10.4), while average diabetes duration was 10.2 years (SD 7). HbA1c was reduced from 9.1% (SD 1) at baseline to 7.3% (SD 0.9); a change of 1.8% (95% CI 1.4 to 2, p<0.001). Fasting plasma glucose was reduced from 11 (SD 3.3) to 6.9 mmol/L (SD 1.8); a change of 4.1 mmol/L (95% CI of 3.3 to 5, p=0.007). Fifty-one per cent of the patients achieved the target HbA1c of ≤7% at the end of the study.ConclusionsThis is the first completed study of independent prescribing by pharmacists. Our results showed similar improvements in glycaemic control as previous physician-led studies. RxING provides further evidence for the benefit of pharmacist care in diabetes.Trial registrationclinicaltrials.gov; Identifier: NCT01335763.

The deficit in CHD knowledge could translate into inadequate preventative behaviour patterns and suboptimal clinical outcomes. If community pharmacists wish to become increasingly involved in public health delivery relating to CHD they need to develop effective and accessible services and promote these to the public who at present do not recognise this role of the community pharmacist.