Quality evaluation of community pharmacy blood pressure (BP) screening services: an English cross-sectional survey with geospatial analysis

Abstract

ObjectivesThe primary objective was to assess the accuracy (calibration and validation status) of digital blood pressure (BP) monitors used within community pharmacy in England and the secondary objectives were to assess the overall quality of the BP service by assessing service prevalence, service utilisation and other in-service considerations.DesignA cross-sectional survey.SettingPrimary-care retail-pharmacies.Participants500 pharmacies that contribute to government dispensing-data were invited by post to complete the survey. Private contractors were excluded.InterventionsWe conducted a questionnaire survey with a follow-up (September 2018 to December 2018).Results109 responses were received. 61% (n=66) of responding pharmacies provided a free BP check to their patients. 40 (61%) pharmacies used recommended validated clinical metres, 6 (9%) had failed validation and 20 (30%) provided too little information to enable us to determine their monitor’s status.ConclusionsResponding pharmacies were able to provide useful BP monitoring services to their patients, though quality enhancements need to be implemented. Majority of pharmacies use validated BP monitors, however, there was a lack of range of cuff sizes, variation in replacement and calibration of monitors and apparent absence of such practice in a minority of pharmacies alongside variation in training standards. We noted higher frequency of BP screening in the most deprived postcodes.We recommend in-service redesign and delivery improvements, and suggest professional bodies and researchers work together to create clearer frameworks for front-line practitioners, creating appropriate incentives to facilitate this service redesign.Funders and policy setters should consider the value added to the National Health Service and other healthcare agencies of such screening by pharmacy providers both nationally and internationally. It has the potential to reduce complications of undiagnosed hypertension and the medicines burden that it creates. Future work should examine the impact of pharmacist-led BP screening on patients.

Perceptions of pharmacists on the quality of automated blood pressure devices: a national survey

“…This finding may indicate knowledge deficits regarding the importance of cuff size to accurate BP measurement, but it is unknown whether the devices that were sold by the pharmacies also had limited cuff sizes available. Consistent with the present study, previous work has also found limited awareness or consideration of validation status of BP devices available or used in pharmacies in Turkey and the United Kingdom [22,24]. Pharmacist education could be facilitated via professional organisations and through accreditation pathways and there is evidence of successful educational interventions related to understanding reference values for BP [25].…”

“…First, increased awareness and education of pharmacists about BP devices, which has also been identified in other countries [22][23][24]. One survey of 109 pharmacies from the United Kingdom identified substantial variability in the training of pharmacists to carry out BP monitoring services [24]. That study also identified that only one cuff size was available for 46% of pharmacy BP monitoring services.…”

“…This survey has identified two important areas that require ongoing work. First, increased awareness and education of pharmacists about BP devices, which has also been identified in other countries [22][23][24]. One survey of 109 pharmacies from the United Kingdom identified substantial variability in the training of pharmacists to carry out BP monitoring services [24].…”

“…pharmacy BP monitoring services were provided by the head office of the business [24]. Fifty percent of respondents also selected "Quality" as a reason for devices to be stocked, and this finding is potentially driven by other factors such as brand recognition and marketing of certain devices by manufacturers.…”

Development and implementation of blood pressure screening and referral guidelines for German community pharmacists

“…In a commentary to the 2017 American College of Cardiology/American Heart Association hypertension guideline, Dixon et al highlighted the opportunity for community pharmacies to “serve as a central hub in local communities for BP screening and overall cardiovascular health awareness.” We agree that face‐to‐face consultations with a community pharmacist should replace BP kiosks for screening and monitoring purposes 9 . Some studies show, however, that quality enhancements in community pharmacies need to be implemented 27 . Nevertheless, broad implementation of screening and monitoring protocols at every pharmacy could significantly abate the harm of undiagnosed and uncontrolled hypertension 9 …”