Profit over patients? Looking deeper into pharmacy CV checks


An article published by a doctor’s publication doesn’t tell the full story, says researcher

A recent article in the Australian Doctor website called “Profit over patients? Concerns about pharmacy CV checks” looked into a study on CVD risk assessment in Australian community pharmacies published in the journal Heart, Lung and Circulation.

The article claims that “pharmacists are offering isolated cardiovascular assessments that seem geared more toward attracting business than identifying patients’ absolute disease risk”.

“The survey of 300 pharmacies finds almost all offer blood pressure testing as a form of cardiovascular risk assessment, but just a quarter offer multi-risk factor assessments,” it continues.

“Even among these assessments, many are too limited to assess absolute CVD risk, and only 18 pharmacies could name the algorithm they use to calculate overall risk.

“This is despite the push in primary care towards conducting absolute risk assessments as opposed to treating isolated risk factors…

“[The authors] said that one reason for pharmacies to offer simple, cheap tests such as BP might be to attract customers, rather than because of their clinical value.”

The lead author of the study, pharmacist and Senior Research Fellow Dr Kevin McNamara from Deakin University, says he would have liked to see a more balanced view of the paper’s findings.

“I think that the interpretation of some findings and statements could be more accurate, or could have provided more context, for a more balanced view,” he tells the AJP.

“For example, the article says: ‘Only one-fifth of pharmacies said that they spoke with GPs about the CVD tests they performed on their patients.’ In fact we said that ‘19% had formal arrangements in place with their GP to coordinate care for one or more professional services’. The fact that they do not have formal arrangements, while it would be great if they did, does not mean that they do not speak about results otherwise.

“[The article also says] ‘Even among these assessments, many are too limited to assess absolute CVD risk, and only 18 pharmacies could name the algorithm they use to calculate overall risk.’ The was an open question directed only to the 49 participants who offered multiple risk factor assessments. It is very common for participants to skip open questions on long surveys like this – we can really only say that the others did not indicate the guideline, not that they could not.”

Dr McNamara says it is “unfortunate” the article did not report on the research team’s detailed examination of perceived barriers to establishing comprehensive screening services.

“When one considers the broader health system and policy environment factors affecting service delivery, one could argue that the absence of comprehensive screening models across the profession is not just understandable, rather it is entirely predictable and requires system change,” he argues.

“Conversely, it is a credit to those pharmacists who reported high levels of service quality and patient education that they could achieve this despite the current system.

“My experience is that such risk assessments fit comfortably within the competencies of community pharmacists following a small amount of training and CPD. While most pharmacists have had undergraduate training to conduct individual risk assessments, guidelines have changed over the past decade, as has our understanding of health behaviour change, and there have been advances with point of care testing equipment – hence there may be a need to update knowledge and skills for some pharmacists, particularly where screening has not been a regular part of their work.”

In regards to Australian Doctor‘s claim that pharmacists may be putting “profit over patients” when it comes to CVD checks, Dr McNamara says the research team did not find evidence to this effect, nor did they investigate it.

“We did speculate in our discussion however, that the nature of screening services provided might be affected by the financial viability of the service. Making the most of limited resources in healthcare is not uncommon throughout healthcare, and we have no reason to speculate that the case is otherwise in pharmacy,” he explains.

“As with any setting where this applies, it is possible that stretched resources might result in suboptimal levels of care from time to time. We did not generate any evidence of any significant income being generated directly or indirectly from screening services or that patient healthcare was being compromised for profits.

“We suggested that ‘it is plausible that the key purpose of delivering services in many pharmacies is to facilitate relationship-building with patients and to promote customer loyalty’– neither of these objectives are necessarily unethical and in fact a stronger pharmacist-patient relationship may promote better patient care.”

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