(1061) Diabetes and Cardiovascular Disease Screening and Referral Programs in Community Pharmacies: Feasible and Effective?

Objectives: Heart disease and diabetes are the first and seventh leading causes of death in the United States respectively. Both conditions can be diagnosed and treated effectively given timely screening and referrals. The transition to value-based care and its focus on patient outcomes, limited healthcare resources, and patient accessibility challenges present a unique opportunity for community pharmacists to provide patient care services to many underserved communities. This study aimed to test the feasibility of implementing two screening and referral (S&R) programs in community pharmacies for the prevention and treatment of cardiovascular disease (CVD) and diabetes (DM).

Methods: This exploratory feasibility study was designed as an effectiveness-implementation hybrid Type II design project using mixed data. During the 12-month implementation, 15 pharmacy sites across five pharmacy organizations identified, screened, and referred patients as appropriate following the protocols outlined in the S&R CVD and DM toolkits created for this project. Evaluating implementation feasibility (aim 1) was based on levels of program adoption; acceptability, appropriateness, feasibility, intent to sustain use, and satisfaction survey scores; and insights from pharmacists’ interviews. To gain preliminary insights into the programs’ effectiveness (aim 2), patient referral and physician follow-up communication rates and pharmacist-reported outcomes were collected through patient tracking logs, surveys, and interviews.

Results: Of the 15 sites initially enrolled, two discontinued participation during the course of the S&R programs, yielding an 86% adoption rate. Patient contact and screening rates varied widely across sites, mainly due to differences in target populations, patient recruitment strategies, and workflow variability (e.g., EHR access, partnerships with local providers, feasibility of point-of-care testing, and staffing availability). Levels of program satisfaction and perceptions of acceptability, compatibility, and feasibility remained high throughout implementation; however, only three out of the participating pharmacy sites reported wanting to continue offering the programs. All at-risk patients (100%) across all sites were appropriately referred based on screening results. These screening results were communicated to the patients’ primary healthcare provider approximately 65% of the time. Perceived benefits of the S&R programs were rated highly and included: increased knowledge and motivation for the pharmacists, enhanced relationships with patients, and a positive impact on patients’ health.

Conclusions: Overall, study results highlight the feasibility and benefits of offering DM and CVD S&R programs in community pharmacies. However, the majority of pharmacies did not intend to continue offering the programs, emphasizing the need for continued focus on advancing the sustainability of pharmacy-based clinical services, in consideration of other pharmacist responsibilities (e.g., COVID and flu vaccinations, dispensing duties). While community pharmacy-based patient care programs are perceived as valuable, a radical culture shift will need to occur to support their sustainability and optimize patient care options.