How to run a CVD screening and assessment service

Scenario: You have decided to run a cardiovascular screening and risk assessment service in the pharmacy. The target screening group is ‘all willing patients over the age of 45 years without a known history of cardiovascular disease (CVD)’.

What do you need to consider when setting up the service?

Screening and risk assessment services should be evidence-based

A pharmacist should ensure that all screening and risk assessment services align with relevant clinical guidelines and program guidelines (Professional Practice Standards [PPS] criterion 10.3.1). For example, individual measures such as blood pressure or lipid levels are risk factors, whereas an evidence-based assessment of absolute cardiovascular risk requires consideration of multiple interacting risk factors.

The absolute CVD risk calculator is the most appropriate method for assessing cardiovascular risk in the Australian context. Using this validated tool helps to identify people who may not be recognised as high risk (e.g. individuals who have multiple risk factors that are not considered significant in isolation), and prevents referral of an individual who may have an isolated elevated single risk factor, but low risk overall (see Australian absolute cardiovascular disease risk calculator, www.cvdcheck.org.au).

Standard operating procedures should outline appropriate referral pathways

A pharmacist should actively facilitate referral and confirm that the patient knows how to access these services (PPS criterion 9.7.6). For example, if a patient is assessed as being at high risk, the pharmacist should refer the person to a general practitioner (GP) for follow-up to ensure continuity of care.

If immediate referral is required, the pharmacist should contact a GP directly to organise prompt follow-up or refer them to the nearest hospital accident and emergency department.

The standard operating procedure for the screening and risk assessment service should outline the appropriate process for referral of high-risk patients. Use of the template, PPS Appendix 9: Screening and risk assessment record and referral form, will ensure that all important information obtained during the service is recorded in a clear and concise manner and easily communicated to the GP. It also enables the pharmacist to communicate results to the patient in a timely and appropriate manner (PPS criterion 10.6.8).

A pharmacist is required to confirm continued consent before sharing information with other healthcare professionals (PPS criterion 1.3.3). The standard operating procedure for the service should describe the process of obtaining patient consent for participation in the service (including consent to allow sharing of necessary information between healthcare providers, if required).

Services should be integrated with other health services

Integrating pharmacy screening and risk assessment services with existing health services, as well as collaborating with other healthcare professionals, is essential to ensure the success of the service.

Health literacy of the patient, service providers and service settings should be recognised, and responses and service tailored accordingly (PPS criterion 9.2.12). Use of the template, PPS Appendix 9: Screening and risk assessment record and referral form, allows the pharmacist to communicate results to the patient in a timely and appropriate manner (PPS criterion 10.6.8).

The pharmacist should work to develop a shared vision among healthcare team members around intended service outcomes and patient healthcare goals (PPS criterion 9.2.5). It is essential that the pharmacist cultivates a team-based approach (PPS criterion 1.9.1) and facilitates collaboration with other healthcare professionals with the primary aim of optimising patient health outcomes (PPS criterion 1.9.2). Pharmacists should also communicate with other healthcare professionals and authorised representatives to help identify patients in need of the service (PPS criterion 9.2.9).

Delivering a screening and risk assessment service appropriate to the pharmacy setting will establish a consistent and visible pharmacist presence (PPS criterion 9.2.11). Approaching GPs and other healthcare providers in the local area to explain the proposed service and how it will integrate and complement existing services will help to:

• reduce the possible reservations of other health professionals
• open lines of communication
• encourage collaborative health care
• establish referral processes for ‘at risk’ patients.

PSA gratefully acknowledges the Australian Government Department of Health for providing funding for the original development of this case study as part of the PBS Access and Sustainability Package including the Sixth Community Pharmacy Agreement.