Acceptability of hypertension screening in pharmacies participating in May Measurement Month

Introduction

Fifty percent of individuals with hypertension are unaware they have the condition; therefore, blood pressure (BP) screening is essential.^1,2 May Measurement Month (MMM) is a global BP screening program ¹ ; however, community pharmacies have not been engaged in this program. From May 1 to July 31, 2023, select pharmacies in Alberta (AB) and British Columbia (BC) participated in phase 1 of MMM 2023. ³ To participate in MMM, pharmacy personnel had to complete a brief, online, free-of-charge, 30-minute BP technique training course from the World Hypertension League. ⁴ A total of 736 participants were enrolled. ³ Overall, more than 20% of participants had elevated BP, and in subgroups of interest, 35.1% of participants with known hypertension, 13.3% of participants with no known history of hypertension, 51.5% of participants with diabetes, and 20.0% of female participants had elevated BP. ³ To inform scale-up planning, we investigated pharmacy personnel’s opinions on participating in MMM and their thoughts on a potential funding model for BP screening.

Methods

We surveyed pharmacy personnel from 24 pharmacies after the completion of the MMM 2023 campaign. We used an online quantitative and qualitative questionnaire that was distributed in REDCap. The questionnaire contained 30 open- and closed-ended questions in total, pertaining to pharmacy personnel demographics and experience, the Theoretical Framework of Acceptability constructs, ⁵ personnel views on compensation for BP screening, and barriers and facilitators that occurred during MMM 2023.

Results

Forty pharmacy personnel from 24 pharmacies across AB and BC participated in the MMM 2023 campaign. The poststudy acceptability questionnaire was distributed to the participating pharmacy personnel in September 2023; the overall response rate was 45%, and 13 pharmacists, 4 pharmacy students, and 1 pharmacy technician completed the questionnaire. Interestingly, 40% of pharmacy personnel stated they had never previously screened patients for hypertension in a pharmacy setting or that this occurred less than monthly (33%).

Pharmacy personnel stated that hypertension screening had a positive influence on their professional satisfaction (agree = 81%), that they felt confident in measuring BP (agree = 94%), and that they were comfortable reviewing BP results with patients (agree = 94%). Pharmacy personnel felt that pharmacy-based screening would help to identify patients who have undiagnosed hypertension (agree = 100%) and would like to continue to screen patients (agree = 81%); 56% did not feel screening was a burden on their workload, and 69% agreed that they were adequately staffed.

As part of the questionnaire, participants were asked, “What, in your own words, do you think is the value of providing BP screening clinics to your patients?” Themes that emerged included health promotion, pharmacist accessibility, pharmacist value, and increased hypertension detection.

Regarding funding for pharmacy-based BP screening, 100% of personnel felt that pharmacies should be reimbursed for this service: $10 (13.3%), $20 (60%), and $25 (26.7%).

Discussion

The World Health Organization recommends that every adult be screened for elevated BP. ² In addition, screening should be done opportunistically and be accessible. ² A multitude of studies have demonstrated the value of pharmacists in BP management, alone or in collaboration with other health care professionals. ⁶ Pharmacy personnel in this study were able to effectively identify individuals who required follow-up and further assessment of their elevated BP, which increases awareness of the largest contributing risk factor for premature death and disability worldwide.^{1 -3}

Facilitators identified to support pharmacy-led BP screening included pharmacy personnel confidence in completing the BP measurements and discussing results with patients after completing the study training. In addition, the vast majority of pharmacy personnel noted that BP screening had a positive influence on their professional satisfaction and wanted to continue BP screening after completion of the study. Themes identified in the qualitative answers were overwhelmingly positive and showcased an association between elevated BP detection, professional satisfaction, and increased value of the pharmacist. The largest barrier to pharmacy-led screening was adequate staffing and workload demands. These barriers and facilitators are in line with previous research conducted; however, there is no standardized measure of acceptability among studies. ⁷

Regarding funding, most personnel felt that $20 per patient screened was acceptable. This is in line with international programs such as the National Health Service Community Pharmacy Blood Pressure Check Service in the United Kingdom. ⁸ Increased funding for BP screening services has the potential to offer health benefits to Canadians and public health implications, which have been demonstrated domestically and internationally.^9,10

Conclusions

Community pharmacy personnel found BP screening acceptable and identified barriers and facilitators that will help enable future scale-up of this important initiative.