Cardiovascular Disease Risk Prevention Services by Pharmacists in Saudi Arabia: What Do Policymakers and Opinion Leaders Think?

Abstract

Background: Cardiovascular disease (CVD) is an emerging contributor to national morbidity and mortality in Saudi Arabia. CVD risk prevention services are limited, particularly with an over-utilised public health sector and an under-utilised and under-resourced primary care sector. Globally, there is evidence that community pharmacists can play a key role in CVD prevention within primary care. However, the perspectives of policymakers and opinion leaders are critical to successful translation of evidence into practice. Thus, the aim was to engage policymakers and professional leaders in discussions about implementing high-quality CVD risk prevention services in community pharmacy. Methods: Qualitative semi-structured interviews were conducted, audio-recorded and transcribed verbatim. All transcripts were thematically analysed. Results: A total of 23 participants (87% male) from government and non-government sectors were interviewed. Of these, almost 65% had pharmacy qualifications. Limited provision of CVD risks preventative services in primary care was acknowledged. However, most participants favoured the concept of utilising community pharmacist’s capacity to assist in preventive health services. The data yielded four key themes: 1) Future pharmacy CVD health service models, 2) Demonstrable outcomes, 3) Professional engagement and advocacy and 4) Implementability. CVD health services roles (health screening, primary and secondary prevention services), pragmatic factors and tiered models of care (minimal, medium and comprehensive pharmacist involvement) were discussed. The need for humanistic, clinical and cost effectiveness outcomes and activation of professional bodies were deemed important. Professional pharmacy governance to develop pharmacy careers and workforce, pharmacy curricular reform and ongoing education were posed as key success factors for pharmacy roles. Practice policies, standards and guidelines were seen as required to adhere to stringent quality control for future pharmacy services provision. Participants implementation vision for such services included scalability, affordability, access, adoption and health system reform. Most discussion focused on the need for structural improvement with limited input regarding processes or outcomes required to establish such models. Conclusions: Most participants favoured pharmacy-based CVD risk prevention services, despite the variability in proposed service models. However, prior to developing such services, support structures at the health system and health professional level are needed as well as building public support and acceptability for pharmacy services.