Table 1 Characteristics of included studies, findings, and outcomes
Author (year), country of study | Study design, sampling technique | Interest population, (sample size) | CVDs, co-morbidities | Community pharmacists’ role | Patients’ perceptions | Strengths and limitations | Type of outcome, (result) | |
|---|---|---|---|---|---|---|---|---|
Prevention of CVDs | Control of CVDs | |||||||
Aguwa et al. (2008), Nigeria [27] | Crossover non-randomized, purposive | Hypertensive patients (40) | “Missing,” hypertension/diabetes | Lifestyle counseling Blood pressure (BP) self-care management Smoking cessation Adherence support Hypertension education | “Missing” | “Missing” | Strengths Subjects were their own control Pharmacists received program training. Limitation Purposive sampling Male-dominated sample (75%) Patient self-reported data | Clinical & humanistic (favorable) |
Ali et al. (2003), Canada [28] | Before-after uncontrolled, purposive | Dyslipidemia patients (149) | “Missing,” dyslipidemia | Health education Lifestyle counseling Available therapies Regular follow-up | “Missing” | The program was perceived as satisfactory and patients were willing to pay for the program | Strengths Pharmacists received program training Limitations No comparator Purposive sampling No randomisation | Clinical & humanistic (favorable) |
Ali et al. (2012), UK (UK) [29] | Randomized controlled trial (RCT), random | Diabetes (type 2) patients (48) | “Missing,” diabetes | Medicine use review Lifestyle counseling Referrals Regular follow-up & monitoring Diabetes education | “Missing” | Patients perceived their knowledge of diabetes and health status were improved following education program | Strengths Allocation concealment Computer-generated random list Low inter-rater Pharmacists received program training High retention rate Limitations Possible group contamination Caucasian-dominated sample Smaller sample size | Clinical & humanistic (favorable) |
Al Hamarney et al. (2012), Canada [30] | Cross-sectional, purposive | Diabetic patients (200) | “Missing,” diabetes | Detection of poorly controlled diabetic patients | “Missing” | “Missing” | Strengths Subjects identified through medical records Limitations Purposive sampling Elderly dominated sample | Not applicable |
Al Hamarney et al. (2013), Canada [31] | Before-after uncontrolled, purposive | Patients with poorly controlled diabetes (type 2) (100) | “Missing,” hypertension/diabetes/dyslipidemia | Medication use counseling Self-care management Pharmacist-initiated insulin prescription | “Missing” | The patients perceived the community treatment as satisfactory | Strengths Pharmacists received program training Intention-to-treat analysis Limitations White-dominated sample No comparator Purposive sampling | Clinical & humanistic (favorable) |
Al Hamarneh et al. (2017), Canada [32] | RCT, random | Diabetic/CVD risk patients (573) | Atherosclerotic vascular disease Heart failure Peripheral arterial disease Atrial fibrillation, hypertension/diabetes/dyslipidemia/chronic kidney disease (CKD) | Pharmacotherapy management (medicine therapy management) CVD risk screening CVD education Referrals Treatment recommendation Pharmacist-initiated prescription Regular follow-up & monitoring | CVD risk screening CVD education Referrals Treatment recommendation Prescription initiation Regular follow-up & monitoring | ‘‘Missing’’ | Strengths Allocation concealment Intention-to-treat analysis Control & treatment groups comparable at baseline Larger sample size Limitations No blinding Patient self-reported data | Clinical (favorable) |
Al Hamarneh et al. (2018), Canada [33] | Cross sectional interviews, purposive | CVD risk patients (14) | “Missing,” hypertension/diabetes/CKD. | CVD risk screening | “Missing” | Community pharmacists were compassionate, collaborators, & articulate Patients were highly satisfied with pharmacist care | Strengths Data analysed by 3 independent reviewers Limitations Purposive sampling Interviews/opinions (information bias) Subjects selected by pharmacists (selection bias). | Humanistic (favorable) |
Aslani et al. (2011), Australia [34] | Cluster randomized trials (CRT), random | Dyslipidemia patients (142) | “Missing,” dyslipidemia | Adherence support Regular follow-up & monitoring | ‘‘Missing’’ | ‘‘Missing’’ | Strengths Pharmacists received program training Control & treatment groups comparable at baseline Minimal group contamination (cluster sampling) Limitations Findings limited to pharmacy users Smaller sample size Higher dropout (32%) Pharmacists compensated | Clinical (favorable) |
Blackburn et al. (2016), Canada [35] | CRT, random | Statin users (1906) | “Missing,” dyslipidemia | Adherence support | ‘‘Missing’’ | ‘‘Missing’’ | Strengths Allocation concealment Randomization Pharmacists received program training Control & treatment groups comparable at baseline Minimal group contamination (cluster sampling) Broader representation of pharmacy type Limitations Findings to limited new statin users One state | Humanistic (unfavorable) |
Boardman & Avery (2014), UK [36] | Cross-sectional, purposive | CVD risk patients (281) | “Missing,” hypertension/diabetes/dyslipidemia | Lifestyle counseling Smoking cessation Regular follow-up & monitoring | “Missing” | “Missing” | Strengths Broader pharmacy types representation Pharmacist & research assistants received program training Limitations The program differed across pharmacies Purposive sampling No comparator White & female-dominated sample | Clinical & humanistic (favorable) |
Chabot et al. (2003), Canada [37] | Before-after uncontrolled, purposive | Hypertensive patients (111) | “Missing,” hypertension | Regular follow-up & monitoring Adherence support Treatment recommendations | “Missing” | “Missing” | Strengths Blinding of data collectors Pharmacists & research assistants received program training Minimal group contamination (cluster sampling) Limitations Pharmacists remunerated Treatment & control groups incomparable at baseline No randomization | Clinical & humanistic (favorable) |
Cranor et al. (2003), USA [38] | Before-after uncontrolled, purposive | Diabetic patients (323) | “Missing,” diabetes | Diabetes education Regular follow-up & monitoring Self-care management Adherence support Physical examination Referrals | “Missing” | “Missing” | Strengths 5 years of follow-up Intention-to-treat analysis Pharmacists received program training Limitation No randomization No comparator Missing data | Clinical, humanistic, & economic (favorable) |
Fahs et al. (2018), Lebanon [39] | Longitudinal before-after uncontrolled, convenience | Patients without CVDs (865) | “Missing,” hypertension/diabetes/dyslipidemia | Lifestyle counseling CVD education | ‘‘Missing’’ | ‘‘Missing’’ | Strengths Rural & urban setting 6 districts represented Standard questionnaire Limitations Findings limited to ≥ 45 years Convenience sampling No comparator Patient self-reported data | Clinical & humanistic (favorable) |
Fikri-Benbrahim et al. (2013), Spain [40] | Before-after controlled, purposive | Hypertensive patients (209) | “Missing,” hypertension | Adherence support Health education Referrals Home BP device Self-care management DRP identification Regular follow-up & monitoring | “Missing” | “Missing” | Strengths Pharmacist received program training Control & treatment groups comparable at baseline Limitations Protocol analysis No randomisation Smaller sample size Possible subject contamination No blinding Possible selection bias (more adherent subjects) | Humanistic (favorable) |
Fonseca et al. (2021), Portugal [41] | Cross-sectional, convenience | Patients with CVD/risk factors (588) | “Missing,” hypertension/diabetes/dyslipidemia | CVD education CVD risk screening | ‘‘Missing’’ | ‘‘Missing’’ | Strengths Pharmacist received program training Limitations Single centre Convenience sampling No comparator Patient self-reported data | Not applicable |
Horgan et al. (2010), UK [42] | Cross-sectional, purposive | Patients with CVD risk factors (1141) | “Missing,” hypertension/diabetes/dyslipidemia | CVD risk screening Referral | “Missing” | “Missing” | Strengths Broader pharmacy type representation Limitations White dominated sample Findings limited to poor health indicators setting | Not applicable |
Hourihan et al. (2003), Australia [43] | Cross-sectional, convenience | Not on dyslipidemia/hypertension treatment (204) | “Missing,” hypertension/dyslipidemia | Health education CVD risk screening Lifestyle counseling Smoking cessation Regular follow-up & monitoring Referrals | “Missing” | Community pharmacist-led healthcare services were convenient | Strengths Pharmacists received program training Regular calibration of meters Limitations Findings limited to rural setting Convenience sampling. Free service might have encouraged patient participation | Humanistic (favorable) |
Hunt et al. (2013), UK [8] | Cross sectional, convenience | Patients without CVDs, (3125) | “Missing”, hypertension/diabetes/dyslipidemia | CVDs risk screening Referral Lifestyle counselling | “Missing” | “Missing” | Strengths Balanced gender representation Limitations Findings limited to minority groups. Single state Convenience sampling | Not applicable |
Jaffray et al. (2007), England [44] | RCT, random | Coronary heart disease (CHD) patients (1614) | Coronary heart disease (CHD), hypertension/diabetes/dyslipidemia | “Missing” | Medication use review Therapy monitoring Medication counseling Lifestyle counseling Smoking cessation Social support Referrals Prescription recommendations | Patients were satisfied with pharmacist care | Strengths Outcome assessors blinded Pharmacists received program training Computer-generated randomization Control & treatment groups comparable at baseline Limitations Patient self-reported data Participation restricted to pharmacies with consultation rooms | Clinical & economic, (unfavorable), humanistic (favorable) |
Jahangard-Rafsanjani et al. (2017), Iran [45] | Cross-sectional, convenience | Subjects with no CVDs or diabetes (287) | “Missing,” hypertension/dyslipidemia | CVD risk screening Lifestyle counseling CVD education. Referrals | ‘‘Missing’’ | ‘‘Missing’’ | Strengths The use of high precision testing devices Limitations Smaller sample size. Single center Urban setting No comparator | Not applicable |
John et al. (2006), USA [46] | Before-after uncontrolled, purposive | Individuals with CVD risk factors (58) | “Missing,” hypertension/diabetes/dyslipidemia | CVDs education CVDs risk screening Lifestyle counseling. Smoking cessation DRP identification Regular follow-up & monitoring Treatment recommendations | ‘‘Missing’’ | ‘‘Missing’’ | Strengths Workplace setting encourages complete follow-up Subjects served as their own controls Limitations Rural setting Smaller sample size male-dominated sample No comparator | Clinical (favorable) |
Katoue et al. (2013), Kuwait [47] | Cross-sectional, random | Community pharmacists (220) | “Missing,” metabolic syndrome | Screening tests Lifestyle counseling Smoking cessation Adherence support Self-care management Referrals | ‘‘Missing’’ | ‘‘Missing’’ | Strengths High response rate (97.8%) Bigger sample size Rural & urban setting Questionnaire piloted Limitations Questionnaire survey not preferred to explore views | Not applicable |
Khettar et al. (2021), France [48] | Cross-sectional, convenience | Community pharmacists (104) | Stroke, “missing” | ‘‘Missing’’ | Medicine use/management review Lifestyle counselling. Smoking cessation. | ‘‘Missing’’ | Strengths Questionnaire piloted & expert-reviewed Limitations Low response rate (1.9%) Youth and male-dominated sample Patient self-reported data Convenience sampling | Not applicable |
Krass et al. (2007), Australia [49] | CRT, random | Diabetes (type 2) patients (335) | “Missing,” hypertension/diabetes/dyslipidemia | Adherence support Lifestyle counseling Medicine use review Self-care management DRP identification Referrals Regular follow-up & monitoring | “Missing” | “Missing” | Strengths Urban and rural setting Multi-states Minimal group contamination (cluster sampling) Pharmacists received program training Subject eligibility verified through medical records Subjects provided one brand device for self-monitoring Limitations Pharmacists remunerated Missing data Significant high drop-out rate in younger participants | Clinical & humanistic (favorable) |
Kwint et al. (2012), Netherlands [50] | Cross-sectional, purposive | Patients taking cardiovascular or anti-diabetic drugs (155) | Coronary artery disease (CAD) Cerebral vascular disease Arrhythmia Heart failure, hypertension/diabetes/dyslipidemia/pulmonary disease/artrosis/osteoporosis | “Missing” | DRP identification Home visits Medication reviews Adherence support | “Missing” | Strengths Pharmacists received program training Experienced independent program reviewers Independent assessors Limitations Findings limited to home dwelling elderly Patient self-report data No comparator Purposive sampling | Not applicable |
Marfo & Owusu-Daaku (2017), Ghana [51] | Before-after controlled, purposive | Hypertensive patients, (180) | “Missing,” diabetes | DRP identification Adherence support Medicine use review Lifestyle counseling Health education | “Missing” | Majority of patients were satisfied with community support services | Strengths Control & treatment groups comparable at baseline Minimal group contamination (cluster sampling) Pharmacists received program training Limitations Pharmacists remunerated Purposive sampling No randomisation Smaller sample size | Clinical & humanistic (favorable) |
McNamara et al. (2015), Australia [52] | Before-after uncontrolled, purposive | Patients with hypertension & dyslipidemia, without CVDs/diabetes (70) | “Missing,” hypertension/dyslipidemia | Drug therapy management Adherence support Lifestyle counseling CVD education Regular follow-up & monitoring Treatment recommendations | “Missing” | “Missing” | Strengths Pharmacists received program training Limitations Female-dominated, rural patients Patient self-reported data No comparator Smaller sample size | Humanistic, (favorable) |
Niquille & Bugnon (2010), Switzerland [53] | Cross-sectional, purposive | Patients on cardiovascular drugs (92) | “Missing,” hypertension/diabetes/dyslipidemia | Medication review | “Missing” | “Missing” | Strengths Pharmacists received program training Limitations Recruitment done by community pharmacists Findings limited to insured participants Smaller sample size Purposive sampling | Clinical, humanistic & economic (favorable) |
Okada et al. (2016), Japan [54] | CRT, random | Diabetes patients (163) | “Missing,” diabetes | Lifestyle counseling Diabetes education Self-care management Adherence support Regular follow-up & monitoring. | “Missing” | “Missing” | Strengths Blinding of data analysts Allocation concealment Low inter-rater Pharmacists received program training Minimal group contamination (cluster sampling) Randomisation Limitations Findings limited to chain pharmacies No blinding Smaller sample size | Clinical & humanistic (favorable) |
Okada et al. (2017), Japan [55] | CRT, random | Hypertensive patients (125) | “Missing,” hypertension | Lifestyle counseling Self-care management Regular follow-up & monitoring | “Missing” | “Missing” | Strengths Pharmacists received program training Participants received validated BP monitors Minimal group contamination (cluster sampling) Randomization Limitations Patient self-reported data Smaller sample size Differences in groups’ baseline data. | Clinical (favourable) & humanistic (unfavorable) |
Olenak & Calpin (2010), USA [56] | Cross-sectional, convenience | Subjects without CHD history (239) | “Missing,” metabolic syndrome | CVD risk screening Lifestyle counseling Smoking cessation | “Missing” | Patients perceived community pharmacist’s screening program as satisfactory | Strengths Participation not restricted to pharmacy patients Use of point-of-care device Limitations Women-dominated sample Patient self-reported data Convenience sampling Single state Free program might have encouraged participation | Clinical & humanistic (favorable) |
Oser et al. (2017), USA [57] | Before-after uncontrolled, purposive | Patients on hypertensive medication (534) | “Missing,” hypertension | Adherence support Regular follow-up & monitoring Lifestyle counseling Referrals Medication management | “Missing” | “Missing” | Strengths Pharmacists received program training All eligible pharmacies were invited to participate Limitations No comparator Rural setting Incentives might have encouraged participation of pharmacists Purposive sampling | Humanistic (favorable) |
Peletidi et al. (2019) UK & Greece [58] | Cross sectional interviews, convenience, snowball & random | Community pharmacists (40) | “Missing,” “missing” | Lifestyle counseling Smoking cessation Adherence support Medicine use review (MUR) New medicine service (NMS) CVD screening | “Missing” | “Missing” | Strengths Questionnaire piloted & expert-reviewed Congruency between aim and design, data collection & analysis Random sampling (low bias) Limitations Findings limited to independent pharmacies Convenience & snowball sampling | Not applicable |
Puspitasari et al. (2013), Australia [59] | Cross-sectional interviews, purposive | Community pharmacists (21) | “Missing,” “missing” | “Missing” | Medicine counseling Lifestyle counseling CVD education Medicine use review Patient home visits | “Missing” | Strengths Questionnaire-piloted & expert-reviewed Congruency between aim and design, data collection & analysis Rural & urban setting Broader representation of pharmacy types Limitations Findings limited to independent pharmacy setting Purposive sampling | Not applicable |
Robinson et al. (2010), USA [60] | Before-after controlled, purposive | Patients with uncontrolled hypertension (376) | “Missing,” hypertension | Adherence support DRP identification Hypertension education | “Missing” | “Missing” | Strengths Pharmacists received training Control & treatment groups comparable at baseline Patients were identified through prescription databases Limitations No randomisation Per protocol analysis Purposive sampling Missing data Findings limited chain pharmacies | Clinical & humanistic (favorable) |
Sandhu et al. (2018), Canada [61] | Cross sectional, random | Community pharmacists, (139) | Atrial fibrillation, “missing” | “Missing” | Identification of preventive therapy eligible CVD patients Physician-guided prescribing | “Missing” | Strengths Random sampling Limitations One city Questionnaire not piloted Smaller sample size | Not applicable |
Sia et al. (2020), Malaysia [62] | Cross-sectional, convenience | Community pharmacists (182) | “Missing,” “missing” | “Missing” | CVD screening Lifestyle counseling Smoking cessation | “Missing” | Strengths Questionnaire-piloted & expert-reviewed) Limitations Urban setting Patient self-reported data Convenience sampling Smaller sample size | Not applicable |
Simpson et al. (2004), Canada [63] | RCT, random | Patients with CVDs & risk factors (675) | “Missing,” hypertension/diabetes/dyslipidemia | CVDs risk screening. CVD education Referral Regular follow-up & monitoring | “Missing” | “Missing” | Strengths Randomization Control & treatment groups comparable at baseline Pharmacists received program training Limitations Patient self-reported data Smaller sample size | Clinical (favorable) |
Stewart et al. (2014), Australia [64] | CRT, random | Hypertensive patients (395) | “Missing,” hypertension | Adherence support BP monitor Self-care management Health education DRP identification Home-based therapy review Referrals Refill reminders Regular follow-up & monitoring | “Missing” | “Missing” | Strengths Multi-center Urban & rural setting Minimal group contamination (cluster sampling) Pharmacists received training Patients’ data verified through a software Replicate measurements Intention-to-treat analysis Treatment & control groups comparable at baseline Limitations Pharmacists remunerated Patient self-reported data No blinding | Clinical & humanistic (favorable) |
Thompson et al. (2020), USA [65] | Cross-sectional, convenience | Hypertensive patients, (61) | “Missing,” hypertension | Medication review Lifestyle counseling Self-care management Hypertension education Adherence support | “Missing” | Community pharmacist-led MTM was highly satisfactory | Strengths Rural & urban setting Pharmacists received program training Limitations Findings limited to insurance members Smaller sample size Convenience sampling No comparator | Humanistic (favorable) |
Tsuyuki et al. (2002), Canada [66] | RCT, random | Patients with CVDs/CVDs risk factors (675) | Atherosclerotic vascular disease, diabetes | “Missing” | Point-of-care testing CVD education Referrals Follow-ups Adherence support | Community pharmacist-led program was satisfactory | Strengths Allocation concealment Intention-to-treat analysis Treatment & control groups comparable at baseline Limitations Patients selected by pharmacists Limited findings limited to pharmacy users Smaller sample size | Clinical & humanistic (favorable) |
Tsuyuki et al. (2004), Canada [67] | Before-after uncontrolled, random | Patients with CVD risk factors/CVD risk factors (419) | Atherosclerotic vascular disease, hypertension/ diabetes/dyslipidemia | “Missing” | Lifestyle counselling Adherence support Health education DRP identification | “Missing” | Strengths Pharmacists received program training Replicate measurements High precision device Multi-center Randomization Limitations Patients selected by pharmacists No comparator | Clinical & humanistic (favorable) |
Tsuyuki et al. (2016), Canada [68] | RCT, random | CVD/CVD risk factors (723) | Atherosclerotic vascular disease Heart failure Atrial fibrillation, hypertension/dyslipidemia/diabetes/CKD | CVD risk screening CVD education Treatment recommendations Smoking cessation Regular follow-up & monitoring | CVD education Treatment recommendations Smoking cessation Regular follow-up & monitoring | “Missing” | Strengths Allocation concealment Computer-generated randomization Pharmacists received program training Treatment & control groups comparable at baseline Intention-to-treat analysis Limitations Shorter follow-up period (3 months) Single state Patient self-reported data) | Clinical & humanistic (favorable) |
van Geffen et al. (2011), Netherlands [69] | Cross-sectional, convenience & random | Patients on CVD treatment (1546) | “Missing,” hypertension/diabetes/dyslipidemia | Medicines counseling advice | “Missing” | Patients were dissatisfied with & perceived community pharmacists as incapable to provide sufficient medication information | Strengths Urban & rural setting Random sampling Limitations Elderly-dominated sample Findings limited to networked pharmacies Possible information bias (patients’ views) | Humanistic (unfavorable) |
Zillich et al., (2005), USA [70] | CRT, random | Hypertensive patients with uncontrolled BP (125) | “Missing,” hypertension | Hypertension education Self-care management Lifestyle counseling Medication counseling Adherence support Referral Home BP device Regular follow-up & monitoring | “Missing” | “Missing” | Strengths Pharmacists received program training Control & treatment groups comparable at baseline Minimal group contamination (cluster sampling) Limitations Findings limited to networked pharmacists No randomization Pharmacists remunerated | Clinical & humanistic (favorable) |