title: The effectiveness of screening for diabetes and cardiovascular disease risk factors in a community pharmacy setting.
abstract: Risk factors for cardiovascular disease including diabetes have seen a large rise in prevalence in recent years. This has prompted interest in prevention through the identifying individuals at risk of both diabetes and cardiovascular disease and has seen increased investment in screening interventions taking place in primary care. Community pharmacies have become increasingly involved in the provision of such interventions and this systematic review and meta-analysis aims to gather and analyse the existing literature assessing community pharmacy based screening for risk factors for diabetes and those with a high cardiovascular disease risk.
  
  
  METHODS
  We conducted systematic searches of electronic databases using MeSH and free text terms from 1950 to March 2012. For our analysis two outcomes were assessed. They were the percentage of those screened who were referred for further assessment by primary care and the uptake of this referral.
  
  
  RESULTS
  Sixteen studies fulfilled our inclusion criteria comprising 108,414 participants screened. There was significant heterogeneity for all included outcomes. Consequently we have not presented summary statistics and present forest plots with I2 and p values to describe heterogeneity. We found that all included studies suffered from high rates of attrition between pharmacy screening and follow up. We have also identified a strong trend towards higher rates for referral in more recent studies.
  
  
  CONCLUSIONS
  Our results show that pharmacies are feasible sites for screening for diabetes and those at risk of cardiovascular disease. A significant number of previously unknown cases of cardiovascular disease risk factors such as hypertension, hypercholesterolemia and diabetes are identified, however a significant number of referred participants at high risk do not attend their practitioner for follow up. Research priorities should include methods of increasing uptake to follow up testing and early intervention, to maximise the efficacy of screening interventions based in community pharmacies.
authors.affiliation: Diabetes Research Unit, University of Leicester, Leicester, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Willis
authors.affiliation: DeMontford University, Leicester, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Rivers
authors.affiliation: Diabetes Research Unit, University of Leicester, Leicester, United Kingdom.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Gray
authors.affiliation: Diabetes Research Unit, University of Leicester, Leicester, United Kingdom.
authors.forename: Melanie
authors.initials: M
authors.lastname: Davies
authors.affiliation: Diabetes Research Unit, University of Leicester, Leicester, United Kingdom.
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Khunti
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis*; D003920:Diabetes Mellitus / Q000175:diagnosis*; D058005:General Practitioners; D006801:Humans; D008403:Mass Screening; D010594:Pharmacies; D015995:Prevalence; D017594:Publication Bias; D012017:Referral and Consultation; D012111:Residence Characteristics; D012307:Risk Factors