title: Atrial fibrillation screening in pharmacies using an iPhone ECG: a qualitative review of implementation.
abstract: BACKGROUND
  Atrial fibrillation guidelines advocate screening to identify undiagnosed atrial fibrillation. Community pharmacies may provide an opportunistic venue for such screening.
  
  
  OBJECTIVE
  To explore the experience of implementing an atrial fibrillation screening service from the pharmacist's perspective including: the process of study implementation; the perceived benefits; the barriers and enablers; and the challenges for future sustainability of atrial fibrillation screening within pharmacies. Setting Interviews were conducted face-to-face in the pharmacy or via telephone, according to pharmacist preference.
  
  
  METHODS
  The 'SEARCH-AF study' screened 1000 pharmacy customers aged ≥65 years using an iPhone electrocardiogram, identifying 1.5 % with undiagnosed atrial fibrillation. Nine pharmacists took part in semi-structured interviews. Interviews were transcribed in full and thematically analysed.
  
  
  METHODS
  Qualitative analysis of the experience of implementing an AF screening service from the pharmacist's perspective.
  
  
  RESULTS
  Four broad themes relating to service provision were identified: (1) interest and engagement in atrial fibrillation screening by pharmacists, customers, and doctors with the novel, easy-to-use electrocardiogram technology serving as an incentive to undergo screening and an education tool for pharmacists to use with customers; (2) perceived benefits to the pharmacist including increased job satisfaction, improvement in customer relations and pharmacy profile by fostering enhanced customer care and the educational role of pharmacists; (3) implementation barriers including managing workflow, and enablers such as personal approaches for recruitment, and allocating time to discuss screening process and fears; and, (4) potential for sustainable future implementation including remuneration linked to government or pharmacy incentives, combined cardiovascular screening, and automating sections of risk-assessments using touch-screen technology.
  
  
  CONCLUSIONS
  Atrial fibrillation screening in pharmacies is well accepted by pharmacists and customers. Many pharmacists combined atrial fibrillation screening with other health screens reporting improved time-efficiency and greater customer satisfaction. Widespread implementation of atrial fibrillation screening requires longterm funding, which could be provided for a combined cardiovascular screening service. Further research could focus on feasibility and cost-effectiveness of combined cardiovascular screening in pharmacies.
authors.affiliation: Cardiology Department, Concord Repatriation General Hospital, Hospital Road, Concord, Sydney, NSW, 2137, Australia. nicole.lowres@sydney.edu.au.|ANZAC Research Institute, Hospital Road, Concord, Sydney, NSW, 2137, Australia. nicole.lowres@sydney.edu.au.|Sydney Medical School, University of Sydney, Sydney, Australia. nicole.lowres@sydney.edu.au.
authors.forename: Nicole
authors.initials: N
authors.lastname: Lowres
authors.affiliation: Faculty of Pharmacy, University of Sydney, Building A15, Sydney, NSW, 2006, Australia.
authors.forename: Ines
authors.initials: I
authors.lastname: Krass
authors.affiliation: The George Institute for Global Health, Level 10, King George V Building, 83-117 Missenden Rd, Camperdown, Sydney, NSW, 2050, Australia.|Sydney Nursing School, University of Sydney, Level 2, Building D17, Sydney, NSW, 2006, Australia.
authors.forename: Lis
authors.initials: L
authors.lastname: Neubeck
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, Australia.|The George Institute for Global Health, Level 10, King George V Building, 83-117 Missenden Rd, Camperdown, Sydney, NSW, 2050, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Redfern
authors.affiliation: Faculty of Pharmacy, University of Sydney, Building A15, Sydney, NSW, 2006, Australia.|Centre for Education and Research on Aging, Concord Repatriation General Hospital, Sydney, Australia.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: McLachlan
authors.affiliation: Faculty of Pharmacy, University of Sydney, Building A15, Sydney, NSW, 2006, Australia.|Centre for Education and Research on Aging, Concord Repatriation General Hospital, Sydney, Australia.|NSW Therapeutic Advisory Group, PO Box 766, Darlinghurst, NSW, 2010, Australia.
authors.forename: Alexandra A
authors.initials: AA
authors.lastname: Bennett
authors.affiliation: Cardiology Department, Concord Repatriation General Hospital, Hospital Road, Concord, Sydney, NSW, 2137, Australia.|ANZAC Research Institute, Hospital Road, Concord, Sydney, NSW, 2137, Australia.|Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: S Ben
authors.initials: SB
authors.lastname: Freedman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis*; D001291:Attitude of Health Personnel; D001315:Australia; D003157:Community Pharmacy Services / Q000458:organization & administration*; D003362:Cost-Benefit Analysis; D004562:Electrocardiography / Q000295:instrumentation; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008403:Mass Screening / Q000295:instrumentation / Q000458:organization & administration; D010595:Pharmacists / Q000523:psychology*; D024382:Professional Role / Q000523:psychology*; D011369:Professional-Patient Relations; D036301:Qualitative Research; D000068997:Smartphone
keywords: Atrial fibrillation; Australia; Barriers; Enablers; Implementation; Pharmacist; Screening