International Journal of Clinical Pharmacy

, Volume 37, Issue 5, pp 834–843 | Cite as

The influence of pharmacy and pharmacist characteristics on the secondary prevention of cardiovascular disease

  • Hanni Prihhastuti PuspitasariEmail author
  • Parisa Aslani
  • Ines Krass
Research Article


Background A range of extended/enhanced pharmacy services (EPS) are increasingly being offered in community pharmacies following a global paradigm shift in professional pharmacy practice from a product-oriented focus to a patient-centered approach. A number of pharmacy/pharmacist characteristics have been reported to influence EPS provision. Objective To investigate the association between EPS provision and community pharmacists’ support in CVD secondary prevention and to identify pharmacy/pharmacist characteristics which predict EPS provision and CVD support. Setting Australian community pharmacies. Methods Mail surveys to 1350 randomly selected pharmacies, stratified by state/territory, exploring professional activities provided to clients with CVD, characteristics of pharmacies (including EPS provision), and pharmacist characteristics. The survey data were analyzed using univariate analyses and multiple linear regression analysis. Main outcome measure The level of community pharmacists’ CVD support, determined by summing respondents’ score for seven CVD support-related activities, and the pharmacies’ level of involvement in EPS provision, determined by summing respondents’ score for four types of EPS. EPS provision was then used as an independent variable in the regression analysis of CVD support. Results A response rate of 15.8 % (209/1320) was obtained after three waves of the survey. Pharmacy documentation, a private area, Quality Care Pharmacy Program accreditation, number of pharmacists, and pharmacists’ resource adequacy were predictors of EPS provision (adjusted R2 = 0.299, p < 0.001). The provision of CVD support was predicted by EPS provision (β = 0.290, p < 0.001), pharmacists’ frequent contacts with general practitioners (β = 0.298, p < 0.001), and pharmacy documentation (β = 0.134, p = 0.033). The regression model of CVD support explained 34.2 % of the variation (p < 0.001). Conclusion Community pharmacists could contribute to CVD secondary prevention if they had frequent contacts with general practitioners and worked in pharmacies with a higher level of involvement in EPS provision. Of all influencing factors, documentation was a predictor of both EPS provision and CVD support, indicating the importance of documentation in supporting the management of chronic conditions.


Australia Cardiovascular disease Chronic disease management Community setting Pharmacy services Pharmaceutical Care 



The authors thank pharmacists who participated in the pilot study and the national survey.


This project was funded by Faculty of Pharmacy, the University of Sydney, Australia.

Conflicts of interest

The authors have declared that no conflicts of interest exist.


  1. 1.
    Hatah E, Braund R, Duffull S, Tordoff J. General practitioners’ perceptions of pharmacists new services in New Zealand. Int J Clin Pharm. 2012;34(2):364–73.CrossRefPubMedGoogle Scholar
  2. 2.
    Cavaco AM, Dias JPS, Bates IP. Consumers’ perceptions of community pharmacy in Portugal: a qualitative exploratory study. Pharm World Sci. 2005;27(1):54–60.CrossRefPubMedGoogle Scholar
  3. 3.
    Ruston A. Achieving re-professionalisation: factors that influence the adoption of an ‘extended role’ by community pharmacists. A national survey. J Soc Adm Pharm. 2001;18(3):103–10.Google Scholar
  4. 4.
    Norris P. Extended roles for pharmacists in New Zealand pharmacies: What kinds of pharmacies and pharmacists are involved? J Soc Adm Pharm. 2003;20(4):125–31.Google Scholar
  5. 5.
    Doucette WR, Kreling DH, Schommer JC, Gaither CA, Mott DA, Pedersen CA. Evaluation of community pharmacy service mix: evidence from the 2004 National Pharmacist Workforce Study. J Am Pharm Assoc. 2006;46(3):348–55.CrossRefGoogle Scholar
  6. 6.
    Berbatis CG, Sunderland VB, Joyce A, Bulsara MK, Mills C. Enhanced pharmacy services, barriers and facilitators in Australia’s community pharmacies: Australia’s National Pharmacy Database Project. Int J Pharm Pract. 2007;15(3):185–91.CrossRefGoogle Scholar
  7. 7.
    Latif A, Boardman HF. Community pharmacists’ attitudes towards medicines use reviews and factors affecting the numbers performed. Pharm World Sci. 2008;30(5):536–43.CrossRefPubMedGoogle Scholar
  8. 8.
    Blake KB, Madhavan SS. Perceived barriers to provision of medication therapy management services (MTMS) and the likelihood of a pharmacist to work in a pharmacy that provides MTMS. Ann Pharmacother. 2010;44(3):424–31.CrossRefPubMedGoogle Scholar
  9. 9.
    Gadkari AS, Mott DA, Kreling DH, Bonnarens JK. Pharmacy characteristics associated with the provision of drug therapy services in nonmetropolitan community pharmacies. J Rural Health. 2009;25(3):290–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Haag JD, Stratton TP. Patient care services in rural Minnesota community pharmacies. J Am Pharm Assoc. 2010;50(4):508–16.CrossRefGoogle Scholar
  11. 11.
    Schoen C, Osborn R, Huynh PT, Doty M, Davis K, Zapert K, et al. Primary care and health system performance: adults’ experiences in five countries. Health Aff. 2004;W4:487–503.Google Scholar
  12. 12.
    Australian Government Department of Health and the Pharmacy Guild of Australia. The fifth community pharmacy agreement between the Commonwealth of Australia and the Pharmacy Guild of Australia. 2010 [cited 2014 Aug 28].
  13. 13.
    Australian Government Department of Health and the Pharmacy Guild of Australia. Programme specific guidelines: pharmacy practice incentives (PPI). 2014 [cited 2014 Aug 28].
  14. 14.
    Australian Government Department of Health and the Pharmacy Guild of Australia. 5CPA general terms and conditions. 2014 [cited 2014 Aug 28].
  15. 15.
    Pharmaceutical Society of Australia. Guidelines for pharmacists providing home medicines review (HMR) services. Canberra: PSA; 2011 [cited 2013 Aug 18].
  16. 16.
    Pharmaceutical Society of Australia. Guidelines for pharmacists providing medicines uses review (MedsCheck) and diabetes medication management (Diabetes MedsCheck) services. Canberra: PSA; 2012 [cited 2013 Aug 18].
  17. 17.
    Puspitasari HP, Aslani P, Krass I. Australian community pharmacists’ awareness and practice in supporting secondary prevention of cardiovascular disease. Int J Clin Pharm. 2013;35(6):1218–28.CrossRefPubMedGoogle Scholar
  18. 18.
    Puspitasari HP, Aslani P, Krass I. Challenges in the care of clients with established cardiovascular disease: lessons learned from Australian community pharmacists. PLoS One. 2014;9(11):e113337.PubMedCentralCrossRefPubMedGoogle Scholar
  19. 19.
    Rao PSRS. Sampling methodologies with applications. Boca Raton: Chapman & Hall/CRC; 2000. ISBN 1-58488-214-X.CrossRefGoogle Scholar
  20. 20.
    Oladapo AO, Rascati KL. Review of survey articles regarding medication therapy management (MTM) services/programs in the United States. J Pharm Pract. 2012;25(4):457–70.CrossRefPubMedGoogle Scholar
  21. 21.
    Australian Government Department of Health. Australian standard geographic classification—remoteness area (ASGC-RA). Canberra: Department of Health; 2001 [updated 2007 Nov 8; cited 2014 Jan 16].
  22. 22.
    Van C, Costa D, Mitchell B, Abbott P, Krass I. Development and initial validation of the pharmacist frequency of interprofessional collaboration instrument (FICI-P) in primary care. Res Soc Adm Pharm. 2012;8(5):397–407.CrossRefGoogle Scholar
  23. 23.
    Van C, Costa D, Abbott P, Mitchell B, Krass I. Community pharmacist attitudes towards collaboration with general practitioners: development and validation of a measure and a model. BMC Health Serv Res. 2012;12:320.PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Doucette WR, Nevins JC, Gaither C, Kreling DH, Mott DA, Pedersen CA, et al. Organizational factors influencing pharmacy practice change. Res Soc Adm Pharm. 2012;8(4):274–84.CrossRefGoogle Scholar
  25. 25.
    Ho R. Handbook of univariate and multivariate data analysis and interpretation with SPSS. Boca Raton: Chapman & Hall/CRC; 2006. ISBN 1-58488-602-1.CrossRefGoogle Scholar
  26. 26.
    Miller LE, Smith KL. Handling nonresponse issues. J Ext. 1983;21(5):45–50.Google Scholar
  27. 27.
    Australian Institute of Health and Welfare. Allied health workforce 2012. National health workforce series no. 5. Cat. no. HWL 51. Canberra: Australian Institute of Health and Welfare; 2013.Google Scholar
  28. 28.
    Roberts AS, Benrimoj SI, Chen TF, Williams KA, Aslani P. Practice change in community pharmacy: quantification of facilitators. Ann Pharmacother. 2008;42(6):861–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Feletto E, Wilson LK, Roberts AS, Benrimoj SI. Building capacity to implement cognitive pharmaceutical services: quantifying the needs of community pharmacies. Res Soc Adm Pharm. 2010;6(3):163–73.CrossRefGoogle Scholar
  30. 30.
    Tordoff J, Chang SY, Norris PT. Community pharmacists’ perceptions of services that benefit older people in New Zealand. Int J Clin Pharm. 2012;34(2):342–50.CrossRefPubMedGoogle Scholar
  31. 31.
    Rosenthal M, Grindrod KA, Lynd L, Marra CA, Bougher D, Wilgosh C, et al. Pharmacists’ perspectives on providing chronic disease management services in the community—part II: development and implementation of services. Can Pharm J. 2009;142(6):284–8.CrossRefGoogle Scholar
  32. 32.
    Ibrahim A, Scott J. Community pharmacists in Khartoum State, Sudan: their current roles and perspectives on pharmaceutical care implementation. Int J Clin Pharm. 2013;35(2):236–43.CrossRefPubMedGoogle Scholar
  33. 33.
    Willink DP, Isetts BJ. Becoming ‘indispensable’: developing innovative community pharmacy practices. J Am Pharm Assoc. 2005;45(3):376–89.CrossRefGoogle Scholar
  34. 34.
    AbuRuz S, Al-Ghazawi M, Snyder A. Pharmaceutical care in a community-based practice setting in Jordan: Where are we now with our attitudes and perceived barriers? Int J Pharm Pract. 2012;20(2):71–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Urbonas G, Jakusovaite I, Savickas A. Pharmacy specialists’ attitudes toward pharmaceutical service quality at community pharmacies. Medicina (Kaunas). 2010;46(10):686–92.Google Scholar
  36. 36.
    Bryant LJM, Coster G, Gamble GD, McCormick RN. General practitioners’ and pharmacists’ perceptions of the role of community pharmacists in delivering clinical services. Res Soc Adm Pharm. 2009;5(4):347–62.CrossRefGoogle Scholar
  37. 37.
    Herbert KE, Urmie JM, Newland BA, Farris KB. Prediction of pharmacist intention to provide Medicare medication therapy management services using the theory of planned behavior. Res Soc Adm Pharm. 2006;2(3):299–314.CrossRefGoogle Scholar
  38. 38.
    Gastelurrutia MA, Benrimoj SI, Castrillon CC, de Amezua MJC, Fernandez-Llimos F, Faus MJ. Facilitators for practice change in Spanish community pharmacy. Pharm World Sci. 2009;31(1):32–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Grindrod KA, Rosenthal M, Lynd L, Marra CA, Bougher D, Wilgosh C, et al. Pharmacists’ perspectives on providing chronic disease management services in the community—part I: current practice environment. Can Pharm J. 2009;142(5):234–9.CrossRefGoogle Scholar
  40. 40.
    Helper CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533–43.Google Scholar
  41. 41.
    Grimes T, Duggan C, Gallagher P, Strawbridge J. Care of the stroke patient—communication between the community pharmacist and prescribers in the Republic of Ireland. Pharm World Sci. 2009;31(6):648–55.CrossRefPubMedGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015

Authors and Affiliations

  • Hanni Prihhastuti Puspitasari
    • 1
    • 2
    Email author
  • Parisa Aslani
    • 1
  • Ines Krass
    • 1
  1. 1.Faculty of PharmacyUniversity of SydneySydneyAustralia
  2. 2.Fakultas FarmasiUniversitas AirlanggaSurabayaIndonesia

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