Systematic review of the effectiveness of community pharmacy-based interventions to reduce risk behaviours and risk factors for coronary heart disease.

BACKGROUND The aim of the study was to provide a critical and comprehensive overview of the published peer-reviewed evidence relating to community pharmacy-based activity in the reduction of risk behaviours and risk factors for coronary heart disease (CHD). METHOD Electronic databases were searched from 1 January 1990 to 1 February 2001. Hand searches for the same period were undertaken of specific journals and proceedings of peer-reviewed conference abstracts. Data abstracted from publications included: participants/setting; study designs intervention including training); outcome measures; key findings. RESULTS Four randomized controlled trials (RCTs) were identified, two in smoking cessation and two in lipid management. All met review criteria and were included. Two (RCTs) involving 976 subjects and three non-randomized experimental studies were identified that evaluated the effectiveness of community pharmacy advice in smoking cessation. Two controlled trials and one before-and-after study investigated the effect of training on pharmacists' smoking cessation advice. One attitudinal survey collected data on reactive and proactive smoking cessation advice-giving by community pharmacists. Two RCTs involving 642 subjects, and two observational studies were identified for community pharmacy-based lipid management. The published studies provided evidence of clinical and cost-effectiveness of community pharmacy services from UK RCTs in smoking cessation, and from US and Canadian RCTs in lipid management in the prevention of heart disease. Although the role of the community pharmacy in disease detection and case finding has been widely discussed, only a small number of studies was found. The findings indicated that further investigation is warranted in these areas. CONCLUSION The peer-reviewed literature demonstrates the contribution of community pharmacy-based services to the reduction of risk behaviours and risk factors for CHD. The evidence supports the wider provision of smoking cessation and lipid management through community pharmacies. Health commissioners and planners can use the findings of this review to incorporate community pharmacy based health development activities into local health services. Further research is needed into the contribution of community pharmacy to disease detection and case finding as part of local public health strategies.