Title: Community pharmacy interventions for public health priorities: a systematic review of community pharmacy delivered smoking alcohol and weight management interventions
Funder: Department of Health (England)

Abstract: Obesity smoking and excessive alcohol intake are three of the most significant modifiable risk factors for morbidity and mortality in the UK. Conditions which are caused or exacerbated by these risk factors include cardiovascular disease liver disease and lung cancer. The way in which society is organised causes inequalities in these conditions and inequalities in these conditions are major contributors to overall inequalities in health morbidity and mortality.The government has set a clear agenda for the future of public health in the UK focused on improving the healthy life expectancy of the population and where possible reducing or removing threats to this aim. Community pharmacies could potentially make a significant positive contribution to this agenda. Compared with other healthcare providers (such as GPs and Practice Nurses) community pharmacies offer the advantage that they are widely available and accessible at a time convenient to users; there are over 10500 in England distributed across urban and rural areas. A recent report has estimated that 99% of the population can get to a pharmacy from their home within 20 minutes either by car by walking or using public transport. Importantly this includes the 10% of the population who live in the most deprived areas of the country.Many community pharmacies now offer services commissioned by local authorities related to weight management smoking cessation and alcohol screening and brief intervention. However despite substantial commissioning of community pharmacy services and the significant potential they have (for the reasons outlined above) to provide a useful service to the public and reduce health inequalities it is not yet clear whether these services are effective.In this systematic review we will assess the effectiveness of public health interventions delivered by community pharmacists that aim to reduce and prevent overweight and obesity smoking and excessive alcohol consumption and assess whether there are heterogeneity effects for population features such as socioeconomic status. We will highlight any gaps in the evidence base and seek to establish how such public health interventions are organised implemented and delivered.Methods and designThe design of our review is informed by the results of our scoping search and will be carried out following established criteria for the good conduct of systematic reviews (Higgins & Green 2011) and guided by a Review Steering Group.Interventions: The review will examine community pharmacy interventions which focus on weight management smoking cessation and alcohol misuse amongst people of all ages in any setting (including NHS settings) and in any country. Study designs: A comprehensive literature search will be conducted for all RCTs NRCTs CBAs ITS and repeated measures studies (EPOC inclusion criteria).In addition given that there is a lack of EPOC level evidence on community pharmacy-based alcohol misuse interventions we will include (independent) UK evaluations of these interventions. Search strategy: We will run one overarching search to identify studies of relevance for all three topics and include the following electronic database searches: MEDLINE Embase CINAHL PsycINFO Social Science Citation Index ASSIA IBSS Sociological Abstracts and the NHS Economic Evaluation Database. All databases will be searched from start date to the present. We will not exclude papers on the basis of language or country of origin. We will supplement the electronic database searches with website and grey literature searches and will search trial registers and websites of funding organisations for ongoing studies. We will handsearch relevant conference abstracts and the bibliographies of all included studies and request relevant information on unpublished and in-progress research from key experts in the field.We will also seek (independent) evaluations on community pharmacy-led interventions related to alcohol from a range of organisations and people in the UK (local councils in the UK; pharmacy local practice forums an advert in the Pharmaceutical Journal; Google searches).Outcomes: The review will utilise the causal modelling framework proposed by Hardeman et al (2005) to conceptualise behavioural outcome measures and we will only include studies if they include at least one outcome which fits into one of four categories listed; Determinant of Behaviour Behaviour outcomes Physiology and biochemical outcomes Hardeman outcomesData on socioeconomic status and context where available will be collected to enable us to answer the secondary objectives of the review. Data extraction and quality appraisal: These tasks will be conducted following established criteria for the good conduct of systematic reviews (Higgins & Green 2011). Analysis and synthesisWe will conduct meta-analyses if appropriate using Stata for regular meta-analyses and WinBUGS for more complex analyses. If meta-analyses are not conducted the synthesis will be restricted to a narrative overview and forest plots may be used to illustrate the results. We will also investigate publication bias by using funnel plot and Egger’s test.Those studies included under the primary outcome analysis that also examine socioeconomic status will be included in the health inequalities analysis. If this data is not available for this analysis we will summarise the best available data (including information reported in evaluations) in a way which is of most use to the users of this review.Our analysis will emphasise explaining heterogeneity of effects including a moderator analyses for population features such as socio-economic status and ethnicity. If there is sufficient data we will also take features of the interventions delivered into consideration as intervention content might be highly heterogeneous.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: GENERIC HEALTH RELEVANCE