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Stakeholders’ Acceptability of Pharmacist-Led Screening in Community Pharmacies: A Systematic Review

Open AccessPublished:June 07, 2022DOI:https://doi.org/10.1016/j.amepre.2022.04.023

      Introduction

      Community pharmacists are among the most accessible healthcare providers. Community pharmacist-led screening may facilitate the early detection of illnesses/medical risk factors, optimizing health outcomes. However, it is important to assess the acceptability of screening services to ensure uptake by key stakeholders. The aim of this review was to explore the acceptability of community pharmacist-led screening by all stakeholders (i.e., patients, pharmacists, and other healthcare professionals) and identify the methods used to evaluate the acceptability of screening.

      Methods

      A systematic search was conducted in Embase, MEDLINE, International Pharmaceutical Abstracts, and Scopus in April 2020 since inception. Studies that explored the acceptability of pharmacist-led screening for any risk factor/medical condition(s) within community pharmacies were included.

      Results

      A total of 44 studies met the inclusion criteria. A total of 17 studies identified community pharmacies as appropriate screening locations. Seven studies reported that patients were comfortable with participating in pharmacist-led screening. Eight studies explored acceptability from the perspective of medical practitioners and other healthcare professionals, with 6 reporting high recommendation acceptance rates and/or acceptability of pharmacist-led screening. Barriers to pharmacist-led screening included time and privacy constraints, whereas adequate remuneration was considered an important enabler.

      Discussion

      Community pharmacist-led screening appears to be acceptable to patients, pharmacists, and other healthcare professionals. However, no uniform psychometrically sound measure of acceptability was used consistently across studies, rendering comparisons difficult and showing the need for future research exploring the psychometric properties of acceptability measures. Findings, including barriers and enablers to pharmacist-led screening, are important to consider when providing screening services in community pharmacies.

      INTRODUCTION

      Community pharmacists are among the most accessible and trusted healthcare professionals (HCPs) with expanding roles in the provision of professional services.
      • Bell NR
      • Grad R
      • Dickinson JA
      • et al.
      Better decision making in preventive health screening: balancing benefits and harms.
      Patients are up to 10 times more likely to visit a pharmacy than a primary care physician,
      • Tsuyuki RT
      • Beahm NP
      • Okada H
      • Al Hamarneh YN
      Pharmacists as accessible primary health care providers: review of the evidence.
      averaging 18 visits per year.

      Community pharmacy. Australian Industry and Skills Committee. https://nationalindustryinsights.aisc.net.au/industries/retail-and-wholesale/community-pharmacy. Updated January 24, 2022. Accessed September 2, 2021.

      Patients may frequent community pharmacies to obtain a prescription or over-the-counter medications.
      • Berenbrok LA
      • Gabriel N
      • Coley KC
      • Hernandez I.
      Evaluation of frequency of encounters with primary care physicians vs visits to community pharmacies among Medicare beneficiaries.
      Hence, pharmacists constantly communicate with patients, fostering the provision of pharmacy-based screening services. Primary care settings, including general practitioners’ (GPs) clinics and community pharmacies, are often the first point of contact in the healthcare system.

      Primary health care in Australia. Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports/primary-health-care/primary-health-care-in-australia/contents/about-primary-health-care. Updated May 24, 2016. Accessed March 14, 2022.

      Owing to their accessibility, community pharmacies may be appropriate locations for pharmacist-led screening for diseases and risk factors, allowing for early detection and intervention.
      • Berbatis CG
      • Sunderland VB
      • Joyce A
      • Bulsara M
      • Mills C.
      Enhanced pharmacy services, barriers and facilitators in Australia's community pharmacies: Australia's National Pharmacy Database Project.
      Studies have shown that patients are willing to participate in pharmacist-led screening for various risk factors/medical conditions
      • Hourihan F
      • Krass I
      • Chen T.
      Rural community pharmacy: a feasible site for a health promotion and screening service for cardiovascular risk factors.
      and reported such services are feasible.
      • Wilson C
      • Twigg G.
      Pharmacist-led depression screening and intervention in an underserved, rural, and multi-ethnic diabetic population.
      Pharmacist-led screening can be time consuming so it is important that these services are revenue generating, which can be achieved through remuneration.
      Community pharmacists are well-placed to deliver screening services, particularly for medical conditions that may not be routinely screened for by other HCPs, such as asthma, and chronic obstructive pulmonary disease.
      • Castillo D
      • Guayta R
      • Giner J
      • et al.
      COPD case finding by spirometry in high-risk customers of urban community pharmacies: a pilot study.
      Furthermore, these services may be especially important in rural/remote areas, where there is a significantly smaller number of healthcare providers than in urban areas.

      Rural & remote health. Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports/rural-remote-australians/rural-remote-health/contents/access-to-health-care. Updated October 22, 2019. Accessed March 14, 2022.

      Pharmacists employed in rural/remote areas may have a wider scope of practice owing to being the only accessible HCP, resulting in greater service provision.
      • Hays CA
      • Taylor SM
      • Glass BD.
      The rural pharmacy practice landscape: challenges and motivators.
      Acceptability has been defined as “the perception among implementation stakeholders that a given treatment, service, practice, or innovation is agreeable, palatable, or satisfactory.”
      • Proctor E
      • Silmere H
      • Raghavan R
      • et al.
      Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda.
      Exploration of acceptability is essential for the adoption and sustainability of screening interventions.
      • Proctor E
      • Silmere H
      • Raghavan R
      • et al.
      Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda.
      ,
      • De Marchis EH
      • Hessler D
      • Fichtenberg C
      • et al.
      Part I: a quantitative study of social risk screening acceptability in patients and caregivers.
      The social validity and clinical impact of interventions may be compromised if they are not acceptable to stakeholders.

      Cancer. World Health Organization. https://www.who.int/cancer/prevention/diagnosis-screening/screening/en/. Accessed July 29, 2020.

      Ayorinde et al.15’s systematic review explored the acceptability and feasibility of pharmacist-led screening services. They concluded that pharmacist-led screening is acceptable to patients, pharmacists, and physicians. However, this review only included studies from 1990 to 2012 and focused solely on WHO major diseases, including cardiovascular disease (CVD) and cancer.
      • Ayorinde AA
      • Porteous T
      • Sharma P.
      Screening for major diseases in community pharmacies: a systematic review.
      Hence, there is not only a need for a comprehensive review of the acceptability of pharmacist-led screening in the last decade but also a need to identify all studies exploring the acceptability of pharmacist-led screening for any medical condition/risk factor. In addition, this previous review did not explore acceptability specifically and had a much broader scope. Furthermore, no previous review has included the perspectives of other HCPs toward pharmacist-led screening. Hence, the aim of this systematic review was to explore the acceptability of pharmacist-led screening in community pharmacies. Specifically, our objectives were to (1) determine whether community pharmacist-led screening is acceptable to all stakeholders (i.e., patients, pharmacists, and other HCPs), (2) identify all medical conditions/risk factors evaluated in studies reporting on the acceptability of pharmacist-led screening, and (3) explore the measurement methods used to evaluate the acceptability of pharmacist-led screening.

      METHODS

      Systematic Search

      The PRISMA statement guided this systematic review.
      • Page MJ
      • McKenzie JE
      • Bossuyt PM
      • et al.
      The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
      Systematic literature searches were conducted through Embase, MEDLINE, International Pharmaceutical Abstracts, and Scopus on April 16, 2020 since inception, by author YLEL. An academic librarian was consulted during the development and refinement of the search keywords and strategies and when deciding which databases to use. Appendix Tables 1 and 2 (available online) present the sample search strategies conducted in Embase and MEDLINE. The search strategy was piloted and reviewed with 2 authors (CLO and SED), included both keywords and medical subject headings (when available), and was based on the following concepts and related terms (depending on the database):
      • screen* or screening or screening tool* or screening test or clinical assessment or risk assessment or community pharmacy services AND
      • pharmac* or pharmacist* or community pharmacist* AND
      • accept* or attitude* or satisf* or patient satisfaction or program acceptability or patient acceptance of health care or pharmacist attitude or pharmacist-patient relationship.

      Inclusion and Exclusion Criteria

      This systematic review specifically explores the evidence pertaining to the acceptability of community pharmacist-led screening, hence it only includes studies reporting on screening services conducted by community pharmacists. Studies involving other HCPs performing a major role in screening were excluded if the results relating to the acceptability of pharmacists’ roles could not be extracted. Studies that mentioned acceptability or its derivatives (e.g., acceptance, accept) in the title, abstract, objectives, methods, or results sections of the manuscript were included. Therefore, studies that investigated related constructs, such as satisfaction or comfort, pertaining to screening but did not explicitly mention acceptability (or its derivatives) in the sections mentioned earlier were excluded. Studies that explored the psychometric properties of screening tools without measuring or reporting on acceptability were excluded. However, studies that met other inclusion criteria and investigated the properties and acceptability of screening tools were eligible for inclusion. Provided the inclusion and exclusion criteria were met, all primary research studies, regardless of study design, were eligible.

      Study Selection

      YLEL conducted searches in all databases and exported records to Endnote (X9.3.1)
      EndNote
      [computer program]. Version EndNote X9.
      for automatic and manual deduplication. Records were screened against the inclusion and exclusion criteria by title and then by abstract. The full texts of the remaining publications were then screened on the basis of the inclusion and exclusion criteria (Table 1) and were classified as included, excluded, or to be discussed because of uncertainty, whereby articles were reviewed by coauthors CLO and SED to reach consensus by YLEL, CLO, and SED.
      Table 1Inclusion and Exclusion Criteria
      Inclusion criteriaExclusion criteria
      Citations were included if they reported on primary research studies whereby:
      • Screening services were conducted within a community pharmacy setting.
      • Screening services were conducted for any illness or medical risk factor (e.g., early depression symptoms, potential risk of obesity).
      • Screening services were conducted by pharmacists.
      • Acceptability or its derivatives (e.g., accept, acceptance) was specifically mentioned in the title, abstract, objectives, methods, or results of the manuscript.
      Citations were excluded if they:
      • were published in languages other than English and
      • reported on the psychometric properties of screening tools but did not explore the acceptability of screening.

      Data Extraction and Synthesis

      Data were initially extracted by YLEL in consultation with SED and CLO and then reviewed and refined independently by DNG in consultation with SED and CLO. Data relating to the study aim, population, risk factor(s)/medical condition(s) being screened, and screening tool used were extracted. Data relating to the acceptability of pharmacist-led screening were extracted in detail and synthesized to identify data pertaining to the population whose acceptability was ascertained, method of acceptability measurement, key outcomes relating to acceptability, and terms used to measure/describe acceptability.

      RESULTS

      Literature Search

      The systematic searches yielded 3,930 potentially relevant citations, of which 767 were duplicates. A systematic screening process was used (Figure 1) to screen titles, abstracts, and full-text publications, resulting in 44 eligible studies. Reasons for exclusion of full texts included that acceptability (or its derivatives) was not explicitly mentioned in the title, abstract, objectives, methods, or results section(s) of the manuscript; pharmacist-led screening services were not provided; or the study only reported on screening tool properties.
      Figure 1
      Figure 1PRISMA flowchart of the article selection process.
      • Page MJ
      • McKenzie JE
      • Bossuyt PM
      • et al.
      The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.

      General Characteristics

      A total of 44 publications published between 2002 and 2020 were included in this systematic review. Detailed information pertaining to the data extracted from each study is presented in Appendix Table 3 (available online). Most studies took place in high-income countries (n=37), including the U.S. (n=10), Australia (n=9), and the United Kingdom (n=8). Studies explored the perspectives of patients (n=19); pharmacists (n=10); and other HCPs, including medical practitioners (n=3), lung function experts (n=1), and physicians and nurse practitioners (n=1). Some studies explored the perspectives of multiple stakeholders, namely patients and pharmacists (n=7), medical practitioners and pharmacists (n=2), and medical practitioners and patients (n=1).
      Studies investigated the acceptability of pharmacist-led screening for various risk factors/medical conditions. Nine studies explored the acceptability of pharmacist-led screening for CVDs,
      • Lowres N
      • Krass I
      • Neubeck L
      • et al.
      Atrial fibrillation screening in pharmacies using an iPhone ECG: a qualitative review of implementation.
      • Marfo AF
      • Owusu-Daaku FT.
      Evaluation of a pharmacist-led hypertension preventative and detection service in the Ghanaian community pharmacy: an exploratory study.
      such as hypertension,
      • Michael D
      • Kezakubi D
      • Juma A
      • Todd J
      • Reyburn H
      • Renju J.
      The feasibility and acceptability of screening for hypertension in private drug retail outlets: a pilot study in Mwanza region, Tanzania.
      ,
      • Vodicka E
      • Antiporta DA
      • Yshii Y
      • Zunt JR
      • Garcia PJ.
      Patient acceptability of and readiness-to-pay for pharmacy-based health membership plans to improve hypertension outcomes in Lima, Peru.
      ,
      • Marfo AF
      • Owusu-Daaku FT.
      Evaluation of a pharmacist-led hypertension preventative and detection service in the Ghanaian community pharmacy: an exploratory study.
      atrial fibrillation,
      • Lowres N
      • Krass I
      • Neubeck L
      • et al.
      Atrial fibrillation screening in pharmacies using an iPhone ECG: a qualitative review of implementation.
      ,
      • Staszewsky L
      • Pasina L
      • Musazzi UM
      • Latini R
      Collaborative Group of Pharmacists 4 of the Health District in Lecco (Northern Italy)
      Screening for unknown atrial fibrillation in older people: a feasibility study in community pharmacies.
      and hyperlipidemia.
      • Tice B
      • Phillips CR.
      Implementation and evaluation of a lipid screening program in a large chain pharmacy.
      Seven studies reported on the acceptability of pharmacist-led screening for excessive alcohol consumption.
      • Brown S
      • Henderson E
      • Sullivan C.
      The feasibility and acceptability of the provision of alcohol screening and brief advice in pharmacies for women accessing emergency contraception: an evaluation study.
      • Sheridan J
      • Stewart J
      • Smart R
      • McCormick R.
      Risky drinking among community pharmacy customers in New Zealand and their attitudes towards pharmacist screening and brief interventions.
      Four studies reported on the acceptability of pharmacist-led screening for chlamydia,

      Baraitser P, Pearce V, Holmes J, Horne N, Boynton PM. Chlamydia testing in community pharmacies: evaluation of a feasibility pilot in south east London. Qual Saf Health Care. 2007;16(4):303–307. https://doi.org/10.1136/qshc.2006.020883.

      • Parker RM
      • Bell A
      • Currie MJ
      • et al.
      Catching chlamydia’: combining cash incentives and community pharmacy access for increased chlamydia screening, the view of young people.
      and 3 studies reported on the acceptability of pharmacist-led screening for HIV,
      • Ryder PT
      • Meyerson BE
      • Coy KC
      • von Hippel CD
      Pharmacists’ perspectives on HIV testing in community pharmacies.
      • Mugo PM
      • Micheni M
      • Shangala J
      • et al.
      Uptake and acceptability of oral HIV self-testing among community pharmacy clients in Kenya: a feasibility study.
      chronic obstructive pulmonary disease,
      • Castillo D
      • Guayta R
      • Giner J
      • et al.
      COPD case finding by spirometry in high-risk customers of urban community pharmacies: a pilot study.
      ,
      • Castillo D
      • Burgos F
      • Guayta R
      • et al.
      Airflow obstruction case finding in community-pharmacies: a novel strategy to reduce COPD underdiagnosis.
      ,
      • Fuller L
      • Conrad WF
      • Heaton PC
      • Panos R
      • Eschenbacher W
      • Frede SM.
      Pharmacist-managed chronic obstructive pulmonary disease screening in a community setting.
      and osteoporosis.
      • Elliott ME
      • Meek PD
      • Kanous NL
      • et al.
      Osteoporosis screening by community pharmacists: use of National Osteoporosis Foundation resources.
      • Chaiyakunapruk N
      • Laowakul A
      • Karnchanarat S
      • Pikulthong N
      • Ongphiphadhanakul B.
      Community pharmacy-based implementation and evaluation of an osteoporosis self-assessment tool for Asians.
      Three studies explored the acceptability of pharmacist-led screening for multiple conditions, namely diabetes and CVD
      • Alzubaidi HT
      • Chandir S
      • Hasan S
      • McNamara K
      • Cox R
      • Krass I.
      Diabetes and cardiovascular disease risk screening model in community pharmacies in a developing primary healthcare system: a feasibility study.
      ; anemia, diabetes, and hypertension
      • Saldarriaga EM
      • Vodicka E
      • La Rosa S
      • Valderrama M
      • Garcia PJ
      Point-of-care testing for anemia, diabetes, and hypertension: a pharmacy-based model in Lima, Peru.
      ; and opioid misuse, HIV, and hepatitis C.
      • Meyerson BE
      • Agley JD
      • Jayawardene W
      • et al.
      Feasibility and acceptability of a proposed pharmacy-based harm reduction intervention to reduce opioid overdose, HIV and hepatitis C.

      Methods of Acceptability Measurement

      A total of 29 studies used quantitative methods,
      • Castillo D
      • Guayta R
      • Giner J
      • et al.
      COPD case finding by spirometry in high-risk customers of urban community pharmacies: a pilot study.
      ,
      • Peterson GM
      • Fitzmaurice KD
      • Kruup H
      • Jackson SL
      • Rasiah RL.
      Cardiovascular risk screening program in Australian community pharmacies.
      • Tice B
      • Phillips CR.
      Implementation and evaluation of a lipid screening program in a large chain pharmacy.
      ,
      • Brown S
      • Henderson E
      • Sullivan C.
      The feasibility and acceptability of the provision of alcohol screening and brief advice in pharmacies for women accessing emergency contraception: an evaluation study.
      ,
      • Hattingh HL
      • Hallett J
      • Tait RJ.
      Making the invisible visible’ through alcohol screening and brief intervention in community pharmacies: an Australian feasibility study.
      ,
      • Khan NS
      • Norman IJ
      • Dhital R
      • McCrone P
      • Milligan P
      • Whittlesea CM.
      Alcohol brief intervention in community pharmacies: a feasibility study of outcomes and customer experiences.
      ,
      • Sheridan J
      • Stewart J
      • Smart R
      • McCormick R.
      Risky drinking among community pharmacy customers in New Zealand and their attitudes towards pharmacist screening and brief interventions.
      ,
      • Taylor KL
      • Clifford RM
      • Marshall L.
      Acceptance of a Chlamydia screening program in community pharmacies.
      ,
      • Darin KM
      • Klepser ME
      • Klepser DE
      • et al.
      Pharmacist-provided rapid HIV testing in two community pharmacies.
      • Papastergiou J
      • Trieu CR
      • Saltmarche D
      • Diamantouros A.
      Community pharmacist-directed point-of-care group A Streptococcus testing: evaluation of a Canadian program.
      12 studies used qualitative methods,
      • Lowres N
      • Krass I
      • Neubeck L
      • et al.
      Atrial fibrillation screening in pharmacies using an iPhone ECG: a qualitative review of implementation.
      • Peterson GM
      • Jackson SL
      • Hughes JD
      • Fitzmaurice KD
      • Murphy LE.
      Public perceptions of the role of Australian pharmacists in cardiovascular disease.
      ,
      • Marfo AF
      • Owusu-Daaku FT.
      Evaluation of a pharmacist-led hypertension preventative and detection service in the Ghanaian community pharmacy: an exploratory study.
      ,
      • Fitzgerald N
      • McCaig DJ
      • Watson H
      • Thomson D
      • Stewart DC.
      Development, implementation and evaluation of a pilot project to deliver interventions on alcohol issues in community pharmacies.
      ,
      • Dhital R
      • Whittlesea CM
      • Norman IJ
      • Milligan P.
      Community pharmacy service users’ views and perceptions of alcohol screening and brief intervention.
      ,
      • Gudka S
      • Marshall L
      • Creagh A
      • Clifford RM.
      To develop and measure the effectiveness and acceptability of a pharmacy-based chlamydia screening intervention in Australia.
      ,
      • Ryder PT
      • Meyerson BE
      • Coy KC
      • von Hippel CD
      Pharmacists’ perspectives on HIV testing in community pharmacies.
      ,
      • Irvine-Meek J
      • Gould ON
      • Wheaton H
      • Todd LE.
      Acceptability and face validity of a geriatric self-medication assessment tool.
      • Dong BJ
      • Lopez M
      • Cocohoba J.
      Pharmacists performing hepatitis C antibody point-of-care screening in a community pharmacy: a pilot project.
      and 3 studies used mixed methods (i.e., both quantitative and qualitative methods) to measure acceptability.

      Krska J, Mackridge AJ. Involving the public and other stakeholders in development and evaluation of a community pharmacy alcohol screening and brief advice service. Public Health. 2014;128(4):309–316. https://doi.org/10.1016/j.puhe.2013.11.001.

      ,

      Baraitser P, Pearce V, Holmes J, Horne N, Boynton PM. Chlamydia testing in community pharmacies: evaluation of a feasibility pilot in south east London. Qual Saf Health Care. 2007;16(4):303–307. https://doi.org/10.1136/qshc.2006.020883.

      ,
      • Parker RM
      • Bell A
      • Currie MJ
      • et al.
      Catching chlamydia’: combining cash incentives and community pharmacy access for increased chlamydia screening, the view of young people.
      Acceptability measurements ranged from 1 to 34 questions; however, most studies did not specify the number of questions included in the surveys or interviews. Quantitative studies were mostly answered on a 5-point Likert scale, and qualitative studies mostly consisted of open-ended questions.
      All quantitative studies involved surveys to measure acceptability. Most surveys were developed by research team members. Although some studies described the development of survey instruments, the psychometric properties, including the validity and reliability, of most surveys were not explored, with some exceptions. For example, the 34-item computer-assisted telephone interview questionnaire developed by Gudka and colleagues
      • Gudka S
      • Marshall L
      • Creagh A
      • Clifford RM.
      To develop and measure the effectiveness and acceptability of a pharmacy-based chlamydia screening intervention in Australia.
      was piloted among 5 pharmacy students and further revised. Similarly, Chaiyakunapruk et al.
      • Chaiyakunapruk N
      • Laowakul A
      • Karnchanarat S
      • Pikulthong N
      • Ongphiphadhanakul B.
      Community pharmacy-based implementation and evaluation of an osteoporosis self-assessment tool for Asians.
      validated survey items using an expert panel and then piloted among 10 patients and refined items accordingly, thereby exploring both content and face validity. Other studies also reported conducting validation using experts
      • Meyerson BE
      • Agley JD
      • Jayawardene W
      • et al.
      Feasibility and acceptability of a proposed pharmacy-based harm reduction intervention to reduce opioid overdose, HIV and hepatitis C.
      and piloting items.
      • Sheridan J
      • Stewart J
      • Smart R
      • McCormick R.
      Risky drinking among community pharmacy customers in New Zealand and their attitudes towards pharmacist screening and brief interventions.
      ,
      • Meyerson BE
      • Agley JD
      • Jayawardene W
      • et al.
      Feasibility and acceptability of a proposed pharmacy-based harm reduction intervention to reduce opioid overdose, HIV and hepatitis C.
      Brown and colleagues
      • Brown S
      • Henderson E
      • Sullivan C.
      The feasibility and acceptability of the provision of alcohol screening and brief advice in pharmacies for women accessing emergency contraception: an evaluation study.
      adapted survey questions from previous studies investigating attitudes toward dentist-led alcohol screening, whereas Ryder et al.
      • Ryder PT
      • Meyerson BE
      • Coy KC
      • von Hippel CD
      Pharmacists’ perspectives on HIV testing in community pharmacies.
      developed survey questions on the basis of a previous literature review.
      Among the 12 qualitative studies included in this review, 11 studies involved the use of semistructured interviews, either face to face (n=8),
      • Lowres N
      • Krass I
      • Neubeck L
      • et al.
      Atrial fibrillation screening in pharmacies using an iPhone ECG: a qualitative review of implementation.
      ,
      • Marfo AF
      • Owusu-Daaku FT.
      Evaluation of a pharmacist-led hypertension preventative and detection service in the Ghanaian community pharmacy: an exploratory study.
      ,
      • Dhital R
      • Whittlesea CM
      • Norman IJ
      • Milligan P.
      Community pharmacy service users’ views and perceptions of alcohol screening and brief intervention.
      ,
      • Ryder PT
      • Meyerson BE
      • Coy KC
      • von Hippel CD
      Pharmacists’ perspectives on HIV testing in community pharmacies.
      ,
      • Irvine-Meek J
      • Gould ON
      • Wheaton H
      • Todd LE.
      Acceptability and face validity of a geriatric self-medication assessment tool.
      • Dong BJ
      • Lopez M
      • Cocohoba J.
      Pharmacists performing hepatitis C antibody point-of-care screening in a community pharmacy: a pilot project.
      or by telephone (n=3).
      • Michael D
      • Kezakubi D
      • Juma A
      • Todd J
      • Reyburn H
      • Renju J.
      The feasibility and acceptability of screening for hypertension in private drug retail outlets: a pilot study in Mwanza region, Tanzania.
      ,
      • Peterson GM
      • Jackson SL
      • Hughes JD
      • Fitzmaurice KD
      • Murphy LE.
      Public perceptions of the role of Australian pharmacists in cardiovascular disease.
      ,
      • Fitzgerald N
      • McCaig DJ
      • Watson H
      • Thomson D
      • Stewart DC.
      Development, implementation and evaluation of a pilot project to deliver interventions on alcohol issues in community pharmacies.
      One study combined semistructured telephone interviews with patients and focus groups with patients and pharmacists.

      Krska J, Mackridge AJ. Involving the public and other stakeholders in development and evaluation of a community pharmacy alcohol screening and brief advice service. Public Health. 2014;128(4):309–316. https://doi.org/10.1016/j.puhe.2013.11.001.

      Concepts Used to Assess Acceptability

      There were no universal tools identified in included studies that assessed the acceptability of screening. However, common terms used to describe or assess acceptability were identified, including appropriateness of pharmacist-led screening, comfort in delivering or participating in screening, satisfaction with screening, confidence in delivering screening, and usefulness of screening.

      Stakeholder Perspectives on the Acceptability of Pharmacist-Led Screening

      A total of 19 studies explored patients’ acceptability of pharmacist-led screening.
      • Michael D
      • Kezakubi D
      • Juma A
      • Todd J
      • Reyburn H
      • Renju J.
      The feasibility and acceptability of screening for hypertension in private drug retail outlets: a pilot study in Mwanza region, Tanzania.
      • Peterson GM
      • Fitzmaurice KD
      • Kruup H
      • Jackson SL
      • Rasiah RL.
      Cardiovascular risk screening program in Australian community pharmacies.
      ,
      • Taylor J
      • Krska J
      • Mackridge A.
      A community pharmacy-based cardiovascular screening service: views of service users and the public.
      • Tice B
      • Phillips CR.
      Implementation and evaluation of a lipid screening program in a large chain pharmacy.
      ,
      • Brown S
      • Henderson E
      • Sullivan C.
      The feasibility and acceptability of the provision of alcohol screening and brief advice in pharmacies for women accessing emergency contraception: an evaluation study.
      ,
      • Hattingh HL
      • Hallett J
      • Tait RJ.
      Making the invisible visible’ through alcohol screening and brief intervention in community pharmacies: an Australian feasibility study.
      ,
      • Dhital R
      • Whittlesea CM
      • Norman IJ
      • Milligan P.
      Community pharmacy service users’ views and perceptions of alcohol screening and brief intervention.
      • Sheridan J
      • Stewart J
      • Smart R
      • McCormick R.
      Risky drinking among community pharmacy customers in New Zealand and their attitudes towards pharmacist screening and brief interventions.
      ,
      • Parker RM
      • Bell A
      • Currie MJ
      • et al.
      Catching chlamydia’: combining cash incentives and community pharmacy access for increased chlamydia screening, the view of young people.
      ,
      • Darin KM
      • Klepser ME
      • Klepser DE
      • et al.
      Pharmacist-provided rapid HIV testing in two community pharmacies.
      ,
      • Mugo PM
      • Micheni M
      • Shangala J
      • et al.
      Uptake and acceptability of oral HIV self-testing among community pharmacy clients in Kenya: a feasibility study.
      ,
      • Alzubaidi HT
      • Chandir S
      • Hasan S
      • McNamara K
      • Cox R
      • Krass I.
      Diabetes and cardiovascular disease risk screening model in community pharmacies in a developing primary healthcare system: a feasibility study.
      ,
      • Saldarriaga EM
      • Vodicka E
      • La Rosa S
      • Valderrama M
      • Garcia PJ
      Point-of-care testing for anemia, diabetes, and hypertension: a pharmacy-based model in Lima, Peru.
      ,
      • Kjome RLS
      • Wright DJ
      • Bjaaen AB
      • Garstad KW
      • Valeur M.
      Dermatological cancer screening: evaluation of a new community pharmacy service.
      ,
      • Breslow RM.
      Patient attitudes regarding pharmacist-administered memory screening in community pharmacies.
      ,
      • Papastergiou J
      • Trieu CR
      • Saltmarche D
      • Diamantouros A.
      Community pharmacist-directed point-of-care group A Streptococcus testing: evaluation of a Canadian program.
      Ten studies assessed the acceptability of pharmacist-led screening from the perspective of community pharmacists conducting screening.
      • Lowres N
      • Krass I
      • Neubeck L
      • et al.
      Atrial fibrillation screening in pharmacies using an iPhone ECG: a qualitative review of implementation.
      ,
      • Staszewsky L
      • Pasina L
      • Musazzi UM
      • Latini R
      Collaborative Group of Pharmacists 4 of the Health District in Lecco (Northern Italy)
      Screening for unknown atrial fibrillation in older people: a feasibility study in community pharmacies.
      ,
      • Marfo AF
      • Owusu-Daaku FT.
      Evaluation of a pharmacist-led hypertension preventative and detection service in the Ghanaian community pharmacy: an exploratory study.
      ,
      • Ryder PT
      • Meyerson BE
      • Coy KC
      • von Hippel CD
      Pharmacists’ perspectives on HIV testing in community pharmacies.
      ,
      • Meyerson BE
      • Agley JD
      • Jayawardene W
      • et al.
      Feasibility and acceptability of a proposed pharmacy-based harm reduction intervention to reduce opioid overdose, HIV and hepatitis C.
      ,
      • Gauld N
      • Braganza C
      • Arroll B.
      Adapting the Auckland Sleep Screening Tool for pharmacy: pharmacists’ experience and feedback.
      ,
      • Mohamed SS
      • Mahmoud AA
      • Ali AA.
      Involvement of Sudanese community pharmacists in public health activities.
      ,
      • Irvine-Meek J
      • Gould ON
      • Wheaton H
      • Todd LE.
      Acceptability and face validity of a geriatric self-medication assessment tool.
      ,
      • Kilkenny MF
      • Johnson R
      • Andrew NE
      • et al.
      Comparison of two methods for assessing diabetes risk in a pharmacy setting in Australia.
      ,
      • Dong BJ
      • Lopez M
      • Cocohoba J.
      Pharmacists performing hepatitis C antibody point-of-care screening in a community pharmacy: a pilot project.
      Patient and pharmacist perspectives were most commonly assessed for CVD screening.
      • Lowres N
      • Krass I
      • Neubeck L
      • et al.
      Atrial fibrillation screening in pharmacies using an iPhone ECG: a qualitative review of implementation.
      • Marfo AF
      • Owusu-Daaku FT.
      Evaluation of a pharmacist-led hypertension preventative and detection service in the Ghanaian community pharmacy: an exploratory study.
      ,
      • Alzubaidi HT
      • Chandir S
      • Hasan S
      • McNamara K
      • Cox R
      • Krass I.
      Diabetes and cardiovascular disease risk screening model in community pharmacies in a developing primary healthcare system: a feasibility study.
      ,
      • Saldarriaga EM
      • Vodicka E
      • La Rosa S
      • Valderrama M
      • Garcia PJ
      Point-of-care testing for anemia, diabetes, and hypertension: a pharmacy-based model in Lima, Peru.
      Five studies reported on the acceptance of screening results by other HCPs,
      • Castillo D
      • Guayta R
      • Giner J
      • et al.
      COPD case finding by spirometry in high-risk customers of urban community pharmacies: a pilot study.
      ,
      • Castillo D
      • Burgos F
      • Guayta R
      • et al.
      Airflow obstruction case finding in community-pharmacies: a novel strategy to reduce COPD underdiagnosis.
      ,
      • Lata PF
      • Binkley NC
      • Elliott ME.
      Acceptability of pharmacy-based bone density measurement by women and primary healthcare providers.
      ,
      • Brown T
      • Robinson JM
      • Renfro CP
      • Blalock SJ
      • Ferreri S.
      Analysis of the relationship between patients’ fear of falling and prescriber acceptance of community pharmacists’ recommendations.
      ,
      • Hatah E
      • Braund R
      • Duffull S
      • Tordoff J.
      General practitioners’ perceptions of pharmacists’ new services in New Zealand.
      with most focusing on respiratory/musculoskeletal conditions.
      • Castillo D
      • Guayta R
      • Giner J
      • et al.
      COPD case finding by spirometry in high-risk customers of urban community pharmacies: a pilot study.
      ,
      • Castillo D
      • Burgos F
      • Guayta R
      • et al.
      Airflow obstruction case finding in community-pharmacies: a novel strategy to reduce COPD underdiagnosis.
      ,
      • Lata PF
      • Binkley NC
      • Elliott ME.
      Acceptability of pharmacy-based bone density measurement by women and primary healthcare providers.
      ,
      • Brown T
      • Robinson JM
      • Renfro CP
      • Blalock SJ
      • Ferreri S.
      Analysis of the relationship between patients’ fear of falling and prescriber acceptance of community pharmacists’ recommendations.
      Seven studies explored the perspectives of both pharmacists and patients,
      • Fitzgerald N
      • McCaig DJ
      • Watson H
      • Thomson D
      • Stewart DC.
      Development, implementation and evaluation of a pilot project to deliver interventions on alcohol issues in community pharmacies.
      ,

      Krska J, Mackridge AJ. Involving the public and other stakeholders in development and evaluation of a community pharmacy alcohol screening and brief advice service. Public Health. 2014;128(4):309–316. https://doi.org/10.1016/j.puhe.2013.11.001.

      ,

      Baraitser P, Pearce V, Holmes J, Horne N, Boynton PM. Chlamydia testing in community pharmacies: evaluation of a feasibility pilot in south east London. Qual Saf Health Care. 2007;16(4):303–307. https://doi.org/10.1136/qshc.2006.020883.

      • Taylor KL
      • Clifford RM
      • Marshall L.
      Acceptance of a Chlamydia screening program in community pharmacies.
      ,
      • Urwin H
      • Wright D
      • Twigg M
      • McGough N.
      Early recognition of coeliac disease through community pharmacies: a proof of concept study.
      ,
      • Nielsen S
      • Picco L
      • Kowalski M
      • et al.
      Routine opioid outcome monitoring in community pharmacy: outcomes from an open-label single-arm implementation-effectiveness pilot study.
      2 studies explored the perspectives of both medical practitioners and pharmacists,
      • Fuller L
      • Conrad WF
      • Heaton PC
      • Panos R
      • Eschenbacher W
      • Frede SM.
      Pharmacist-managed chronic obstructive pulmonary disease screening in a community setting.
      ,
      • Elliott ME
      • Meek PD
      • Kanous NL
      • et al.
      Osteoporosis screening by community pharmacists: use of National Osteoporosis Foundation resources.
      and 1 study explored the perspectives of both medical practitioners and patients.
      • Chaiyakunapruk N
      • Laowakul A
      • Karnchanarat S
      • Pikulthong N
      • Ongphiphadhanakul B.
      Community pharmacy-based implementation and evaluation of an osteoporosis self-assessment tool for Asians.

      Patients’ perspectives

      Among patients who participated in screening and follow-up interviews/surveys, 81%‒97% of respondents were satisfied with pharmacist-led screening.

      Baraitser P, Pearce V, Holmes J, Horne N, Boynton PM. Chlamydia testing in community pharmacies: evaluation of a feasibility pilot in south east London. Qual Saf Health Care. 2007;16(4):303–307. https://doi.org/10.1136/qshc.2006.020883.

      ,
      • Chaiyakunapruk N
      • Laowakul A
      • Karnchanarat S
      • Pikulthong N
      • Ongphiphadhanakul B.
      Community pharmacy-based implementation and evaluation of an osteoporosis self-assessment tool for Asians.
      ,
      • Alzubaidi HT
      • Chandir S
      • Hasan S
      • McNamara K
      • Cox R
      • Krass I.
      Diabetes and cardiovascular disease risk screening model in community pharmacies in a developing primary healthcare system: a feasibility study.
      ,
      • Kjome RLS
      • Wright DJ
      • Bjaaen AB
      • Garstad KW
      • Valeur M.
      Dermatological cancer screening: evaluation of a new community pharmacy service.
      ,
      • Breslow RM.
      Patient attitudes regarding pharmacist-administered memory screening in community pharmacies.
      ,
      • Papastergiou J
      • Trieu CR
      • Saltmarche D
      • Diamantouros A.
      Community pharmacist-directed point-of-care group A Streptococcus testing: evaluation of a Canadian program.
      Community pharmacy was perceived to be an appropriate location for screening,
      • Peterson GM
      • Fitzmaurice KD
      • Kruup H
      • Jackson SL
      • Rasiah RL.
      Cardiovascular risk screening program in Australian community pharmacies.
      ,
      • Taylor J
      • Krska J
      • Mackridge A.
      A community pharmacy-based cardiovascular screening service: views of service users and the public.
      ,
      • Marfo AF
      • Owusu-Daaku FT.
      Evaluation of a pharmacist-led hypertension preventative and detection service in the Ghanaian community pharmacy: an exploratory study.
      ,
      • Fitzgerald N
      • McCaig DJ
      • Watson H
      • Thomson D
      • Stewart DC.
      Development, implementation and evaluation of a pilot project to deliver interventions on alcohol issues in community pharmacies.
      ,
      • Hattingh HL
      • Hallett J
      • Tait RJ.
      Making the invisible visible’ through alcohol screening and brief intervention in community pharmacies: an Australian feasibility study.
      ,
      • Dhital R
      • Whittlesea CM
      • Norman IJ
      • Milligan P.
      Community pharmacy service users’ views and perceptions of alcohol screening and brief intervention.
      ,

      Baraitser P, Pearce V, Holmes J, Horne N, Boynton PM. Chlamydia testing in community pharmacies: evaluation of a feasibility pilot in south east London. Qual Saf Health Care. 2007;16(4):303–307. https://doi.org/10.1136/qshc.2006.020883.

      ,
      • Taylor KL
      • Clifford RM
      • Marshall L.
      Acceptance of a Chlamydia screening program in community pharmacies.
      ,
      • Parker RM
      • Bell A
      • Currie MJ
      • et al.
      Catching chlamydia’: combining cash incentives and community pharmacy access for increased chlamydia screening, the view of young people.
      ,
      • Mugo PM
      • Micheni M
      • Shangala J
      • et al.
      Uptake and acceptability of oral HIV self-testing among community pharmacy clients in Kenya: a feasibility study.
      ,
      • Chaiyakunapruk N
      • Laowakul A
      • Karnchanarat S
      • Pikulthong N
      • Ongphiphadhanakul B.
      Community pharmacy-based implementation and evaluation of an osteoporosis self-assessment tool for Asians.
      • Saldarriaga EM
      • Vodicka E
      • La Rosa S
      • Valderrama M
      • Garcia PJ
      Point-of-care testing for anemia, diabetes, and hypertension: a pharmacy-based model in Lima, Peru.
      ,
      • Kjome RLS
      • Wright DJ
      • Bjaaen AB
      • Garstad KW
      • Valeur M.
      Dermatological cancer screening: evaluation of a new community pharmacy service.
      ,
      • Urwin H
      • Wright D
      • Twigg M
      • McGough N.
      Early recognition of coeliac disease through community pharmacies: a proof of concept study.
      ,
      • Breslow RM.
      Patient attitudes regarding pharmacist-administered memory screening in community pharmacies.
      ,
      • Papastergiou J
      • Trieu CR
      • Saltmarche D
      • Diamantouros A.
      Community pharmacist-directed point-of-care group A Streptococcus testing: evaluation of a Canadian program.
      and most patients stated that they were comfortable discussing health-related issues with pharmacists.
      • Taylor J
      • Krska J
      • Mackridge A.
      A community pharmacy-based cardiovascular screening service: views of service users and the public.
      ,
      • Hattingh HL
      • Hallett J
      • Tait RJ.
      Making the invisible visible’ through alcohol screening and brief intervention in community pharmacies: an Australian feasibility study.
      ,

      Krska J, Mackridge AJ. Involving the public and other stakeholders in development and evaluation of a community pharmacy alcohol screening and brief advice service. Public Health. 2014;128(4):309–316. https://doi.org/10.1016/j.puhe.2013.11.001.

      ,
      • Sheridan J
      • Stewart J
      • Smart R
      • McCormick R.
      Risky drinking among community pharmacy customers in New Zealand and their attitudes towards pharmacist screening and brief interventions.
      ,

      Baraitser P, Pearce V, Holmes J, Horne N, Boynton PM. Chlamydia testing in community pharmacies: evaluation of a feasibility pilot in south east London. Qual Saf Health Care. 2007;16(4):303–307. https://doi.org/10.1136/qshc.2006.020883.

      ,
      • Parker RM
      • Bell A
      • Currie MJ
      • et al.
      Catching chlamydia’: combining cash incentives and community pharmacy access for increased chlamydia screening, the view of young people.
      ,
      • Darin KM
      • Klepser ME
      • Klepser DE
      • et al.
      Pharmacist-provided rapid HIV testing in two community pharmacies.
      Patients perceived the information provided by pharmacists to be helpful and useful
      • Brown S
      • Henderson E
      • Sullivan C.
      The feasibility and acceptability of the provision of alcohol screening and brief advice in pharmacies for women accessing emergency contraception: an evaluation study.
      ,
      • Hattingh HL
      • Hallett J
      • Tait RJ.
      Making the invisible visible’ through alcohol screening and brief intervention in community pharmacies: an Australian feasibility study.
      ,
      • Lata PF
      • Binkley NC
      • Elliott ME.
      Acceptability of pharmacy-based bone density measurement by women and primary healthcare providers.
      ,
      • Nielsen S
      • Picco L
      • Kowalski M
      • et al.
      Routine opioid outcome monitoring in community pharmacy: outcomes from an open-label single-arm implementation-effectiveness pilot study.
      ; however, Peterson and colleagues
      • Peterson GM
      • Jackson SL
      • Hughes JD
      • Fitzmaurice KD
      • Murphy LE.
      Public perceptions of the role of Australian pharmacists in cardiovascular disease.
      found that most respondents were more likely to participate in screening services for conditions such as diabetes, high cholesterol, and CVD if delivered by GPs as opposed to being delivered by pharmacists. Encouragingly, most patients would recommend pharmacist-led screening services to others
      • Michael D
      • Kezakubi D
      • Juma A
      • Todd J
      • Reyburn H
      • Renju J.
      The feasibility and acceptability of screening for hypertension in private drug retail outlets: a pilot study in Mwanza region, Tanzania.
      ,
      • Khan NS
      • Norman IJ
      • Dhital R
      • McCrone P
      • Milligan P
      • Whittlesea CM.
      Alcohol brief intervention in community pharmacies: a feasibility study of outcomes and customer experiences.
      ,
      • Parker RM
      • Bell A
      • Currie MJ
      • et al.
      Catching chlamydia’: combining cash incentives and community pharmacy access for increased chlamydia screening, the view of young people.
      ,
      • Mugo PM
      • Micheni M
      • Shangala J
      • et al.
      Uptake and acceptability of oral HIV self-testing among community pharmacy clients in Kenya: a feasibility study.
      ,
      • Kjome RLS
      • Wright DJ
      • Bjaaen AB
      • Garstad KW
      • Valeur M.
      Dermatological cancer screening: evaluation of a new community pharmacy service.
      ,
      • Urwin H
      • Wright D
      • Twigg M
      • McGough N.
      Early recognition of coeliac disease through community pharmacies: a proof of concept study.
      ; however, potential barriers to screening in community pharmacies were identified, including lack of privacy/confidentiality,
      • Taylor J
      • Krska J
      • Mackridge A.
      A community pharmacy-based cardiovascular screening service: views of service users and the public.
      ,
      • Dhital R
      • Whittlesea CM
      • Norman IJ
      • Milligan P.
      Community pharmacy service users’ views and perceptions of alcohol screening and brief intervention.
      ,
      • Khan NS
      • Norman IJ
      • Dhital R
      • McCrone P
      • Milligan P
      • Whittlesea CM.
      Alcohol brief intervention in community pharmacies: a feasibility study of outcomes and customer experiences.
      ,

      Baraitser P, Pearce V, Holmes J, Horne N, Boynton PM. Chlamydia testing in community pharmacies: evaluation of a feasibility pilot in south east London. Qual Saf Health Care. 2007;16(4):303–307. https://doi.org/10.1136/qshc.2006.020883.

      ,
      • Parker RM
      • Bell A
      • Currie MJ
      • et al.
      Catching chlamydia’: combining cash incentives and community pharmacy access for increased chlamydia screening, the view of young people.
      limited time,
      • Dhital R
      • Whittlesea CM
      • Norman IJ
      • Milligan P.
      Community pharmacy service users’ views and perceptions of alcohol screening and brief intervention.
      ,
      • Meyerson BE
      • Agley JD
      • Jayawardene W
      • et al.
      Feasibility and acceptability of a proposed pharmacy-based harm reduction intervention to reduce opioid overdose, HIV and hepatitis C.
      and difficulty in communicating with pharmacists because of an unfriendly or unapproachable attitude.
      • Dhital R
      • Whittlesea CM
      • Norman IJ
      • Milligan P.
      Community pharmacy service users’ views and perceptions of alcohol screening and brief intervention.
      Factors including pharmacists’ nonjudgmental communication styles were also noted as enablers of patient participation in screening.
      • Fitzgerald N
      • McCaig DJ
      • Watson H
      • Thomson D
      • Stewart DC.
      Development, implementation and evaluation of a pilot project to deliver interventions on alcohol issues in community pharmacies.

      Pharmacists’ perspectives

      Outcomes among pharmacists included their confidence and comfort in providing screening. For example, Dong et al.,
      • Dong BJ
      • Lopez M
      • Cocohoba J.
      Pharmacists performing hepatitis C antibody point-of-care screening in a community pharmacy: a pilot project.
      Gudka and colleagues,
      • Gudka S
      • Marshall L
      • Creagh A
      • Clifford RM.
      To develop and measure the effectiveness and acceptability of a pharmacy-based chlamydia screening intervention in Australia.
      and Nielsen et al.
      • Nielsen S
      • Picco L
      • Kowalski M
      • et al.
      Routine opioid outcome monitoring in community pharmacy: outcomes from an open-label single-arm implementation-effectiveness pilot study.
      reported that pharmacists were confident in providing screening services. Pharmacists also indicated that they were comfortable performing screening.
      • Lowres N
      • Krass I
      • Neubeck L
      • et al.
      Atrial fibrillation screening in pharmacies using an iPhone ECG: a qualitative review of implementation.
      ,
      • Fuller L
      • Conrad WF
      • Heaton PC
      • Panos R
      • Eschenbacher W
      • Frede SM.
      Pharmacist-managed chronic obstructive pulmonary disease screening in a community setting.
      ,
      • Gauld N
      • Braganza C
      • Arroll B.
      Adapting the Auckland Sleep Screening Tool for pharmacy: pharmacists’ experience and feedback.
      However, these findings may be disease specific because Krska and colleagues

      Krska J, Mackridge AJ. Involving the public and other stakeholders in development and evaluation of a community pharmacy alcohol screening and brief advice service. Public Health. 2014;128(4):309–316. https://doi.org/10.1016/j.puhe.2013.11.001.

      identified that pharmacists were uncomfortable in proactively raising alcohol-related issues and preferred patients to actively ask for advice. In addition, Nielsen et al.
      • Nielsen S
      • Picco L
      • Kowalski M
      • et al.
      Routine opioid outcome monitoring in community pharmacy: outcomes from an open-label single-arm implementation-effectiveness pilot study.
      identified a decrease in comfort levels after screening among some pharmacists who reported high levels of comfort at baseline, potentially because of pharmacists overestimating their comfort level before delivering screening. Pharmacists also noted barriers, such as time and documentation associated with screening,
      • Gudka S
      • Marshall L
      • Creagh A
      • Clifford RM.
      To develop and measure the effectiveness and acceptability of a pharmacy-based chlamydia screening intervention in Australia.
      and enablers, such as training
      • Gauld N
      • Braganza C
      • Arroll B.
      Adapting the Auckland Sleep Screening Tool for pharmacy: pharmacists’ experience and feedback.
      and remuneration,
      • Lowres N
      • Krass I
      • Neubeck L
      • et al.
      Atrial fibrillation screening in pharmacies using an iPhone ECG: a qualitative review of implementation.
      to their involvement in screening.

      Other HCPs’ perspectives

      Acceptability was also assessed from the perspective of other HCPs. Castillo and colleagues
      • Castillo D
      • Guayta R
      • Giner J
      • et al.
      COPD case finding by spirometry in high-risk customers of urban community pharmacies: a pilot study.
      ,
      • Castillo D
      • Burgos F
      • Guayta R
      • et al.
      Airflow obstruction case finding in community-pharmacies: a novel strategy to reduce COPD underdiagnosis.
      reported that 69% and Fuller et al.
      • Fuller L
      • Conrad WF
      • Heaton PC
      • Panos R
      • Eschenbacher W
      • Frede SM.
      Pharmacist-managed chronic obstructive pulmonary disease screening in a community setting.
      reported that 99% of spirometry measurement results obtained and interpreted during community pharmacist-led screening were accepted by other HCPs, including lung function experts and pulmonologists. In addition, no difference in results was reported when spirometry was conducted by expert nurses in hospital settings and pharmacists in community pharmacy settings for the same individual.
      • Castillo D
      • Guayta R
      • Giner J
      • et al.
      COPD case finding by spirometry in high-risk customers of urban community pharmacies: a pilot study.
      Lata and colleagues
      • Lata PF
      • Binkley NC
      • Elliott ME.
      Acceptability of pharmacy-based bone density measurement by women and primary healthcare providers.
      concluded that clinicians found results obtained from pharmacy-based bone density screening useful and indicated a willingness to incorporate the results in decision making. However, Brown et al.
      • Brown T
      • Robinson JM
      • Renfro CP
      • Blalock SJ
      • Ferreri S.
      Analysis of the relationship between patients’ fear of falling and prescriber acceptance of community pharmacists’ recommendations.
      reported on medical practitioners’ acceptance of pharmacists’ recommendations after screening the risk for falls, showing that the median acceptance rate of recommendations was 33% and that 79% of participating pharmacies had acceptance rates ≤50%. Despite this, pharmacists may play a large role in the prevention of falls through the management of fall risk‒increasing drugs.
      • Brown T
      • Robinson JM
      • Renfro CP
      • Blalock SJ
      • Ferreri S.
      Analysis of the relationship between patients’ fear of falling and prescriber acceptance of community pharmacists’ recommendations.
      Moreover, Hatah and colleagues
      • Hatah E
      • Braund R
      • Duffull S
      • Tordoff J.
      General practitioners’ perceptions of pharmacists’ new services in New Zealand.
      reported that pharmacist-led screening requires collaboration between pharmacists and GPs and results in additional information pertaining to patients’ conditions being provided to GPs because patients’ screening results are often sent to GPs.
      • Lata PF
      • Binkley NC
      • Elliott ME.
      Acceptability of pharmacy-based bone density measurement by women and primary healthcare providers.
      ,
      • Brown T
      • Robinson JM
      • Renfro CP
      • Blalock SJ
      • Ferreri S.
      Analysis of the relationship between patients’ fear of falling and prescriber acceptance of community pharmacists’ recommendations.
      Chaiyakunapruk et al.
      • Chaiyakunapruk N
      • Laowakul A
      • Karnchanarat S
      • Pikulthong N
      • Ongphiphadhanakul B.
      Community pharmacy-based implementation and evaluation of an osteoporosis self-assessment tool for Asians.
      explored the views of 6 medical practitioners regarding osteoporosis screening in community pharmacies, with all medical practitioners strongly agreeing/agreeing with the role of community pharmacists in osteoporosis screening and 5 of 6 medical practitioners finding the screening tool useful. Hence, other HCPs were generally accepting of pharmacist-led screening for respiratory and musculoskeletal risk factors/medical conditions.

      Discussion

      To the authors’ knowledge, this systematic review is the first to comprehensively explore the evidence pertaining to the acceptability of community pharmacist-led screening for any risk factor/medical condition, from the perspective of all stakeholders. Pharmacist-led screening was generally acceptable to patients, pharmacists, and other HCPs; however, there is no uniform, standardized, psychometrically tested measure of screening acceptability used among studies, despite the identification of 44 studies reporting on acceptability, specifically. Considering the variations across acceptability measures, it is difficult to conduct accurate comparisons across studies. Nonetheless, this systematic review presents and synthesizes the literature, identifying that a broad range of terms and constructs are often used when measuring acceptability, which can facilitate the measurement of acceptability and the development of a valid and reliable acceptability measure in future studies.
      The overall findings of this systematic review support those reported by Ayorinde and colleagues
      • Ayorinde AA
      • Porteous T
      • Sharma P.
      Screening for major diseases in community pharmacies: a systematic review.
      because most stakeholders are accepting of pharmacist-led screening. Because patients are the target population for screening services, their perceptions of pharmacist-led screening are important to ensure uptake of services. This review shows that community pharmacist-led screening is acceptable to patients and that patients are willing to recommend pharmacist-led screening to others. However, time influences patients’ participation in screening because services with shorter waiting times for appointments were easier for patients to access,
      • Hattingh HL
      • Hallett J
      • Tait RJ.
      Making the invisible visible’ through alcohol screening and brief intervention in community pharmacies: an Australian feasibility study.
      ,

      Baraitser P, Pearce V, Holmes J, Horne N, Boynton PM. Chlamydia testing in community pharmacies: evaluation of a feasibility pilot in south east London. Qual Saf Health Care. 2007;16(4):303–307. https://doi.org/10.1136/qshc.2006.020883.

      ,
      • Parker RM
      • Bell A
      • Currie MJ
      • et al.
      Catching chlamydia’: combining cash incentives and community pharmacy access for increased chlamydia screening, the view of young people.
      and the perception that screening was time-consuming deterred patients’ participation.
      • Gudka S
      • Marshall L
      • Creagh A
      • Clifford RM.
      To develop and measure the effectiveness and acceptability of a pharmacy-based chlamydia screening intervention in Australia.
      Similarly, studies exploring HIV testing and cervical cancer screening show that long waiting times discourage patients from accessing these services.
      • Kwapong GD
      • Boateng D
      • Agyei-Baffour P
      • Addy EA.
      Health service barriers to HIV testing and counseling among pregnant women attending antenatal clinic; a cross-sectional study.
      ,
      • Agurto I
      • Bishop A
      • Sánchez G
      • Betancourt Z
      • Robles S.
      Perceived barriers and benefits to cervical cancer screening in Latin America.
      Pharmacists also highlighted the time required for documentation and communication with patients during busy hours.
      • Khan NS
      • Norman IJ
      • Dhital R
      • McCrone P
      • Milligan P
      • Whittlesea CM.
      Alcohol brief intervention in community pharmacies: a feasibility study of outcomes and customer experiences.
      ,
      • Gudka S
      • Marshall L
      • Creagh A
      • Clifford RM.
      To develop and measure the effectiveness and acceptability of a pharmacy-based chlamydia screening intervention in Australia.
      ,
      • Meyerson BE
      • Agley JD
      • Jayawardene W
      • et al.
      Feasibility and acceptability of a proposed pharmacy-based harm reduction intervention to reduce opioid overdose, HIV and hepatitis C.
      ,
      • Gauld N
      • Braganza C
      • Arroll B.
      Adapting the Auckland Sleep Screening Tool for pharmacy: pharmacists’ experience and feedback.
      ,
      • Dong BJ
      • Lopez M
      • Cocohoba J.
      Pharmacists performing hepatitis C antibody point-of-care screening in a community pharmacy: a pilot project.
      Thus, future studies can provide crucial information by reporting on screening time because this is important to consider when assessing the acceptability and feasibility of screening.
      Strategies to overcome barriers included simplifying the paperwork involved and providing incentives.
      • Gudka S
      • Marshall L
      • Creagh A
      • Clifford RM.
      To develop and measure the effectiveness and acceptability of a pharmacy-based chlamydia screening intervention in Australia.
      Houle et al.
      • Houle SK
      • Grindrod KA
      • Chatterley T
      • Tsuyuki RT.
      Paying pharmacists for patient care: a systematic review of remunerated pharmacy clinical care services.
      described variability in remuneration for current pharmacist-delivered clinical services, whereby most remuneration for clinical services was provided through government funding, with the remainder being covered by private insurance plans. They suggested that pharmacists assess the time required to deliver these services to ensure adequate remuneration.
      • Houle SK
      • Grindrod KA
      • Chatterley T
      • Tsuyuki RT.
      Paying pharmacists for patient care: a systematic review of remunerated pharmacy clinical care services.
      Hence, it is important to consider time constraints from the perspective of patients and pharmacists.
      Privacy and confidentiality were also noted as potential barriers to screening because of the lack of private areas and consulting rooms in some pharmacies.
      • Lowres N
      • Krass I
      • Neubeck L
      • et al.
      Atrial fibrillation screening in pharmacies using an iPhone ECG: a qualitative review of implementation.
      ,
      • Taylor J
      • Krska J
      • Mackridge A.
      A community pharmacy-based cardiovascular screening service: views of service users and the public.
      ,
      • Hattingh HL
      • Hallett J
      • Tait RJ.
      Making the invisible visible’ through alcohol screening and brief intervention in community pharmacies: an Australian feasibility study.
      ,

      Krska J, Mackridge AJ. Involving the public and other stakeholders in development and evaluation of a community pharmacy alcohol screening and brief advice service. Public Health. 2014;128(4):309–316. https://doi.org/10.1016/j.puhe.2013.11.001.

      ,
      • Parker RM
      • Bell A
      • Currie MJ
      • et al.
      Catching chlamydia’: combining cash incentives and community pharmacy access for increased chlamydia screening, the view of young people.
      Agurto and colleagues
      • Agurto I
      • Bishop A
      • Sánchez G
      • Betancourt Z
      • Robles S.
      Perceived barriers and benefits to cervical cancer screening in Latin America.
      reported that lack of privacy during cervical cancer screening may cause discomfort in patients. Furthermore, private counseling areas were found to enhance the professional image of pharmacists performing atrial fibrillation screening and encouraged the recruitment of participants.
      • Lowres N
      • Krass I
      • Neubeck L
      • et al.
      Atrial fibrillation screening in pharmacies using an iPhone ECG: a qualitative review of implementation.
      Pharmacies that lacked a consultation room often had to improvise to provide a counseling area.
      • Lowres N
      • Krass I
      • Neubeck L
      • et al.
      Atrial fibrillation screening in pharmacies using an iPhone ECG: a qualitative review of implementation.
      The need for private counseling areas in pharmacies has been recognized as essential, with an RCT of diabetes screening in community pharmacies rendering a private counseling area an eligibility requirement for participation.
      • Krass I
      • Carter R
      • Mitchell B
      • et al.
      Pharmacy Diabetes Screening Trial: protocol for a pragmatic cluster-randomised controlled trial to compare three screening methods for undiagnosed type 2 diabetes in Australian community pharmacy.
      Therefore, it is crucial to consider environmental aspects when establishing community pharmacy-based screening.
      Pharmacists also reported that screening in community pharmacies was acceptable. Lowres et al.
      • Lowres N
      • Krass I
      • Neubeck L
      • et al.
      Atrial fibrillation screening in pharmacies using an iPhone ECG: a qualitative review of implementation.
      showed that pharmacists who performed atrial fibrillation screening in community pharmacies gained a sense of professional identity and reported greater job satisfaction because of an increased clinical role. Pharmacists also viewed screening as rewarding, noted an improvement in customer relations, and experienced a greater sense of giving back to the community. In addition, pharmacists felt comfortable providing screening services,
      • Lowres N
      • Krass I
      • Neubeck L
      • et al.
      Atrial fibrillation screening in pharmacies using an iPhone ECG: a qualitative review of implementation.
      as shown in studies by Meyerson and colleagues
      • Meyerson BE
      • Agley JD
      • Jayawardene W
      • et al.
      Feasibility and acceptability of a proposed pharmacy-based harm reduction intervention to reduce opioid overdose, HIV and hepatitis C.
      and Gauld et al.,
      • Gauld N
      • Braganza C
      • Arroll B.
      Adapting the Auckland Sleep Screening Tool for pharmacy: pharmacists’ experience and feedback.
      whereby 60% and 64%–94% of pharmacists reported that they were comfortable, respectively. However, studies have highlighted the importance of adequate training and knowledge to support pharmacists in providing such services
      • Urwin H
      • Wright D
      • Twigg M
      • McGough N.
      Early recognition of coeliac disease through community pharmacies: a proof of concept study.
      and to ensure confidence in conducting screening.

      Krska J, Mackridge AJ. Involving the public and other stakeholders in development and evaluation of a community pharmacy alcohol screening and brief advice service. Public Health. 2014;128(4):309–316. https://doi.org/10.1016/j.puhe.2013.11.001.

      ,

      Baraitser P, Pearce V, Holmes J, Horne N, Boynton PM. Chlamydia testing in community pharmacies: evaluation of a feasibility pilot in south east London. Qual Saf Health Care. 2007;16(4):303–307. https://doi.org/10.1136/qshc.2006.020883.

      ,
      • Meyerson BE
      • Agley JD
      • Jayawardene W
      • et al.
      Feasibility and acceptability of a proposed pharmacy-based harm reduction intervention to reduce opioid overdose, HIV and hepatitis C.
      ,
      • Nielsen S
      • Picco L
      • Kowalski M
      • et al.
      Routine opioid outcome monitoring in community pharmacy: outcomes from an open-label single-arm implementation-effectiveness pilot study.
      ,
      • Dong BJ
      • Lopez M
      • Cocohoba J.
      Pharmacists performing hepatitis C antibody point-of-care screening in a community pharmacy: a pilot project.
      For example, Thakur and colleagues
      • Thakur T
      • Frey M
      • Chewning B.
      Pharmacist roles, training, and perceived barriers in naloxone dispensing: a systematic review.
      reported that training for pharmacists was essential to build their confidence in communicating with patients when dispensing naloxone. Likewise, O'Reilly et al.
      • O'Reilly CL
      • Wong E
      • Chen TF.
      A feasibility study of community pharmacists performing depression screening services.
      showed that most pharmacists felt that training on how to approach patients about depression screening and participating in role plays to practice counseling skills increased their confidence when screening. Castillo and colleagues
      • Castillo D
      • Burgos F
      • Guayta R
      • et al.
      Airflow obstruction case finding in community-pharmacies: a novel strategy to reduce COPD underdiagnosis.
      also noted the importance of adequate training for pharmacists to perform high-quality spirometry measurements. They reported that pharmacists’ skills should be regularly reviewed and evaluated to ensure ongoing quality of service provision,
      • Castillo D
      • Burgos F
      • Guayta R
      • et al.
      Airflow obstruction case finding in community-pharmacies: a novel strategy to reduce COPD underdiagnosis.
      which can be achieved using professional practice standards that guide the provision of high-quality services.

      Professional practice standards. Pharmaceutical Society of Australia. https://www.psa.org.au/practice-support-industry/professional-practice-standards/. Accessed March 14, 2022.

      Hence, training may be required before the provision of screening
      • O'Reilly CL
      • Wong E
      • Chen TF.
      A feasibility study of community pharmacists performing depression screening services.
      but should be supplemented with opportunities to maintain and practice skills.
      Pharmacist-led screening requires government investment and in some cases the support of policymakers and access to private insurance to ensure that pharmacists are supported through training and remuneration for their role in the early detection of risk factors/medical conditions. The importance of considering how community pharmacist-led screening could be funded in the future was recognized among included studies.
      • Lowres N
      • Krass I
      • Neubeck L
      • et al.
      Atrial fibrillation screening in pharmacies using an iPhone ECG: a qualitative review of implementation.
      ,
      • Gudka S
      • Marshall L
      • Creagh A
      • Clifford RM.
      To develop and measure the effectiveness and acceptability of a pharmacy-based chlamydia screening intervention in Australia.
      Furthermore, there is a need to establish follow-up and referral pathways to facilitate triage of high-risk individuals to medical practitioners for diagnostic and treatment services. For instance, in a study by Alzubaidi et al.,
      • Alzubaidi HT
      • Chandir S
      • Hasan S
      • McNamara K
      • Cox R
      • Krass I.
      Diabetes and cardiovascular disease risk screening model in community pharmacies in a developing primary healthcare system: a feasibility study.
      patients were provided with a referral letter and advised to follow-up with their GP if they were deemed at-risk of diabetes and CVD after screening; however, only 24% of patients followed this recommendation. Hence, there is a need to improve referral pathways to allow for better health outcomes.
      This systematic review identified that pharmacist-led screening results were accepted by medical practitioners; however, there was limited research exploring the acceptability of pharmacist-led screening from other stakeholders’ perspectives. Two studies by Castillo and colleagues
      • Castillo D
      • Guayta R
      • Giner J
      • et al.
      COPD case finding by spirometry in high-risk customers of urban community pharmacies: a pilot study.
      ,
      • Castillo D
      • Burgos F
      • Guayta R
      • et al.
      Airflow obstruction case finding in community-pharmacies: a novel strategy to reduce COPD underdiagnosis.
      reported that most spirometry measurements conducted in community pharmacies were rated clinically acceptable. Although more data are required, the small body of evidence identified is positive. Screening services require collaboration among multiple HCPs; hence, the relationship between a pharmacist and medical practitioner, for instance, may influence the referral outcomes. Brown et al.
      • Brown T
      • Robinson JM
      • Renfro CP
      • Blalock SJ
      • Ferreri S.
      Analysis of the relationship between patients’ fear of falling and prescriber acceptance of community pharmacists’ recommendations.
      reported highly variable prescriber acceptance rates of community pharmacists’ recommendations relating to fall risks and that the relationship between medical practitioners and pharmacists influenced the decisions of medical practitioners. Strong working relationships between pharmacists and medical practitioners have the potential to improve patient care.
      • Kelly DV
      • Bishop L
      • Young S
      • Hawboldt J
      • Phillips L
      • Keough TM.
      Pharmacist and physician views on collaborative practice: findings from the community pharmaceutical care project.
      For example, collaborative relationships between pharmacists and other HCPs, including nurses and medical practitioners, were found to optimize drug use and decrease preventable adverse drug reactions.
      • Makowsky MJ
      • Schindel TJ
      • Rosenthal M
      • Campbell K
      • Tsuyuki RT
      • Madill HM.
      Collaboration between pharmacists, physicians and nurse practitioners: a qualitative investigation of working relationships in the inpatient medical setting.
      This reinforces the importance of collaborative communication between HCPs to ensure optimal outcomes for patients. However, a collaborative practice may be hindered by the lack of compensation and time to communicate between multiple HCPs.
      • Kelly DV
      • Bishop L
      • Young S
      • Hawboldt J
      • Phillips L
      • Keough TM.
      Pharmacist and physician views on collaborative practice: findings from the community pharmaceutical care project.
      Furthermore, the expectations of medical practitioners and nurses toward the role of pharmacists and the development of mutual respect and trust contribute to establishing a collaborative relationship between HCPs.
      • Makowsky MJ
      • Schindel TJ
      • Rosenthal M
      • Campbell K
      • Tsuyuki RT
      • Madill HM.
      Collaboration between pharmacists, physicians and nurse practitioners: a qualitative investigation of working relationships in the inpatient medical setting.
      These aspects should be considered to enhance collaborative communication between HCPs involved in screening.
      Despite the lack of a standardized acceptability measure, terms were identified that were used across multiple studies when exploring acceptability, including satisfaction, comfort, and appropriateness. Similar terms have been identified when measuring acceptability across different contexts, including a systematic review exploring the acceptability of perinatal depression screening.
      • El-Den S
      • O'Reilly CL
      • Chen TF
      A systematic review on the acceptability of perinatal depression screening.
      Some patients from studies included in this systematic review recognized the appropriateness of community pharmacies as locations for screening owing to their accessibility and long operating hours. Satisfaction was another common term used to assess the acceptability of community pharmacist-led screening. Acceptability has been shown to be a critical determinant of satisfaction with health services.
      • Sovd T
      • Mmari K
      • Lipovsek V
      • Manaseki-Holland S.
      Acceptability as a key determinant of client satisfaction: lessons from an evaluation of adolescent friendly health services in Mongolia.
      In this systematic review, most patients who underwent screening were satisfied with the service.
      • Hattingh HL
      • Hallett J
      • Tait RJ.
      Making the invisible visible’ through alcohol screening and brief intervention in community pharmacies: an Australian feasibility study.
      ,
      • Castillo D
      • Burgos F
      • Guayta R
      • et al.
      Airflow obstruction case finding in community-pharmacies: a novel strategy to reduce COPD underdiagnosis.
      ,
      • Brown T
      • Robinson JM
      • Renfro CP
      • Blalock SJ
      • Ferreri S.
      Analysis of the relationship between patients’ fear of falling and prescriber acceptance of community pharmacists’ recommendations.
      ,
      • Nielsen S
      • Picco L
      • Kowalski M
      • et al.
      Routine opioid outcome monitoring in community pharmacy: outcomes from an open-label single-arm implementation-effectiveness pilot study.
      Kjome and colleagues
      • Kjome RLS
      • Wright DJ
      • Bjaaen AB
      • Garstad KW
      • Valeur M.
      Dermatological cancer screening: evaluation of a new community pharmacy service.
      reported that 99% of participants who underwent community pharmacist-led screening for skin cancer rated their overall satisfaction as good, very good, or extremely good. Similarly, Alzubaidi et al.
      • Alzubaidi HT
      • Chandir S
      • Hasan S
      • McNamara K
      • Cox R
      • Krass I.
      Diabetes and cardiovascular disease risk screening model in community pharmacies in a developing primary healthcare system: a feasibility study.
      reported that 94.5% of participants were satisfied/very satisfied after pharmacist-led screening for diabetes and cardiovascular risk. Cumulatively, these findings indicate high satisfaction with pharmacist-led screening.
      Patients were also highly comfortable with pharmacist-led screening.
      • Taylor J
      • Krska J
      • Mackridge A.
      A community pharmacy-based cardiovascular screening service: views of service users and the public.
      ,
      • Hattingh HL
      • Hallett J
      • Tait RJ.
      Making the invisible visible’ through alcohol screening and brief intervention in community pharmacies: an Australian feasibility study.
      ,

      Krska J, Mackridge AJ. Involving the public and other stakeholders in development and evaluation of a community pharmacy alcohol screening and brief advice service. Public Health. 2014;128(4):309–316. https://doi.org/10.1016/j.puhe.2013.11.001.

      ,
      • Sheridan J
      • Stewart J
      • Smart R
      • McCormick R.
      Risky drinking among community pharmacy customers in New Zealand and their attitudes towards pharmacist screening and brief interventions.
      ,

      Baraitser P, Pearce V, Holmes J, Horne N, Boynton PM. Chlamydia testing in community pharmacies: evaluation of a feasibility pilot in south east London. Qual Saf Health Care. 2007;16(4):303–307. https://doi.org/10.1136/qshc.2006.020883.

      ,
      • Parker RM
      • Bell A
      • Currie MJ
      • et al.
      Catching chlamydia’: combining cash incentives and community pharmacy access for increased chlamydia screening, the view of young people.
      ,
      • Darin KM
      • Klepser ME
      • Klepser DE
      • et al.
      Pharmacist-provided rapid HIV testing in two community pharmacies.
      Comfort is commonly used as an indicator of acceptability. For example, Chae and colleagues
      • Chae YM
      • Park HJ
      • Cho JG
      • Hong GD
      • Cheon KA.
      The reliability and acceptability of telemedicine for patients with schizophrenia in Korea.
      used comfort levels to report on the acceptability of telemedicine for patients living with schizophrenia. Similarly, Buist et al.
      • Buist A
      • Condon J
      • Brooks J
      • et al.
      Acceptability of routine screening for perinatal depression.
      reported that women experienced no discomfort when reporting on the acceptability of routine perinatal depression screening. However, it should be noted that because most studies included in this review were conducted on specific population groups, findings may not be generalizable and hence warrant further research on larger representative samples.
      The lack of uniform psychometric measures of acceptability has been noted previously in the literature pertaining to screening across a range of settings. El-Den and colleagues70’s systematic review on perinatal depression screening acceptability identified that acceptability measures had not been psychometrically tested, rendering comparisons difficult to accurately conduct. Similarly, a review exploring the acceptability of human papillomavirus vaccinations
      • Allen JD
      • Coronado GD
      • Williams RS
      • et al.
      A systematic review of measures used in studies of human papillomavirus (HPV) vaccine acceptability.
      identified a conceptual overlap, whereby a number of studies used a combination of concepts to address multiple constructs, leading to possible errors in measurement. Furthermore, two thirds of studies did not include an assessment of validity and reliability of acceptability measurements.
      • Allen JD
      • Coronado GD
      • Williams RS
      • et al.
      A systematic review of measures used in studies of human papillomavirus (HPV) vaccine acceptability.
      This systematic review has identified a similar issue relating to the acceptability of pharmacist-led screening, with most studies not reporting or reporting very little on the development of acceptability measures. Hence, future research focusing on the development and psychometric testing of acceptability measurement instruments is needed

      Limitations

      The inclusion of studies, regardless of methodologic design, is both a strength and limitation, allowing a comprehensive overview of all the evidence pertaining to the acceptability of pharmacist-led screening while resulting in difficulty in conducting accurate comparisons and synthesizing results across a range of heterogeneous study designs and outcomes. Nonetheless, even among studies with similar study designs, acceptability measures and outcomes were found to be heterogeneous, so limiting inclusion criteria to specific study designs would not have overcome this limitation. Therefore, conducting risk of bias and quality assessments among included studies was deemed unsuitable.
      Specific measurement of/reporting on acceptability (or its derivatives) served as an inclusion criterion. However, there may have been different concepts/terms used to assess acceptability in studies excluded from this review. For example, a study on pharmacist-led screening for cognitive memory decline found that 98.6% of respondents who participated in the screening program were very satisfied/satisfied with the service.
      • Rickles NM
      • Skelton JB
      • Davis J
      • Hopson J.
      Cognitive memory screening and referral program in community pharmacies in the United States.
      However, because this study did not explicitly refer to acceptability in the title, abstract, objectives, methods, or results sections of the manuscript, it was excluded. Therefore, to meet the aims of the systematic review, a potential limitation may have been that studies exploring similar constructs (but not specifically reporting on acceptability) were excluded. However, this inclusion criterion was essential to ensure that only studies exploring acceptability were included and that no inferences were made on behalf of study authors.

      Conclusions

      This systematic review has identified that pharmacist-led screening for various medical conditions/risk factors is acceptable to both patients and pharmacists and that screening results are accepted by other HCPs. Standardization of acceptability measures is required to accurately measure and compare the acceptability of pharmacist-led screening across studies and to measure the construct of acceptability more broadly in the literature, across a range of settings and medical conditions. The barriers and facilitators identified in this systematic review can guide researchers when establishing pharmacist-led screening services in community pharmacies, to ensure acceptability to stakeholders.

      ACKNOWLEDGMENTS

      The authors thank Academic Librarian Dr. Yulia Ulyannikova from The University of Sydney for help with the development and revision of the search strategy.
      No financial disclosures were reported by the authors of this paper.

      CRediT AUTHOR STATEMENT

      Sarira El-Den: Conceptualization, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Visualization, Writing – review and editing. Yee Lam Elim Lee: Data curation, Formal analysis, Investigation, Methodology, Validation, Visualization, Writing – original draft. Duha Nur Gide: Data curation, Visualization, Writing – review and editing. Claire L. O'Reilly: Conceptualization, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Visualization, Writing – review and editing.

      Appendix. SUPPLEMENTAL MATERIAL

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