Patients With CVD Trust Pharmacists, Underuse Preventive Services

Patients with cardiovascular disease (CVD) view community pharmacists primarily as providers of medication rather than partners in disease prevention, according to a qualitative study published in African Health Sciences.¹

Researchers conducted semi-structured interviews with 10 CVD patients who use community pharmacy services in the Maseru and Berea districts of Lesotho, identifying 4 major themes: the perceived role of the community pharmacist, patient health care–seeking behavior, perceived pharmacist care outcomes, and future expectations. Although most patients said they visit community pharmacies monthly for prescription refills, many reported being unaware of, or underutilizing, other services such as screening, risk assessment, and lifestyle counseling.¹

Prescription Refills Remain the Primary Draw

Respondents described community pharmacists chiefly as medication experts, visiting pharmacies to refill prescriptions or to obtain medication when clinics experienced stockouts. Community pharmacists were noted for placing orders to meet individual prescription needs and for contacting patients directly to remind them about refills.¹

Patients also credited pharmacists with suggesting therapeutic alternatives when a prescribed brand was unavailable, reflecting an established relationship between prescribers and pharmacists.¹ However, several patients said that beyond dispensing, they were unaware of any additional services offered at the pharmacy.

Beyond dispensing, some patients described seeking blood sugar tests at the pharmacy when feeling unwell or on a pharmacist's advice. Most respondents, however, said they did not use pharmacy-based testing because they were unaware such services existed, preferred to test at a doctor's office, or already owned a home testing device.¹

Patients who did receive lifestyle counseling reported that pharmacists encouraged regular exercise, discussed dietary modifications, and monitored body weight during visits, generally advising patients to see a doctor when readings were abnormal.¹

The study authors noted that this counseling was often described by patients as passive rather than proactive, pointing to an opportunity for community pharmacists to more consistently incorporate risk assessment tools and follow-up into routine care.¹

Similar utilization gaps have been reported outside Lesotho. In a nationwide cross-sectional survey of 312 community pharmacists in Malaysia, 84.3% of respondents said they never or rarely gave patients cardiac risk assessment tools to self-assess their cardiac risk, and 73.7% said they never or rarely used such tools themselves to assess patients' individual cardiovascular disease risk.²

That study also found that a lack of access to medical records, cited by 71.2% of respondents, and a lack of CVD-related educational materials, cited by 70.8%, were the top perceived barriers to providing more comprehensive services.²

Trust and Affordability Shape Pharmacy Choice

Patients in the Lesotho study said they routinely see a doctor every 3 to 6 months but visit a community pharmacist monthly for prescription refills, paying with a combination of medical aid and out-of-pocket cash. Several respondents said they use only 1 or 2 trusted pharmacies rather than the pharmacy nearest to them, citing affordability, reliability, cleanliness, and staff conduct as deciding factors.¹

"There are many of them even here in [name of a residential place], but I never use them. I am not comfortable buying them just anywhere. So, I only use one pharmacy in town. When you walk into a pharmacy, you check how clean it is. You look at the staff and their approach or conduct when they assist you," one patient, respondent MAS014, said.¹

Patients generally reported feeling content and respected by their pharmacists, and several said they would be willing to use, and pay for, expanded services such as weight management programs, provided the professional delivering care was a licensed pharmacist.¹

Patients Want Pharmacists to Lead, Not Just Dispense

Looking forward, patients said they would like to see community pharmacists take a more visible leadership role in cardiovascular disease education, including forming patient support communities and advocating for people managing hypertension, diabetes, or other cardiovascular conditions.¹

"I would like them to be involved in raising awareness, providing education, and actually advocating for people with diabetes, hypertension, or these cardiovascular diseases so that people with such conditions know that they have the support of a pharmacist in their communities," one patient, respondent MAS005, said.¹

Respondents also called for standardized training requirements across pharmacies to ensure consistent quality of care regardless of location. The study authors concluded that patients' underuse of expanded pharmacy services stems largely from a lack of awareness rather than a lack of willingness, writing that the findings present "an opportunity for community pharmacists to raise awareness of their current scope of work and expansion of care."¹

The findings add to a growing body of literature examining how pharmacist-led models can extend cardiovascular care beyond traditional dispensing. In the United States, a retrospective study of a pharmacist and community health worker–managed clinic model at a free clinic in Indianapolis, Indiana, found that patients with hypertension who engaged in the collaborative service experienced a mean systolic blood pressure reduction of 9.63 mmHg and a mean diastolic blood pressure reduction of 7.57 mmHg over time.³

That model paired a clinical pharmacist with a community health worker to address both medication management and social drivers of health, an approach the study authors said helped counter patient mistrust in the health care system.³

REFERENCES

1. Motlohi NF, Mensah KB, Padayachee N, Petrus R, Alqifari SF, Bangalee V. Patients' perceptions of the role of community pharmacists in the prevention and control of cardiovascular diseases: a qualitative investigation. African Health Sciences. 2026;26(2):90-98. doi:10.4314/ahs.v26i2.11

2. Ismail FF, Md Redzuan A, Chong WW, Ahmad Nizaruddin M. Role of community pharmacists in cardiovascular diseases-related health promotion and dyslipidemia management in Malaysia: a nationwide cross-sectional study. PLoS One. 2023;18(9):e0290883. doi:10.1371/journal.pone.0290883

3. Struewing ML, Adeoye-Olatunde OA, Yang Y, Byrd KAD, Conklin ME, Gonzalvo JD, Smith K, Meredith AH. Outcomes of the pharmacist and community health worker heart healthy clinic model. Journal of the American College of Clinical Pharmacy. 2025;8(9):850-859. doi:10.1002/jac5.70108