Co-design and development of a community pharmacy-based CVD risk screening service in Saudi Arabia: a Multi-stakeholders Nominal Group Technique (NGT) Consensus method

Introduction: Cardiovascular diseases (CVDs) are the leading cause of death in Saudi Arabia, making their prevention a top public health priority. Despite the success of community pharmacy-based CVD risk screening programmes internationally, no similar programme exists in Saudi Arabia.

Aim: To co-design a community pharmacy-based CVD risk screening service in Saudi Arabia through stakeholder involvement and consensus-building.

Methods: A modified nominal group technique (NGT) was employed, integrating a pre-NGT questionnaire and an in-person NGT meeting. Purposive sampling was adopted to recruit experts from Saudi Arabia. Ideas regarding the service-targeted populations, screening processes, and post-screening interventions were collected from a literature review and preNGT questionnaire. Experts discussed and ranked these ideas by priority. A 70% consensus level was considered acceptable.

Results: Six experts attended the NGT meeting including a clinical pharmacist, a community pharmacist, a representative from the Ministry of Health, a public health representative, and two community pharmacy owners. Six ideas for age groups, 12 for targeted populations, 10 for screening processes and 8 for post-screening interventions were considered during the NGT meeting. The prioritised age group was ≥ 40 years, with priority given to individuals with comorbidities or currently on treatment for those conditions, with a family history of CVDs, or any lifestyle-related risk factors, currently on medications that cause CV harm, without comorbid conditions and not currently on treatment for any comorbidities. The top 6 screening process priorities included calculating the CVD risk scores, collecting patients’ data, point of care testing, anthropometric measurements, diabetes risk assessment, and medication adherence assessment. The top 3 interventions focused on education, physician referrals with follow-ups, and medication therapy management with follow-ups. A 100% consensus was achieved on the final priorities.

Conclusion: This study has mapped a potential model for the service. Further research is required to achieve national consensus using an e-Delphi.