A further source of potential bias was publication bias since only published studies were included.

This review included studies from nine different countries with differing arrangements for provision of community pharmacy services. The studies covered a diverse range of diseases and risk factors, and employed a range of study designs, populations and outcomes. This heterogeneity, together with poor quality of reporting in the majority of the included studies, meant that it was not possible to do a meta-analysis of the available quantitative results. Neither was it possible to determine why some screening interventions appeared to be more successful than others (in terms of the measured outcomes). This is likely to have implications for

the generalisability of the findings. The quality of most included studies was poor, which is perhaps unsurprising APO866 price see more given the broad range of study designs included. Only one RCT and two cluster randomised studies of moderate quality were identified. There were four non-randomised comparative studies and the remaining 42 studies were uncontrolled studies many of which were assessed as being of poor quality. Lack of control groups made it difficult to associate findings with interventions. The poor quality of the majority of the studies in this review is of concern and raises questions about the validity and generalisability of the studies’ findings. However, the pragmatic nature of most of the included studies gives them a degree most of applicability. By contrast, screening for major diseases in other primary care settings has been the subject of substantial research, including numerous RCTs.[72-78] Little published evidence was found that compared pharmacy-based screening with screening initiatives in other comparable healthcare settings. None of the

included studies provided enough information about intervention design and development. The importance of identifying existing evidence, establishing theoretical underpinning and modelling processes and outcomes, when developing complex interventions (such as the screening interventions described here) has been highlighted in UK Medical Research Council guidance.[79] Without such information, it is difficult to assess the reliability of the interventions. All 47 studies that presented the proportion of participants with risk factors/condition identified some participants at risk suggesting that the community pharmacy may be a feasible location for the screening services investigated. Forty-eight of the 50 included studies involved opportunistic screening (that is, non-targeted screening of people visiting the community pharmacy or responding to screening advertisements) while two studies[41, 63] involved targeted screening of at-risk populations (identifying and inviting people who were at-risk for screening). Gardner et al.