4th National Pharmacy Conference 2026
Development of Primary Healthcare Quality Measures for Community Pharmacy in Non-Communicable Diseases
A modified e-Delphi study in South Africa · Hypertension, diabetes mellitus, dyslipidaemia
Ms Simoné Eksteen, BPharm · University of KwaZulu-Natal · Supervisors: Dr Andy Gray, Dr Sham Moodley
Abstract
Study summary
Background. Non-communicable diseases (NCDs), including hypertension, diabetes mellitus and dyslipidaemia, are major contributors to morbidity and mortality in South Africa. Community pharmacists are among the most accessible primary healthcare providers, yet South Africa lacks a contextually relevant, consensus-based set of quality measures for NCD care in community pharmacy and low- to middle-income settings.
Aim. To develop a literature-informed set of quality measures and achieve expert consensus on their relevance, feasibility and clarity for use in South African community pharmacy.
Methods. A modified electronic Delphi using the RAND/UCLA Appropriateness Method. Candidate indicators across nine domains are rated by an expert panel on a 9-point scale over iterative rounds; consensus is defined as ≥75% agreement (scores 7–9).
Expected contribution. A consensus-based, multidomain quality indicator framework to support standardised performance measurement, inform policy and reimbursement models, and strengthen the role of pharmacists in primary healthcare.
The quality-measure framework
Nine domains of care
Access and coverage
e.g. Essential NCD medicine availability
Screening and early diagnosis
e.g. Opportunistic blood pressure screening
Risk stratification
e.g. Cardiovascular risk stratification
Monitoring and follow-up
e.g. Blood pressure monitoring frequency
Pharmacotherapy
e.g. Appropriate first-line therapy
Pharmacotherapy adherence and persistence
e.g. Medication adherence and persistence
Continuity of chronic care
e.g. Long-term pharmacotherapy management
Lifestyle
e.g. Lifestyle assessment and counselling
Treat-to-target
e.g. Blood pressure / HbA1c / LDL control
Methodology
Modified e-Delphi + RAND/UCLA
- Step 1
Structured literature review
Completed. Evidence-informed development of candidate measures.
- Step 2
Indicator development
Completed. Candidate indicators organised into nine predefined domains.
- Step 3
Expert panel
10–15 experts recruited using purposive and snowball sampling.
- Step 4
Iterative rating
Each indicator rated 1–9 for appropriateness, feasibility and clarity (RAND/UCLA).
- Step 5
Consensus testing
Indicators with insufficient agreement are revised and re-rated.
- Step 6
Consensus threshold
≥75% agreement, represented by scores of 7–9.
Participate
Experts in community pharmacy, NCDs, PHC, policy and funding are invited to join the panel.
Start Round 1 →Contact & ethics
Researcher and supervisor details, ethics approval and HSSREC contacts.
See details →