Rates of participating in screening varied widely (21%[41] to 74%[25]). We found some evidence that screening interventions that were immediately available attracted more participants than those offered at limited

times. Interventions requiring more invasive BKM120 screening tests (e.g. capillary blood glucose measurements) also attracted fewer participants. These findings concur with those reported in the review by Jepson et al.,[4] and suggest that providing flexible screening interventions requiring less-invasive tests is likely to encourage more people to participate. Where screening was aimed at both genders, 30 of the 33 studies reporting the male : female ratio of participants recruited a higher proportion of women.[23-52] The reasons for this are not fully understood but may be related to the fact that some men are reluctant to seek medical help.[80] Screening interventions mostly target apparently healthy people and it may be difficult to convince men of the benefits of participating in screening. This underlines the importance of finding ways to engage men in

more active preventive health care. The majority of the studies included in this review used screening tools that are used in Ipilimumab mw other primary care settings such as those used by medical and nursing staff for spirometry, BMD measurements and cholesterol testing. Similarly, questionnaires were usually based on existing instruments such as the five-item COPD screening questionnaire based on criteria of the Global Initiative for Chronic Obstructive Lung Disease[25] and the Zung Self-rating Depression Scale.[34] However, evidence about the accuracy of these interventions being used in enough community pharmacies by pharmacists was limited. Only five papers included in this review reported accuracy-related outcomes for screening tools; two each for diabetes and lung function,

and one for knee osteoarthritis. The limited findings reported in these studies suggest that the pharmacy-based screening tests used were reasonably accurate, but more studies are needed to compare these with screening tests performed by other providers, and to evaluate sensitivity and specificity of screening tests, as provided by pharmacy staff. Such comparative studies should also consider the relative cost-effectiveness of pharmacy-based screening with screening performed by other providers. Our review found little evidence of this type; only one study was found which compared the cost of screening performed in community pharmacies to that performed in another location.[47] Of the few studies that measured the extent to which screening participants followed pharmacist advice, most reported that less than 50% of screening participants who were advised to seek further help from another health professional, went on to do so.