Wales offers point-of-care testing in community pharmacies.
Point-of-care testing (POCT) is a hot topic worldwide with the spread of the novel coronavirus. Countries have raced to provide more testing to help contain the outbreak and reopen economies. As testing improves in a pandemic, it drives home the importance of implementing POCT for other ailments. For example, sore throat test-and-treat (STTT) service has recently been successful in Wales’ community pharmacies in the United Kingdom.
But, is pharmacy POCT safe and should pharmacists be filling this role? Do general practitioners (GPs) feel comfortable with these tests shifting to pharmacies?
The “Choose Pharmacy” campaign in Wales, United Kingdom
An on-the-spot throat swab scheme implemented in Wales’ community pharmacies aims to diagnose if an illness is viral or bacterial and aid decisions about whether antibiotics are appropriate, and it is helping reduce the burdens on GPs. The National Health Service (NHS) Wales’ “Choose Pharmacy” service has been a success since its 2018 pilot and was expanded in 2019. NHS Wales Informatics Service (NWIS) secured funding through “Efficiency through Technology Funding” from the Welsh government in 2018 to develop an update to the existing “Choose Pharmacy” technology – a national IT platform available in 98% of community pharmacies in Wales.
The STTT service has potential for rebalancing management of uncomplicated sore throats within primary care. Data gathered between November 2018 and January 2019 from the “Choose Pharmacy STTT” pathfinder project and study showed that almost 94% of patients seen would have sought an appointment with a GP had the service not been available. Almost all patients who provided feedback said that they would return to the pharmacy instead of trying to see a GP next time they had a sore throat.
The service has been well received by pharmacists who recognize its role in providing patient education as well as contributing to principles of antimicrobial stewardship. Sore throat-related antimicrobial prescribing is high in general practices in the U.K. POCT has not routinely been used in general practices to confirm the presence of a viral infection and complications can sometimes arise from the presence of group A streptococci. Throat swabs use is limited in general practices because samples must be sent to a separate laboratory.
Patients can self-present with acute sore throat in participating pharmacies
Under STTT, patients with acute sore throat can self-present to a participating pharmacy in Wales. The pharmacist undertakes a swab test from patients over a given threshold – clinical scoring data: FeverPAIN >3 or CENTOR >2 – and offers immediate POCT. Pharmacists can supply antibiotics to patients with a positive test result, based on predetermined dosing schemes. Outcomes of the consultation are communicated to the patient’s GP within 24 hours of the consultation.
Benefits include providing a more accessible, efficient, and high-quality pathway for patients with sore throat, utilizing pharmacists’ skills and freeing up GP time for more complex and urgent medical issues. STTT can also accurately screen for group A streptococci and potentially reduce unnecessary antibiotic prescribing.
Group A strep bacteria are often found on the surface of the skin and inside the throat. They are common and contagious, spreading through coughs or sneezes or through direct contact with an infected person or contaminated object.
OSOM® Strep A Test and OSOM® Influenza A&B Test
Two Sekisui Diagnostics’ POCT products – OSOM® Strep A Test and OSOM® Influenza A&B Test – can provide pharmacists the tools needed to feel empowered to provide the clinical service and educate patients in a structured way. These provide the patient with a better chance of receiving the correct treatment more quickly and reduce the dependence on presumptive treatment.
OSOM® Strep A Test is a color immunochromatographic assay intended for the qualitative detection of Group A streptococcus antigen directly from throat swab specimens. It has easy-to-read two-color results, 96% sensitivity, 98% specificity versus culture, two additional test sticks for external QC testing and results in five minutes.
OSOM® Influenza A&B Test is an immunochromatographic assay that differentiates between Influenza A and B. It has three easy-to-read lines and two extra test sticks included for external QC testing. It takes less than one minute to test with results in 10 minutes, intended for the qualitative detection of Influenza A and B viral nucleoprotein antigens from nasal swabs specimens.
POCT is predicted to exceed immunizations as a driver of revenue for community pharmacies. Pharmacists have proven willing to perform POCT and recommend appropriate treatment for influenza and streptococcal pharyngitis. They have the knowledge and skills to do so.