What is the quality and effectiveness of point-of-care testing in community pharmacy and their related interventions?
University of Canberra researchers have analysed 11 studies related to point-of-care testing in the community pharmacy setting.
Among these studies, outcomes measured were: International Normalized Ratio (INR) (n = 4), cholesterol (n = 4), blood glucose (n = 3), bone mineral density (n = 1), forced expiratory volume (n = 1), creatinine (n = 1), uric acid (n = 1), liver enzymes (n = 1), and HIV (n = 1).
Six studies evaluated analytical tests – by comparing the pharmacy test with a laboratory one.
Three studies that investigated blood glucose measurements found pharmacy testing was acceptably accurate compared to laboratory testing.
Two studies on cholesterol measurements showed satisfactory correlation between laboratory and in-pharmacy measurements for total cholesterol and HDL-cholesterol.
However there were significantly different results for triglyceride values.
Especially when testing triglyceride concentrations, appropriate sample collection was essential to obtain appropriate results.
“One common mistake observed was that the fingertip from which the sample was taken was not sufficiently cleaned in advance,” said the researchers, adding that this led to contamination, falsifying the results.
“I think there is enough evidence that these devices can be used and it is perhaps just a need to ensure the people using them are appropriately trained in their use,” co-author Dr Mark Naunton, head of pharmacy at the University of Canberra, told AJP.
“Pharmacists or anyone for that matter should not be using devices they are unfamiliar with and have not been trained in appropriately.”
One study investigated blood values for creatinine, uric acid, aspartate, aminotransferase, and alanine aminotransferase levels, and all showed satisfactory correlation between pharmacy and laboratory results.
Two studies that compared point-of-care INR testing in community pharmacies found almost equivalent results with a laboratory: 85% of pharmacy results, respectively, were within 0.4 and 0.5 INR units of the laboratory results.
Testing for INR values for anticoagulation management was appreciated by patients, with finger prick tests being less invasive compared to venepuncture.
Two studies investigated effectiveness of anticoagulation management in community pharmacies comparing it with general practitioners or an anticoagulation clinic.
In one study, the pharmacists achieved a statistically significant higher mean time in therapeutic range (TTR) compared to GP care (P < 0.001).
Meanwhile in the other study the pharmacists accomplished a mean TTR comparable to an anticoagulation clinic (P = 0.58).
Both studies revealed no significant differences in INR values between pharmacy-led care and comparison groups.
The authors of the paper published in Research in Social and Administrative Pharmacy say the results show that community pharmacies can conduct point-of-care tests with satisfactory quality and effectiveness.
They add that GPs should get onboard with pharmacist screening and testing.
“For a successful implementation of programs such as the anticoagulation management, it appears beneficial if local GPs are involved and to recognise that pharmacists are intending to reduce GPs’ workload and not to reduce the GPs’ source of income,” said the researchers.
“When community pharmacists deliver public health services, for example by performing point-of-care screening tests, they need to collaborate with patients’ GPs to assure continuity of care.”
Patients appreciated the availability and convenience of point-of-care tests in community pharmacies, and were even willing to pay a small amount (approximately US$5) to use the service.
Dr Naunton told AJP: “I think we have provided a summary of the evidence that does indicate that pharmacists, if appropriately trained, can contribute and take on a greater responsibility for patient care. We see examples overseas where pharmacists are leading anticoagulation services.”
The results “should encourage policy makers to provide funding in this area to establish effective pilot programs in community pharmacies allowing a wider range of screenings for various risk factors and diseases,” said the researchers.
“Through this, patients with chronic diseases may be earlier diagnosed and treated, with a potential decrease in societal costs.
“Other healthcare practitioners could prioritise different aspects of their workload if community pharmacists conducted tasks such as anticoagulation management.”