Pharmacy screening ‘opportunistic, wasteful’

blood sample pathology

The Australian Medical Association has slammed pharmacy pathology testing, calling it “bordering on irresponsible”

On Monday 26 June, Sigma’s Amcal Pharmacy network rolled out a pathology testing initiative, under a partnership between Sigma and SmartHealth.

Under the Pathology Health Screening Service, Amcal is offering consumers clinical bundles for health screening purposes to customers who meet certain criteria. Screenings include diabetes, heart, kidney, fatigue, vitamin D deficiency and general health and wellbeing bundles.

AMA vice president Dr Tony Bartone argues that the move will leave patients out of pocket and put patient care at risk.

Package prices start at $54.50 for a kidney health check and go up to $219.50 for a comprehensive general health check.

“This is more than worrying – it is opportunistic, wasteful and bordering on irresponsible,” says Dr Bartone.

“It makes absolutely no sense on any level, and is only fragmenting care and discouraging continuous, life-long care. It is the antithesis of the medical home model of care.”

He says that pharmacists “are simply not trained” to assess whether a patient requires a pathology test.

“This requires significant training and expert clinical judgement to determine whether the ordering of pathology tests is actually appropriate for a patient and the subsequent interpretation and management of that result,” Dr Bartone says.

“Unnecessary tests are a waste of patients’ money and can cause unnecessary worry, confusion or even more unnecessary downstream costs for patients.

“If a pharmacist thinks one of their customers has risk factors that merit further investigation, they should encourage them to see their GP as the first step, so that their GP can undertake an examination to determine whether any further diagnostic tests are warranted.

“This also means that if tests are ordered, they are clinically justified and will attract an MBS rebate, so the patient avoids paying the full cost of the test.”

Dr Bartone says the AMA supports evidence-based advice and guidelines issued by NPS MedicineWise and specialist medical colleges for deciding when tests should be ordered – for example, to test for vitamin D or iron deficiency.

“For example, current guidelines recommend against testing asymptomatic patients for these deficiencies unless they fall into particular high-risk categories,” says Dr Bartone.

“Health checks, screening activities, and diagnostic tests should only be conducted if they are clinically indicated, evidence backed, and cost effective—that is, they benefit patients and don’t incur unnecessary costs.

“This kind of opportunistic health testing only caters to the worried well, without reaching those most at risk or in need of preventive health care.

“We have been watching the continuous march of pharmacy into areas beyond its traditional scope of practice into areas such as vaccinations. This move goes too far.” 

An article by News Corp health correspondent Sue Dunlevy was also critical of the move.

“Chemists are charging patients $220 for blood tests they can get for free from a doctor,” she wrote.

The screening program has received the support of the Royal College of Pathologists of Australia, however.

Its president, Dr Michael Harrison, said this week that offering the testing through pharmacy will allow those who are not seeing their doctor to be screened for common health issues.

“This is an area that’s under-serviced, and these tests provide another mechanism or avenue to get tested,” he said.

Amcal senior pharmacist James Nevile told the AJP today that far from attempting to wrest services from GPs, the program’s intent is to work with them.

“That’s the whole idea – to motivate people to see their doctor, as opposed to stopping them from going,” he says.

He says that Medicare funding applies to testing for diagnostic purposes or for the purposes of chronic disease management, whereas services offered under the Sigma model are for screening purposes, and thus would not be funded anyway.

“These services are aimed at somebody relatively young and fit who wants to understand how their baseline levels are going, and for general health purposes, as opposed to risk assessment or diagnosis,” Mr Nevile says.

“We encourage consumers, if a test for them would be Medicare funded, to seek the services of a GP. And if they do that and don’t purchase a test, that’s a terrific outcome for us.

“There’s a real need for this because there’s significant underdiagnosis of conditions like diabetes. Thirty per cent are thought to have vitamin D deficiency. And there’s no Medicare funding for screening these.

“There is funding for diagnosis, but as we know a lot of people aren’t talking to their GP and may not suspect a problem, this is a good first step to encourage them in that direction.”

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  1. bernardlou1

    I applause Sigma for launching the service.
    Gp’s group AMA are obviously insecure, looking at it from a competition point of view and it’s obviously political. AMA should be focused to patients well being and care.

  2. tvren

    “These services are aimed at somebody relatively young and fit who wants to understand how their baseline levels are going, and for general health purposes, as opposed to risk assessment or diagnosis,”

    I’m fairly sure this is not what the Minister had in mind as in the other article that states; “In step with Health Minister Greg Hunt’s recently announced focus on preventative health, Sigma plans to provide easy access to Pathology Health Screening and encourage Australians – especially those at risk of chronic diseases – to proactively participate in early detection and wellness screening.

    So which is it – are tests flogged to young healthy and curious patients who are just curious or is this genuine screening for chronic disease ?

    • Jarrod McMaugh

      Why not both Thinus?

      Also the minister’s interest is in what the Govt funds…. Which does not include services privately offered by any health professional

      • tvren

        Evidence. Show me valid evidence that screening low risk healthly young patients improve outcomes. Without this the venture has no more validity than those homeopathic drops on the shelf.

        And if this is all about private funded tests why the prominent exposure to the Government’s Health Minister in the articles. It either realtes or it does not

  3. vixeyv

    Great idea. Theranos shows theres a demand for easy to access lab tests for the public. Booking a doctors appointment, or waiting in line for an hour, to have a pathology request written and handed to someone else… sure it seems “free” *cough* Medicare *cough* but it takes up patient and clinical time!

    A pharmacist is well trained to assess a need for a pathology test, and to read results. If there is a need for more knowledge, it won’t be difficult to supply more training to fill the gap. This is the same rebuff given by the AMA for pharmacist immunisation about not being “trained” enough… its a weak an ignorant retort, that gets in the way of seeing opportunities for the potential of a better health system with improved access to services.

    Sit on it, AMA. Welcome to the shake up!

  4. amanda cronin

    I think people have a right to access these tests themselves if they want and are paying for it.
    Obviously those with health problems will go to a doctor for subsidised care but for the “worried well” it might put their minds to rest or encourage lifestyle change.
    I read Priceline have finger prick haemoglobin tests- that would be great where you notice a huge change in someone. I have had a few patients diagnosed with cancer that was initially pointed out by the pharmacist they looked pale and anaemic and thin suddenly to insist on a blood tests. Some refuse- a quick check like this might get them to the doctor if the results indicate an obvious problem.
    Doctors forget many people avoid them like the plague and suffer for it with late diagnosis of diseases like cancer or diabetes with terrible consequences. I quick base check is better then nothing and most pharmacists would encourage a doctors appointment that might never have happened.
    I am a bit that way myself. I can convince myself I am being a hypochondriac and ignore symptoms myself and feel embarrassed to see a doctor and never get around to it. Access to blood tests I want to either put my mind to rest or escalate to seeing a doctor would suit me nicely.

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