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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