8 Min In Clinical
Let’s get clinical. Follow the links below to find out more about the latest clinical insight in community pharmacy.
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Record learning outcomes
Learning objectives
After reading this feature you should be able to:
- Discuss the latest research regarding pharmacist-led point-of-care testing
- Recognise ways to embrace the opportunities afforded by POCT
- Locate useful guidance and training on POCT in community pharmacies.
Pharmacy-based point-of-care testing (POCT) is associated with important clinical and economic benefits, including significant cost savings and more efficient overall healthcare delivery, according to new research published by the International Pharmaceutical Federation (FIP).1
People undergoing POCT in pharmacy benefited from improved quality of life, which was driven by more rational antibiotic use, earlier disease detection and better risk stratification, as well as key benefits such as convenience and the promotion of good health and general wellbeing, says the FIP report, which is based on a review of existing literature together with surveys and case studies.
The authors conclude that, “the future of healthcare will benefit from the expansion and implementation of POCT services by pharmacies, contributing to sustainable health systems and the achievement of quality health for all”.
What does POCT cover?
According to the International Organization for Standardization (ISO), POCT is defined as: “Testing that is performed near or at the site of a patient with the result leading to a possible change in the care of the patient”.1 In practice, POCT encompasses a wide range of near-patient tests used to identify, diagnose, assess or monitor indicators of health conditions or bodily functions.
Applications include both chronic, non-communicable conditions (NCDs) – for example, blood pressure, blood cholesterol levels, glycaemia – and infectious diseases, including sexually transmitted infections, human immunodeficiency virus (HIV), hepatitis C and influenza.
The potential application of POCT in pharmacy runs the whole gamut from identifying and diagnosing healthcare conditions to treating and monitoring them. As the FIP report explains, people with chronic NCDs can be offered POCT as part of a disease state management programme to monitor treatment outcomes, such as from cholesterol-lowering therapy or diabetes management.
Similarly, pharmacy professionals can use POCT to intervene and provide safe and rapid treatment or referral in acute situations. The net result is faster and more appropriate care, less disease exacerbation and savings in healthcare costs. Assessing POCT in community pharmacy can also lead to pharmacists offering appropriate self-care recommendations as part of their key role as healthy living ambassadors.1
“Due to their accessibility, convenience and expert health workforce, community pharmacies are ideal places for the provision of primary healthcare services, including POCT,” notes Paul Sinclair, FIP president.
“Considering the global significance of the role of pharmacies, which intensified during the Covid-19 pandemic, it is paramount that pharmacists can perform these tests, and receive the necessary training and reimbursement for the provision of these valuable services,” he said.
Sore throat test and treat
In Wales, a NHS-funded sore throat test and treat service in community pharmacies is continuing to be rolled out and expanded after an initial pilot found that routine in-pharmacy POCT could cut the overall antibiotic supply rate when used as part of a multifaceted approach.1, 3
The POC test employed in the delivery of this service is a rapid antigen detection test (RADT), which has a specificity of greater than 95 per cent and sensitivity of 70-90 per cent for group A beta-haemolytic streptococcus (GABHS).3
Overall, the Welsh model has been found to offer a safe option for patients which can be delivered at scale to align with a pre-specified pathway that promotes appropriate use of POCT and encourages good antibiotic stewardship.1
Interestingly, patient satisfaction with the service was not shown to be correlated with actual antibiotic supply.1
Moving into the mainstream
“We are hugely excited about community pharmacy’s ability to deliver a range of health services, including POCT,” says Steve Roest, chief executive and co-founder of PocDoc, an app-based technology platform that combines proprietary lateral flow tests and cloud-based AI diagnostics to deliver end-to-end digital pathways for the assessment, diagnosis and treatment of major diseases.
“Based on the success we have seen with pharmacies across the country rolling out a UK-first digital health heart check powered by PocDoc, we have no doubt that there is a perfect circle here: community pharmacies want to do more health screening; the NHS benefits from reduced pressure on local primary care services; and patients like the convenience of popping to their local pharmacy to access healthcare.”
Despite the obvious potential, the FIP report identifies several hurdles that need to be overcome in order to make POCT more mainstream within pharmacy practices. These barriers include:
- Inadequate clinical training for pharmacy staff
A lack of private consultation areas for performing tests and IT infrastructure for inputting and collating results - Insufficient guidance in the area of POCT
- Poor community awareness of testing initiatives
- Legal and regulatory restrictions
- Insufficient interconnectivity within broader healthcare systems
- Inadequate reimbursement for services provided.
“There are already many examples of successful POCT already happening at scale in pharmacy, not just PocDoc’s cardiovascular screening – the NHS Blood Pressure Check Service is extremely successful, as are the audiology services offered by companies like Tympa Health,” says Roest.
“However, pharmacists need to be supported properly by companies looking to launch services in partnership with community pharmacy. Firms need to provide ongoing support and training, and clear pathways for long-term patient care should it be required, including how to embed the service alongside other existing offerings.” Support, guidance and a clear pathway to growth are key to help pharmacists deliver more services, he concludes.
The document ‘Point of care testing in community pharmacies: guidance for commissioners and community pharmacies delivering NHS services’ from NHS England provides useful pointers to help pharmacy navigate these potential pitfalls and fully embrace the opportunities afforded by POCT.2 According to this guidance, the critical first step in rolling out POCT services from community pharmacies is the selection of equipment and technology that ensures adequate safety and quality to optimise care, manage costs and minimise risk.
This step requires careful planning and should start with a thorough needs assessment, followed by an ‘options appraisal’ to evaluate which POCT technologies on the market are suitable for the service and are of good quality to meet the identified needs. Budgeting and financing to gauge the expense for both equipment purchase and ongoing costs associated with the service lifecycle should also be considered upfront.
The second stage is to outline an operational management system applicable to community pharmacy that ensures the POCT technology is efficiently maintained and competently used by trained operators, risks are effectively addressed, medical device performance is optimised and a high standard of service is delivered.2
Finally, it is important for pharmacies providing POCT services to establish a model of clinical governance that satisfies independent regulators and meets applicable quality standards supporting commissioner assurance.2 The nominated pharmacy lead is responsible for ensuring this programme for clinical governance is in place and is monitored appropriately.
Harnessing the potential of at-home testing
In addition to POCT services delivered within pharmacy premises, pharmacists can also benefit from the sale of over-the-counter self-tests to customers.
POCT here includes both quantitative and qualitative tests, and much of the equipment now comprises small portable hand-held devices or simple-to-use testing kits that individuals can easily use themselves, in the comfort of their own home.
In this respect, pharmacy teams can play a valuable supportive role, advising customers on which test is most appropriate, supplying the necessary kit and explaining how to perform the testing itself, including troubleshooting any problems that may arise. Pharmacists will then also be on hand to help customers interpret the results of the test and take any necessary action in terms of onward referral, medical treatment or lifestyle changes.
“It is easy to think that services delivered in pharmacy are completely separate to tests done at home when, in fact, they can be part of the same care pathway and should be viewed as such by pharmacies,” Steve Roest of PocDoc says. “A good example is with PocDoc where, if someone has had a healthy heart check in the pharmacy and has elevated levels of certain risk factors, they are asked if they would like to take a home test kit away with them to re-test after a certain period of time, along with a clear set of guidelines as to how to reduce those risk factors.”
This turns a single service encounter into an ongoing relationship that spans both in-pharmacy and at-home testing, enabling pharmacists to capitalise on the burgeoning growth of diagnostic self-tests. “I believe this hybrid approach is likely to be the most successful path along which pharmacies can blend self-diagnostics into a successful pharmacy service,” Roest concludes.
Expanding avenues
Pharmacists may be most familiar with the more commonplace applications of POCT such as glucose and cholesterol testing. However, with advances in technology, the range of healthcare applications is continuing to expand. According to the FIP report, POCT deliverable by community pharmacists now includes infectious illnesses such as streptococcus A pharyngitis, influenza, hepatitis C and HIV, as well as long-term conditions like coeliac disease.
For common infectious diseases, performing POCT in community pharmacies has the scope to pinpoint bacterial pathogens that require antibiotic intervention, such as strep A, while simultaneously helping to reduce inappropriate antimicrobial use for viral infections. POCT may also help reduce community transmission of infectious pathogens and improve disease surveillance by monitoring and tracking local exposure rates (see panel on Wales).
Expansion of POC testing for respiratory viruses is a key priority, says the World Health Organization (WHO), because acute respiratory illnesses carry a huge global socio-economic burden.4 Replacing the current paradigm of empiric antibiotic use with directed use, based on antigen detection test results, is also one of WHO’s main goals in the reduction in antibiotic resistance.4
For chronic virus-driven diseases like hepatitis C and HIV, POCT has a further important role in tackling the entrenched problems of under-diagnosis. This is particularly vital in vulnerable patients or disadvantaged at-risk groups who may be less likely to engage with traditional healthcare service providers and for whom pharmacy can provide an accessible and more approachable safety net for testing.
The FIP report in particular highlights the role of community pharmacy in HCV and HIV screening for patients who are homeless or do not have access to a regular GP.1 Improving the diagnosis of these diseases through pharmacy-led POCT has the scope to improve the overall quality of care for individual patients by facilitating timely access to effective treatment and/or prophylaxis as appropriate, helping to stem ongoing community transmission of the causative viruses.
For the more advanced applications of POCT it is particularly vital to ensure that tests used are well-validated and will yield robust results. The WHO designates seven characteristics that POC tests should have, using the acronym “ASSURED”:
- Affordable
- Sensitive (avoid false negative results)
- Specific (avoid false positive results)
- User-friendly (simple to perform, uses non-invasive specimens)
- Rapid and robust
- Equipment-free
- Deliverable (accessible to end-users).1
Looking to the future, in-pharmacy POCT may ultimately be expanded to new frontiers, including pharmacogenomic testing as a bridge to personalised medicine where individual genetic information is used to guide treatment decisions. Now that the technology to analyse a person’s genome is becoming ever more fast and affordable, increasing numbers of private companies are already offering direct-to-consumer POC genetic/genomic testing in the UK.2
References
1. International Pharmaceutical Federation (FIP). Pharmacy-based point-of-care testing: a global intelligence report. 2023
2. NHS England. Point of care testing in community pharmacies. Guidance for commissioners and community pharmacies delivering NHS services. Version 1. January 2022
3. Mantzourani E et al. Impact of a pilot NHS-funded sore throat test and treat service in community pharmacies on provision and quality of patient care. BMJ Open Qual. 2020; 9(1): e000833. doi: 10.1136/bmjoq-2019-000833
4. Brendish NJ et al. Point-of-care testing for respiratory viruses in adults: current landscape and future potential. J Infect. 2015; 71(5):501-10
“Expansion pharmacy POCT for respiratory viruses is a key priority according to WHO”
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In Clinical
Let’s get clinical. Follow the links below to find out more about the latest clinical insight in community pharmacy.