Pharmacy-Based Infectious Disease Management Programs Incorporating CLIA-Waived Point-of-Care Tests

Advancements in magnetic nanoparticle-based biosensors for point-of-care testing

The significance of point-of-care testing (POCT) in early clinical diagnosis and personalized patient care is increasingly recognized as a crucial tool in reducing disease outbreaks and improving patient survival rates. Within the realm of POCT, biosensors utilizing magnetic nanoparticles (MNPs) have emerged as a subject of substantial interest. This review aims to provide a comprehensive evaluation of the current landscape of POCT, emphasizing its growing significance within clinical practice. Subsequently, the current status of the combination of MNPs in the Biological detection has been presented. Furthermore, it delves into the specific domain of MNP-based biosensors, assessing their potential impact on POCT. By combining existing research and spotlighting pivotal discoveries, this review enhances our comprehension of the advancements and promising prospects offered by MNP-based biosensors in the context of POCT. It seeks to facilitate informed decision-making among healthcare professionals and researchers while also promoting further exploration in this promising field of study.

Expanding scope: Impact and preferred implementation strategies for statewide test and treat protocols

BACKGROUND

Arkansas Act 503 allows pharmacists to test and treat health conditions performed with waived tests using a statewide protocol. To guide development and implementation of these protocols, this study was conducted after enactment of Act 503 and before protocols were published.

OBJECTIVES

The objectives were to determine pharmacy leaderships' perceived impact on point-of-care testing (POCT) services in Arkansas and preferred implementation strategies for expanding scope of practice.

METHODS

A cross-sectional electronic survey of pharmacies holding a Clinical Laboratory Improvement Amendments certificate of waiver in Arkansas was conducted. The primary point of contact of 292 pharmacies was invited by e-mail. Chain, regional, or multi-independent pharmacies of the same company completed one survey on behalf of their organization. The questions assessed perceptions of Act 503 on POCT services and preferred implementation strategies. Study data were collected using REDCap and analyzed using descriptive statistics.

RESULTS

One hundred and twenty-five invitations were e-mailed to pharmacy owners or representatives with a response rate of 64.8% (n = 81 surveys). This represented 238 of 292 invited pharmacies (81.5%). In 2021, 82.6% of pharmacies provided POCT services, specifically 27% influenza, 26% streptococcus, and 47% coronavirus disease 2019. Ninety pharmacies (37.9%) reported they are certain or almost certain they will prescribe using the protocol. More pharmacies (63%) reported the youngest age they would prescribe treatment is 6 to 12 years. Most pharmacies (82.2%) do not anticipate or are unsure about increasing their fee once the protocol is adopted. Most pharmacies (> 95%) reported virtual training, online modules, central contact, and a one-page resource with key protocol information would be most helpful in implementing new statewide protocols.

CONCLUSION

Arkansas pharmacies are willing to use a protocol for 6 years and older and did not anticipate increasing fees to support the expanded service. Pharmacists indicated virtual training and one-page resources would be most helpful. This work highlights implementation strategies that could be most useful as pharmacy scope expands in other states.

Point-of-care testing in private pharmacy and drug retail settings: a narrative review

BACKGROUND

Point-of-care testing (POCT) using rapid diagnostic tests for infectious disease can potentially guide appropriate use of antimicrobials, reduce antimicrobial resistance, and economise use of healthcare resources. POCT implementation in private retail settings such as pharmacies and drug shops could lessen the burden on public healthcare. We performed a narrative review on studies of POCTs in low- and middle-income countries (LMICs), and explored uptake, impact on treatment, and feasibility of implementation.

METHODS

We searched MEDLINE/PubMed for interventional studies on the implementation of POCT for infectious diseases performed by personnel in private retail settings. Data were extracted and analysed by two independent reviewers.

RESULTS

Of the 848 studies retrieved, 23 were included in the review. Studies were on malaria (19/23), malaria and pneumonia (3/23) or respiratory tract infection (1/23). Nine randomised controlled studies, four controlled, non-randomised studies, five uncontrolled interventions, one interventional pre-post study, one cross-over interventional study and three retrospective analyses of RCTs were included. Study quality was poor. Overall, studies showed that POCT can be implemented successfully, leading to improvements in appropriate treatment as measured by outcomes like adherence to treatment guidelines. Despite some concerns by health workers, customers and shop providers were welcoming of POCT implementation in private retail settings. Main themes that arose from the review included the need for well-structured training with post-training certification covering guidelines for test-negative patients, integrated waste management, community sensitization and demand generation activities, financial remuneration and pricing schemes for providers, and formal linkage to healthcare and support.

CONCLUSION

Our review found evidence that POCT can be implemented successfully in private retail settings in LMICs, but comprehensive protocols are needed. High-quality randomised studies are needed to understand POCTs for infectious diseases other than malaria.

Implementing community pharmacy-based influenza point-of-care test-and-treat under collaborative practice agreement

Background

Early and accessible testing for influenza with point-of-care testing (POCT) can be a critical factor for deciding to begin antiviral treatment. More than 10,000 pharmacies across the USA offer Clinical Laboratory Improvement Amendments-waived POCT for infectious diseases, such as influenza A/B. Knowledge of barriers and facilitators to large-scale POCT implementation may be useful in scaling POCT for influenza test-and-treat services (Flu POCT). The objective of this study was to explore the experiences of pharmacists who were early adopters of Flu POCT and treatment under collaborative practice agreement in community pharmacy settings.

Methods

Qualitative research design with in-depth, semi-structured virtual video interviews of licensed US community pharmacists. Interview questions were derived from the Consolidated Framework for Implementation Research (CFIR). Interviewees were selected via a purposeful sampling of pharmacists who were enrolled in a nationwide clinical trial involving pharmacy-based influenza test-and-treat under a collaborative agreement. Interviews were recorded and transcribed. A deductive analytic approach was used via constructs from the CFIR.

Results

Six pharmacists were interviewed. Interviews ranged from 28 to 70 min, with an average length of 46 min. Four broad themes emerged from the data, and each had corresponding subthemes and supporting quotes: influence of the Flu POCT service characteristics on pharmacy implementation, influence of factors outside of the pharmacy setting in Flu POCT implementation, factors within the pharmacy setting influencing implementation, and process of implementing Flu POCT. A novel pharmacy-based Flu POCT implementation framework is presented.

Conclusions

Implementation of community pharmacy-based Flu POCT services is feasible; but, a thorough understanding of both barriers and facilitators to their implementation is needed to increase the spread and scale of these programs. Specifically, pharmacy stakeholders should focus efforts on increasing patient and provider awareness, pharmacist acceptance, leadership support, and support of health providers external to the pharmacy to improve implementation success.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43058-022-00324-z.

Evaluation of Point-of-Care Testing in Pharmacy to Inform Policy Writing by the New Brunswick College of Pharmacists

Pharmacy practice continues to advance, allowing professionals to contribute further to patient care and the healthcare system. Pharmacists are authorized to perform point-of-care testing (POCT) in seven out of ten Canadian provinces. In considering the potential for enhanced clinical decision-making with the opportunity to gain patient data at the site of care, the New Brunswick College of Pharmacists (NBCP) proceeded to draft regulatory amendments and a policy to enable POCT scope in New Brunswick. Policy writing is a core function of Provincial Regulatory Authorities in Canada as the process determines principles that direct pharmacy practice. Each province has a differing scope of practice and method for developing documents. This paper highlights the approach, analysis, and findings of the NBCP pursuant to drafting a POCT policy. The policy development process included a literature search and environmental scan of the ten Canadian provincial regulatory authorities along with other countries. The findings highlighted in this paper describe the use of POCT, quality assurance, regulatory framework, educational opportunities, and the role of pharmacy technicians in relation to POCT in a pharmacy setting. The approach NBCP took to engage professionals and decisions on the direction of the policy are described. As point-of-care services continue to expand in pharmacies, the insights by the NBCP can be utilized by other regulatory bodies or pharmacy professionals who are implementing or enhancing POCT policies or procedures within their organizations.

Professional Certification in Point-of-Care Testing

Professional certification is affirmation and documentation that the certified individual has the knowledge, training, and skills necessary to practice some aspect of medicine or other profession. Herein is a description of the genesis of a professional certification in point of care testing (POCT), inclusive of rationale and goals. A distinction between professional certification and certificate training programs is made. Details regarding eligibility to sit for the board exam are provided along with a list exam content areas. Finally, successes of this professional certification program are highlighted.

At-home Specimen Self-Collection and Self-Testing for STI Screening Demand Accelerated by the COVID-19 Pandemic - A Review of Laboratory Implementation Issues

The idea of specimen self-collection or self-STI testing is not new. In 2019, the World Health Organization (WHO) published the "WHO Consolidated Guideline on Self-Care Interventions for Health" as a first installment in a planned series for various diseases (8). The first document focused on "Sexual and Reproductive Health and Rights". Self-care including self-testing has the readily apparent benefits of privacy, confidentiality, speed, convenience, and access if the price is affordable. It is "people-centered" (9) and enables active participation in one's own health. It is also a health system approach as it can reduce burden on stretched systems with world-wide shortages in medical personnel or other barriers to health care access. Potential risks include: low specimen return rates, uncertain follow-up (linkage to care including treatment, repeat testing including test of cure, partner notification, counseling on risk reduction), unintended/unnecessary use (resulting in false positives with their own set of associated problems), incorrect use, lack of understanding of window periods (resulting in false negatives), lack of surveillance data generation, among other issues (9). The WHO systematically reviewed evidence for self-testing or specimen self-collection for GC, CT and syphilis, including US studies, and published a meta-analysis of available evidence (9). Programs offering self-collection of samples increased overall uptake of STI testing services (RR: 2.941, 95% CI 1.188 to 7.281) and case finding (RR: 2.166, 95% CI1.043 to 4.498), prior to the pandemic (9). U. S. laboratory research on the equivalence and/or superiority of self-collected versus provider-collected specimens for test sensitivity was reported by Gaydos et al (summarized or referenced in (10)). Based on this evidence, WHO issued a new recommendation in 2019 "Self-collection of samples for Neisseria gonorrhoeae and Chlamydia trachomatis should be made available as an additional approach to deliver STI testing services for individuals using STI testing services" (8). In addition, WHO issued a new and conditional recommendation: "Self-collection of samples for Treponema pallidum (syphilis) and Trichomonas vaginalis may be considered as an additional approach to deliver STI testing services for Individuals using STI testing services" (8). Thus, even before the COVID-19 pandemic, substantial expert agreement existed concerning benefits of this approach.

Pharmacists' response during a pandemic: A survey on readiness to test during COVID-19

BACKGROUND

Testing is a principle component to reopening society and bringing the coronavirus 2019 (COVID-19) pandemic to an end. Pharmacists have the ability to perform certain point-of-care tests under federal regulations. On April 8, 2020, the Office of the Assistant Secretary for Health issued new guidance authorizing licensed pharmacists to order and administer COVID-19 tests.

OBJECTIVE

The primary objective of this study was to investigate the views of pharmacists about pharmacist-ordered and -administered COVID-19 testing.

METHODS

A 13-item questionnaire was developed to survey pharmacists who currently hold an active license in Rhode Island.

RESULTS

A total of 122 (13.8%) pharmacists consented and responded to at least 1 question of the survey. The results indicated that the primary concern of the pharmacists in regard to performing COVID-19 testing was spreading the infection to family members (71.3%). Becoming personally infected (59.8%) and not having access to appropriate personal protective equipment (PPE) (62.3%) were the second and third most common concerns of the pharmacists. Almost all of the pharmacists (99.9%) responded that they would be willing to take part in the testing process if they had appropriate PPE. A total of 46% of the pharmacists expressed concern regarding reimbursement for their company, whereas 56% of the pharmacists requested personal compensation for this service.

CONCLUSION

Expanding the pool of health care providers who can perform testing is critical to achieving and sustaining proposed testing thresholds. Rhode Island pharmacists are willing to take part in performing COVID-19 testing provided appropriate PPE is available and services are reimbursed. Pharmacists are the most accessible and essential health care providers willing to take on critically important roles during the COVID-19 pandemic provided appropriate safety measures can be met.

A state-level needs analysis of community pharmacy point-of-care testing

Background

The uptake of point-of-care testing (POCT) within community pharmacies at state and national levels is largely unknown despite the endorsement and advocacy efforts of pharmacy organizations, recent legislative advances, and numerous models for successful POCT implementation within individual pharmacy sites.

Objectives

The study aimed to describe the current landscape of POCT in Wisconsin community pharmacies and identify opportunities for the advancement of testing and the key factors influencing the realization of these opportunities.

Methods

A survey was administered over the telephone to pharmacy managers of community pharmacies in Wisconsin. The sites were randomly selected from predefined geographic regions to mirror pharmacy distribution across Wisconsin. The survey items evaluated provision of POCT, future direction of POCT, barriers and motivators to offering POCT, and pharmacy demographics. Descriptive statistics and thematic analysis were used to analyze data.

Results

Pharmacy managers from 147 of the 938 registered community pharmacies (15.7%) participated in the survey. Only 17.1% of the pharmacies were offering POCT; however, 48.3% of managers reported that their pharmacy would likely implement or expand POCT within the next 5 years. The most commonly reported barriers to initiating or expanding POCT were the limitations on pharmacist availability to oversee testing and workflow restrictions. Continuing to advance the pharmacy profession was a top reason for offering or expanding testing services.

Discussion

While few pharmacies are offering POCT in Wisconsin, there is motivation for expansion in coming years. Understanding, anticipating and addressing common barriers can faciliate this process.

Conclusion

This needs analysis offers a blueprint for researchers, educators, and clinicians to shape POCT efforts by examining the landscape of pharmacy-based testing in their own states and communities.

Implementation of primary care clinical pharmacy services for adults experiencing homelessness

BACKGROUND

It is estimated that on any given night in the United States, more than half a million individuals experience homelessness. Within the homeless population, chronic conditions such as diabetes, heart disease, and human immunodeficiency virus are found at rates 3-6 times higher than in the general population. Despite this, access to appropriate treatment and preventive care remains difficult for those experiencing homelessness, and many barriers exist to achieving positive health outcomes.

OBJECTIVE

The primary objective of this study was to determine the clinical impact and sustainability of implementing clinical pharmacy services in a clinic for adults experiencing homelessness.

PRACTICE DESCRIPTION

As a pilot service, a postgraduate year 2 ambulatory care pharmacy resident attended the Pedigo clinic for adults experiencing homelessness 1 half-day per week to provide independent cardiovascular risk reduction (CVRR) disease state management under a collaborative practice agreement.

PRACTICE INNOVATION

The existing CVRR model was applied at a clinic location that did not previously have clinical pharmacy services. The provision of these services was adapted to meet the unique health needs of the homeless population.

EVALUATION METHODS

The outcomes from having a clinical pharmacist in this clinic setting were retrospectively reviewed from September 2019 to March 2020.

RESULTS

During the pilot period, the pharmacist conducted 28 encounters for 14 unique patients and made a mean of 4 clinical interventions per patient encounter. A total of 124 interventions occurred, including comprehensive medication review (n = 23; 82.1%), patient education (n = 21; 75%), medication regimen optimization (n = 18; 64.3%), and tobacco cessation (n = 18; 64.3%), among several others. Clinical outcomes (glycosylated hemoglobin level, blood pressure, and weight) remained stable with pharmacist management throughout the pilot period.

CONCLUSION

The addition of a clinical pharmacist to the interdisciplinary care team for patients experiencing homelessness addresses a health care disparity and enhances the care provided to this vulnerable population.