Welcome to the front line - health testing and your PharmacyPublished on 27th September 2019 2019-09-27T11:00:00+00:00 - Last update on 30th September 2019 2019-09-30T15:42:07+00:00
Technological advances mean that your pharmacy has a bigger role to play in screening and diagnostics - if you integrate testing and screening into your practice.
The principle of pharmacy health screening in certainly isn’t new. Blood and glucose tests have been available for years.
What has changed is health testing technology - and a willingness of customers to come to you, their pharmacist, rather than their doctor. Tests have improved so much that results that used to take weeks are now often available in minutes rather than days - and customers expect that speed of response. Every General Practitioner is under huge pressure and urgently needs a programme that reduces demand on his or her time and resources. Community pharmacy is the only provider with the presence and capacity to step into the breach.
It means that there are many new opportunities to develop and grow your pharmacy - if you make the right decisions and investment now.
You know about the old tests that your patients rely on, from blood pressure to glucose and cholesterol, but what are the new tests available?
The NHS Health Check service is a national screening programme currently being rolled out. It targets people aged 40-74 years to assess their risk of heart disease, diabetes, kidney disease and stroke.
Only a small number of pharmacies have been commissioned to deliver the service so far. However, initial evaluation has shown that they reached people with modifiable risk factors, identified those requiring further investigation and referred appropriately. Thus, it looks as though the service will be expanded in the near future, and you may wish to get your pharmacy involved.
Diabetes and HbA1c
Community pharmacies can already offer diabetes risk assessments for type 2 diabetes - and have performed over 1.5 million checks in the last 15 years.
However, pharmacy tests may be able to identify those at risk of complications by screening for high HbA1c levels – one of the annual checks NICE recommends for people with diabetes.
A simple kit can be used, and can be the first stage in building a service at pharmacy level which will help those with a diabetes diagnosis to manage their condition, with help such as foot care awareness and medicines advice.
You may be able to set up a diabetes advice service in your pharmacy.
Strep A throat tests are being piloted in some Boots stores. The service aims to ensure that viral infections are not inappropriately treated with antibiotics. This can help avoid over-medication and antibiotic misuse, while helping ensure that the spread of infection is reduced, preventing complications of infection and saving GP time.
Numark is now also launching a pharmacy-based Strep A testing service for people complaining of sore throats. The service will include training materials marketing materials and the testing equipment itself.
The economics of testing for Strep A may not yet be established - but it could offer an important new area for your practice - and support your development as a ‘health business.’
A recent proof-of-concept study using a point-of-care test to identify and refer patients for confirmatory coeliac disease testing has delivered positive results. The study was performed on a sample group of men and women receiving prescribed treatments or who had requested OTC treatments for either IBS and/or iron, vitamin B12 or folate deficiency anaemia - and who had no previous diagnosis or investigation for coeliac disease.
The test uses a finger-prick blood sample, and thus far has delivered a negative predictive value (NPV) of more than 99.1 per cent, successfully identifying 9.4% of the total tested as suffering from coeliac disease.
Pharmacies on the Isle of Wight have recently started to offer dry blood spot testing for hepatitis C, blood-borne viruses and syphilis to anyone attending for needle exchange and opiate substitution therapy.
Each patient underwent pre-test counselling and the sample was then sent off for testing. Around 9% of people tested positive, allowing them to be referred for specialised treatment programmes.
Testing may be rolled out across the UK in due course.
The National Chlamydia Screening Programme carries out 1.5m chlamydia tests a year on young people aged 15 to 24 years.
Anyone under 25 years who is sexually active should be screened for chlamydia annually and on change of sexual partner. Men who have sex with men (MSM) should test annually for HIV and STIs, and every three months if having condomless sex with new or casual partners.
A greater awareness of the importance of sexual health is driving uptake of the programme.
As part of a Public Health England (PHE) initiative, the National HIV Prevention Innovation Fund awarded is making a preliminary trial of pharmacy-based rapid HIV testing in selected pharmacies across Cumbria. Anyone can receive a free HIV test with the result available within approximately 15 minutes.
Other current programmes include micro-spirometry testing, mole screening, cystitis and atrial fibrillation monitoring – and the current range of screening is expected to expand further. Even cancer screening may be provided in due course.
Setting up a service
There is more to setting up a testing service than simply offering the kits on your shelves. An essential part of developing a successful health screening service in your pharmacy is to build up consumer trust. This means that you will need to provide sympathetic help when the customer receives his or her results. This must take the form of a provide consultation where you can build on the relationship with the patient, offering a chance to give advice as well as direct them to other services - such as GPs in your area.
Naturally, where it appropriate, you will also be able to explain to customers what you can do to help them with over the counter remedies.
What about the costs?
Innovation in testing technology is bringing more and more tests to your pharmacy. Making sure that people know where and how to access simple and safe testing procedures that give results in a few minutes with high levels of accuracy is of benefit to them, and lets you make the most of your professional skills and your practice. But there will be costs to cover.
Staff will need to be trained, a private consulting room will be essential, and you may require to invest in suitable equipment with some tests. Refurbishing, training and new equipment may be necessary.
At Rangewell, we have financial specialists working to support the pharmaceutical sector. We recognise the scale of the task and of the level of funding you may need to set up a testing service, with a dedicated team and a private consultation room.
Fortunately, we also know the solutions. It means that by calling on us at Rangewell you can be sure of getting the most cost-effective ways to raise the finance you need.
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