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Point of Care Testing in Pharmacies
- 1. Advancing Population HealthOutcomes 1 Point of Care Testing in Pharmacies
- 2. Advancing Population HealthOutcomes 2 THE EXPANDING SCOPE OF PHARMACY PRACTICE Immunizations Basic Screenings Point of Care Testing Initiating Drug Therapy Modifying Drug Therapy Acute Care Chronic Disease Mgmt Preventative Services
- 3. Advancing Population HealthOutcomes 3 • Increased Demands of an aging and unhealthy population • Shortage of Primary Care Professionals Access WHAT’S DRIVING THE EXPANDING ROLE OF THE PHARMACIST? 25% with undiagnosed Diabetes 35% of patients have no PCP Increased Needs
- 4. Advancing Population HealthOutcomes 4 BENEFITS OF ENGAGING THE PHARMACIST AS A PROVIDER 7 Day Access No Appointment Needed No office visit fees Immediate access to Medications & Immunizations 93% of Americans live within 5 miles of a Pharmacy 300 Million Customer visits to a pharmacy every week
- 5. Advancing Population HealthOutcomes 5 PREVIOUS PHARMACIST SCOPE EXPANSIONS HAVE BEEN SUCCESSFUL • Over 25% of people get their flu shot at a pharmacy • Immunization rates for Shingles have increased from 12% in 2009 to 20% in 2014
- 6. Advancing Population HealthOutcomes 6 BASIC SCREENINGS TO SUPPORT POPULATION HEALTH • Glucose • Blood Pressure • BMI • Cholesterol • A1C Most states will allow pharmacists to perform CLIA waived testing
- 7. Advancing Population HealthOutcomes 7 POINT OF CARE TESTING (POCT) • Trained Pharmacists performing Rapid Strep or Flu test and dispensing appropriate therapy if positive • Structured similar to Immunizations – Special Training Course – Collaborative Practice agreements with Physicians to dispense therapy • Current NACDS Pilots underway in multiple states – started in MN, MI & NE Strep test Flu test Most states will allow pharmacists to perform CLIA waived testing, but not all will permit them to “act” upon a result even with a CPA
- 8. Advancing Population HealthOutcomes 8 COLLABORATIVE PRACTICE AGREEMENTS • Collaborative Practice Agreements with Physicians To Dispense Medications – Smoking Cessation Products • CPA + CLIA testing capabilities: – Strep and Flu – Oral Diabetic & Statin medications to patients after screenings Benefit: The CPA should follow the CDC treatment protocols and ensure prescribing guidelines are followed, no overprescribing and only dispensing appropriate therapy
- 9. Advancing Population HealthOutcomes 9 PROVIDE AFFORDABLE ACCESS TO TREATMENT • CPAs combined with the ability to conduct basic screenings will allow pharmacies to get patients on therapy and into the healthcare system Abnormal Screening result CPA “standing order” New or “modified” Rx based on CPA
- 10. Advancing Population HealthOutcomes 10 MOST STATES ALREADY ALLOW • Ability of Pharmacist to MODIFY drug therapy with a Collaborative Practice Agreement • Ability to INITIATE new drug therapy with a Collaborative Practice Agreement 45 38
- 11. Advancing Population HealthOutcomes 11 How Advancing Pharmacy Scope could help Public Health with Disease Surveillance
- 12. Advancing Population HealthOutcomes 12 HELP IN BATTLING INFLUENZA • Pharmacist flu testing in stores provides quick access to patients • Treatment with anti-virals will decrease the severity and minimize the contagious period • Provide real-time reporting to the states • Immunizing negative test patients
- 13. Advancing Population HealthOutcomes 13 SCREENINGS FOR HEP C AND HIV • Testing patients for Hep C and HIV, reporting reactive and non-reactive cases to state and referring to public health for diagnosis and follow up • Pharmacy barriers to performing today are: – Privacy concerns (space issue) – Pharmacist training on having these difficult conversations with patients
- 14. Advancing Population HealthOutcomes 14 ZIKA VIRUS OR ANY NEW “THREAT” • Providing education to patients • As soon as CLIA waived test available, could test patients • As soon as vaccine is available could immunize patients to prevent spread • Reporting desired information to the states
- 15. Advancing Population HealthOutcomes 15 HOW PUBLIC HEALTH COULD HELP PHARMACIES • Collaborative Practice Agreements are a big barrier for Pharmacies in treating strep and flu – Would the public health protocol physician consider partnering with pharmacies?
Editor's Notes
- #5 First off they are a highly trained and qualified provider
- #6 The first big expansion for pharmacist’s was immunizations. The fact that 25% of Seniors now get their flu shot from a pharmacy shows that it’s working and patients have embraced the availability of expanded services at their pharmacy. And the easy access and availability is moving us in the right direction. Immunization rates for Shingles have grown from 12% to over 20% in 5 years – and that’s with the dramatic increase in patient eligibility driven by the boomers. So what once was theory, about using pharmacists as a primary care touch point to improve patient health is now proven. This is opening up additional services as infectious disease and public health officials are taking notice of these successes.
- #7 Many pharmacies are already providing this service… However, until they have provider status they are doing it for free or patient is paying cash for test Other tests could be Hep C, HIV, Vitamin D, etc.
- #8 Point of Care testing or Rapid diagnostic testing. This is a specially trained pharmacist performing a rapid strep or flu tests and DISPENSING medication if positive. Think of it, if you get sick on a Friday afternoon or a Saturday, you think you may have strep, maybe your kid just had it and now you have it, you can go in and see a pharmacist, get swabbed, and less than an hour later, walk away with a script in hand. POCT is where immunizations was about 7-8 years ago, it’s about to take off. From a cursory glance, looks like we could do it in about 80% of states. It requires special training course, structured almost exactly like the APhA training for Immunizations – including a train the trainer type program. Need to have a collaborative practice agreement with a physician – outlines protocols – allows you to dispense the scripts if test is positive. There was a current NACDS pilot underway in 3 states this year, they have expanded that to 5 states now. We are looking to get into this pilot this year in a small number of stores.