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

Abstract

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.

Community pharmacist‐provided test and treat programs for acute infectious conditions

“…Various studies have demonstrated the ability, successes, and challenges of pharmacies to operate CLIA-waived POCT and management programs for acute infectious diseases like influenza and group A streptococcus pharyngitis. 18,[20][21][22][23][24][25] The well-defined decision criteria and management processes of these diseases make them clear candidates for pharmacy disease management programs. Utilizing a community pharmacy program helps reduce the misuse of medical facilities like urgent care centers, the overuse of antibiotics, and the cost of managing these illnesses.…”

“…18,[20][21][22][23]25,34 The other influenza study was a survey that solicited feedback from community pharmacists regarding the implementation process. 24 Within the influenza and group A streptococcal pharyngitis studies, pharmacists were able to prescribe or at least dispense antivirals for those testing positive for influenza and antibiotics for those who tested positive for group A streptococcal pharyngitis. 18,[20][21][22][23]25,34 The COVID-19 studies varied in their methods and objectives.…”

“…All studies mentioned barriers to implementing disease state management programs or POCT, with the most common barriers being disruption of workflow and lack of reimbursement measures [29][30][31][32][33]35 ; see Table 1 for more details of the studies. 18,[20][21][22][23][24][25][29][30][31][32][33][34][35] While the above studies evaluated outcomes following implementation of community-pharmacy POCT, another study examined pharmacists' perceptions of influenza and streptococcal testing and treating in chain pharmacies. In a survey sent to large national supermarket chain pharmacies in Tennessee, Mississippi, and Arkansas, it was found that a majority of surveyed pharmacists were willing to perform POCT in a community pharmacy practice and recommend treatment for influenza and streptococcal pharyngitis.…”

“…Seventy-five T A B L E 1 Studies of U.S. Community Pharmacies' Implementation of Clinical Laboratory Improvement Amendment (CLIA)-waived point-of-care testing (POCT) for Acute Infectious Pathogens. 18,[20][21][22][23][24][25][29][30][31][32][33][34] percent of the "niche group" were willing to pay $50 or more for pharmacy POCT services. 39 Results from this survey also suggest that consumer demand for testing in community pharmacies is likely higher for infectious diseases like influenza and GAS compared to chronic conditions like diabetes.…”

“…Community pharmacy disease management programs provide access to medical treatment for patients who otherwise may not receive treatment or who may delay their treatment. Various studies have demonstrated the ability, successes, and challenges of pharmacies to operate CLIA‐waived POCT and management programs for acute infectious diseases like influenza and group A streptococcus pharyngitis 18,20–25 . The well‐defined decision criteria and management processes of these diseases make them clear candidates for pharmacy disease management programs.…”