Point-of-Care Testing: Train, Practice, Prepare
Point-of-care testing can help patients determine whether or not they need to see a prescriber for an antibiotic or for other types of treatment, and it can address the growing primary care provider shortage.
Laboratory testing of any kind is regulated by the Clinical Laboratory Improvement Amendment of 1988 (CLIA) in the United States. In 1988, CLIA increased access to a number of tests. Facilities that possess a Certificate of Waiver—and 9,300 pharmacies do—can conduct point-of-care testing (POCT). Many community pharmacists now help patients with POCT for diabetes, cholesterol, influenza, group A strep (GAS) pharyngitis, and human immunodeficiency virus (HIV) among others.
POCT has many advantages. It can identify community-dwelling individuals who have underdiagnosed conditions like HIV. It can help patients determine whether or not they need to see a prescriber for an antibiotic or for other types of treatment, and it can address the growing primary care provider shortage if collaborative care agreements are in place.
Researchers from the Washington State University College of Pharmacy, Spokane, Washington, have published a study in the American Journal of Pharmaceutical Education that addresses training student pharmacists to perform POCT. These authors point out that while most colleges of pharmacy teach students about POCT (usually diabetes and cholesterol screening), often they do not teach students how to administer specific tests.
The researchers involve 651 students on 2 campuses. A number of faculty members helped with the training. One faculty member had completed the National Association of Chain Drug Stores Community Pharmacy-based POCT Certificate program. Community pharmacists should note that this program, revised most recently in February 2018, is a valuable asset for pharmacists who are currently working and need training.
These researchers taught students how to administer POCT for influenza, GAS pharyngitis, and HIV. They devoted 3.5 hours of classroom time in a weeklong, intensive clinical skills course. Key teaching points were the mechanics of administering tests and interpreting results; understanding when to initiate treatment under collaborative drug therapy agreements, and the importance of referral when necessary. Students needed to demonstrate appropriate technique to pass the course.
At the end of training, 97% of the class successfully passed the module. They successfully described the diseases or conditions for which the tests were used, identified appropriate referral agencies for patients reactive for HIV, and had appropriate counseling strategies for patients who had any positive test.
Many of the points made by these researchers are germane to community pharmacies. The best time to learn how to use point-of-care testing is not when a patient asks for help. Pharmacists need to be prepared before the patient approaches with a problem.
In addition, cost is a concern. Pharmacists need to budget to purchase tests so that they can open them, examine the contents, and perhaps practice on each other.
McKeirnan K, Czapinski J, Bertsch T, Buchman C, Akers J. Training student pharmacists to perform rapid strep, influenza, and HIV point-of-care testing. AM J Pharmaceut Ed. 2018. [E-pub ahead of print]