Community pharmacist-directed point-of-care group A Streptococcus testing: Evaluation of a Canadian program.

ABSTRACT

OBJECTIVE: Streptococcus pyogenes is an aerobic, gram-positive bacterium responsible for a wide variety of infections including common pharyngitis. Novel rapid antigen detection tests allow for diagnosis of group A Streptococcus (GAS) at the point of care. The objective of the study is to evaluate the effects and feasibility of community pharmacist-directed GAS testing. SETTING: A retrospective analysis of aggregate billing data was conducted using descriptive statistics to evaluate the acceptance and feasibility of a community pharmacist-directed Streptococcus testing program at Shoppers Drug Mart pharmacies in the Canadian provinces of British Columbia, Alberta, and Nova Scotia. PRACTICE DESCRIPTION Pharmacists trained in sample collection offered the screening to patients with symptoms suggestive of Streptococcus species infection from November 28, 2015, to May 31, 2016. Throat swabs were collected and analyzed using the BD Veritor system for rapid detection of GAS. PRACTICE INNOVATION Pharmacist-directed point-of-care group A Streptococcus testing and management. EVALUATION Proportion of GAS-positive cases that resulted in the same day initiation of antibiotic therapy by pharmacists were collected. Patient satisfaction with the service was also evaluated. RESULTS: Seven thousand and fifty patients were tested across 204 participating locations. The average age was 27.3 years, with children (age 5-14 years) representing 30.7% of the population; 25.5% of patients tested positive for GAS infection. Of the patients with positive results, antibiotic therapy was initiated within the same day in 68.7% of cases. In Alberta, where pharmacists have advanced prescribing authority, same-day initiation of therapy was 73.8% compared with a rate of 40.5% (P < 0.05) in the other jurisdictions. CONCLUSION: These results highlight both the public readiness to access point-of-care services in community pharmacies and the ability of pharmacists to expedite management of patients with GAS. Pharmacy-based Streptococcus testing can facilitate prompt and appropriate access to antibiotic therapy, as was demonstrated in regions with advanced prescribing authority. Communication of recommendations to the physician remains a barrier.