Download Block 7 - Point-of-care Testing Summary

Pharmacy Care through the use of Point of Care Testing
Learning objectives:
1. Describe the clinical importance of health screenings and point of care testing for patients with
chronic disease states.
2. Discuss pharmacy care practices that support other health care providers in improving patient
health outcomes
3. Identify new methods in which pharmacies and other community health settings are delivering
direct patient care services
Needs Assessment:
Routine testing is an integral component in the management of most chronic disease states, serving to
screen, diagnose, and monitor progress of diseases. As the role of the community pharmacist expands,
more clinical services are being provided. Community pharmacies are becoming the site of several
point-of-care services, including point-of-care testing (PoCT). Defined as “diagnostic testing performed
at or near the site of patient care", PoCT increases the accessibility of routine tests to patients.1 The
adoption of PoCT technology in the community pharmacy setting must be in such a way that balances
accessibility and evidence-based practices.
Point-of-care testing has been studied in four settings, each at varying degrees of patient accessibility.
These include patient self-monitoring, community pharmacies and other community settings, general
practice, and critical care settings.2 The role of the pharmacist in providing preventive services has been
shown in the clinic. Using evidence-based recommendations for clinical preventive services provided by
the U.S. Preventive Services Task Force, clinic-based pharmacist-directed identification found 60 unmet
screening needs in 9 patients, of which 52 were provided by the pharmacist.3 With the success of
providing preventive services, significant interest surrounds point-of-care testing in community
pharmacies for chronic disease state management. The SCRIP study found that 0f 3304 hospitalized,
high-risk cardiovascular patients, only 28% had documented cholesterol tests within the previous 5
years. Of these, only 8% were treated with cholesterol-lowering medications.4 With the average
American living 1.61 miles from a community pharmacy, the availability of testing significantly improves
access.5
The question of the appropriateness of PoCT in community pharmacies arises. A study in the Journal of
Clinical Pharmacy and Therapeutics found PoCT of creatinine levels feasible, for the purpose of
monitoring CKD and drugs affecting renal function.6 PoCT provided by pharmacists in the 1996-1999
ImPACT study for cholesterol management, resulted in accepted pharmacist recommendations in 265 of
the 346 reported interventions and a mean decrease of 30.5 mg/dL in total cholesterol.7 The SCRIP
study which compared usual care to community-based pharmacist-led interventions found that 57% of
the intervention group showed improvement in the process of cholesterol risk management versus 31%
receiving usual care.4
In addition to improving patient outcomes and accessibility, PoCT in community pharmacies impacts
collaboration between the healthcare team. General practitioners working with pharmacists to monitor
kidney function found PoCT in community pharmacies acceptable.6 Practice model observations were
also noted in the ImPACT study, including referral to and from physicians, regular communication
between all parties, sharing of treatment data, and timely adjustments in treatment plans.
With so many available point-of-care tests, the appropriateness of providing each test in the community
pharmacy setting still warrants investigation.7
Furthermore, the payment model for PoCT services needs determined. Providers for the ImPACT study
were able to set up contracts with two managed care organizations, billed third party payers, and
charged some patients directly. However, reimbursement across the payment spectrum was lower than
the pharmacist-assigned value of $55 per visit, which included the cost of testing and counseling.7
Implementation of PoCT in community pharmacies is a step-wise process, involving population needs
assessment, restructuring of the practice site to accommodate testing and counseling, compliance with
federal and state regulations governing PoCT, training of staff, development of educational and
marketing materials for patients, means of documentation, and continuous quality improvement.1
As testing and counseling on PoCT takes pharmacists away from their normal dispensing role,
consideration must be given to work flow adjustments. Therefore, implementation of PoCT requires
profit/time analysis to ensure optimal resource allocation and ROI.
1. Rodis JL, Thomas RA. Stepwise approach to developing point-of-care testing services in the
community/ambulatory pharmacy setting. J Am Pharm Assoc. 2006;46(5):594-604.
2. St John A. The evidence to support point-of-care testing. Clin Biochem Rev. 2010;31:111-19.
3. Murphy BL, Rush MJ, Kier KL. Design and implementation of a pharmacist-directed preventive
care program. Am J Health Syst Pharm. 2012;69(17):1513-18
4. Tsuyuki RT, Johnson JA, Teo KK, et al. A randomized trial of the effect of community pharmacist
intervention on cholesterol risk management: The study of cardiovascular risk intervention by
pharmacists (SCRIP). Arch Intern Med. 2002;162:1149-55.
5. NACDS Chain Member Fact Book, 2012-2013. 2012;14.
6. Geerts AFJ, De Koning FHP, De Vooght KMK, et al. Feasibility of point-of-care creatinine testing
in community pharmacy to monitor drug therapy in ambulatory elderly patients. J Clin Pharm
Ther. 2013;38:416-22.
7. Blumi BM, McKenney JM, Cziraky MJ. Pharmaceutical care services and results in Project
ImPACT: Hyperlipidemia. J Am Pharm Assoc. 2000;40:157-65.