Test and Treat
Clarissa Chan, PharmD
Over half of survey participants were open to using pharmacies for testing and treatment of influenza and group A streptococcal pharyngitis infections, according to study results published in the January/February 2023 issue of JAPhA. They were also willing to pay $25 or more for out-of-pocket testing costs.
“More pharmacies are moving toward offering cash-based services, which makes financial sense for pharmacies as long as they are meeting patients’ needs,” said Matthew Witry, PharmD, PhD, an associate professor at the University of Iowa College of Pharmacy, and co-author of the study.
Pharmacies have the potential to provide a more convenient, one-stop service than acute or primary care settings, especially for flu and strep.
“Pharmacists might ask themselves, ‘what can we offer that clinics do not?’ ” Witry said.
Study design and results
The study explored patient perspectives on community pharmacist–provided point-of-care testing and medication dispensing for Streptococcus pyogenes and influenza at one community pharmacy in the Midwest United States following recent state-level legislation allowing for such services. Conducted through a cross-sectional survey at community pharmacies, the researchers evaluated patient acceptance, willingness to seek testing, and willingness to pay.
The findings—based on 152 respondents who were 18 years and older and received their COVID-19 vaccination at the study site pharmacy—revealed that while pharmacies were not the preferred testing site, over half of participants expressed readiness to use pharmacy services for testing and treatment. Despite most respondents preferring their primary care provider or a walk-in setting for testing, the majority demonstrated a willingness to pay more than their office visit copay for the convenience of services offered at a pharmacy. This suggests that patients value the accessibility of testing and treatment at pharmacies.
Study limitations
One main limitation of the study is the potential for selection bias. Witry said that individuals receiving a COVID-19 vaccine for themselves and their children were offered the survey, and their answers may differ from those of the general public.
Also, distinct challenges may confront rural and urban communities that contrast from those encountered by the community pharmacy examined in the study. “People living in a large city or rural town could see a pharmacy-based test and treat service as meeting an unmet need in a different way,” Witry said. “Pharmacies should gauge how hard it is to get a strep test in their community.”
Testing for other conditions?
Influenza and streptococcal pharyngitis have generic treatments, which can be affordable for patients out-of-pocket.
“Seeking third-party reimbursement for tests and treatments are often either not an option, too challenging, or reimbursements are too low to be financially sustainable,” said Witry.
Since COVID-19 therapeutics are not affordable for most people paying cash, this was not studied, he said.
“Shingles are a nice vaccine to offer, and there are pharmacies that are targeting older adults, and that is a nice niche for many pharmacies, but these are not relevant as test and treat options,” Witry said.
Pharmacists pave the way
“Accurately gauging interest is a challenge because the real test is ‘what do patients or parents do when they are actually ill?’ ” said Witry. “They will probably do what they have always done unless they have a reason to go looking for new options.”
There may be options for pharmacists who want to offer testing and treatment services with area employers, targeted advertising, and search engine optimization. “Raising awareness of the service and the benefits may put the option in someone’s head that getting tested and treated at the pharmacy has advantages over what they have done before,” said Witry.
Since there is increasing consumer interest around wellness—such as consultations around supplements—pharmacists could reach out to patients who previously paid for pharmacy services to market the test and treat service, he said.
Also, incorporating testing and treatment may segue into a menu of cash-based services. “While not yet common, these could fit within a membership model or be made available to employees of local businesses that have made contract arrangements with pharmacies,” Witry said.
Although pharmacies are slow to adopt these services, ultimately, “getting trained and obtaining all the approvals to provide testing and treatment in the pharmacy can be challenging, even for motivated pharmacists and pharmacies,” said Witry. Pharmacists should be aware of how the process varies from state to state.
However, “the more pharmacists can meet unmet patient needs and demonstrate their unique expertise, the more patients may be willing to use and pay for services,” said Witry. ■