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As other states expand scope of practice, Arkansas’ test-and-treat program offers takeaways

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Test and Treat

Loren Bonner

Could point of care testing (POCT) services become as common as immunization services in pharmacies? Megan Smith, PharmD, lead author of a new study in JAPhA, thinks so. In a new research paper, she and PharmD candidate Elma Abdullah highlight strategies for pharmacy leadership to put in place as pharmacy scope of practice expands in many states.

Smith and Abdullah honed in on the state of Arkansas to understand pharmacists’ perceived impact of POCT services in the state and their preferred implementation strategies for expanding scope of practice.

“The data reveal that the journey toward implementing POCT services need not be all-or-nothing,” said Smith, who is an associate professor in the Department of Pharmacy Practice at the University of Arkansas for Medical Sciences. “It can be tailored to suit individual practice settings.”

Useful results

Arkansas Act 503 allows pharmacists to prescribe based on CLIA-waived tests using a statewide protocol. However, protocols were not developed by  the time of its passage.

To actively contribute to guiding the development of these protocols, researchers conducted a cross-sectional survey of CLIA-waived pharmacies in Arkansas. A sample of 81 pharmacists representing 238 chain, regional, or multi-independent pharmacies participated in the survey. Survey questions assessed perceptions of Act 503 on POCT services and preferred implementation strategies.

After analyzing the results, they found that 37.9% of pharmacies reported that they are certain or almost certain they would prescribe using the protocol. More pharmacies (63%) reported the youngest age they would prescribe treatment is 6 years to 12 years. Most pharmacies (82.2%) said they do not anticipate or are unsure about increasing their fee once the protocol is adopted. And more than 95% of responding pharmacies reported virtual training, online modules, central contact, and a one-page resource with key protocol information would be most helpful in putting the new statewide protocols in place.

A particularly intriguing result, according to Smith, was whether pharmacists planned to continue their current method of obtaining treatment by working with providers or referrals, or if they intended to leverage the newly established protocol to prescribe independently. Roughly half of the respondents indicated a complete transition to the protocol, while the other half opted for a dual approach.

“The strategic decision-making process involved in determining when to use the protocol versus collaborating with providers highlights the importance of maintaining these valuable connections,” said Smith.

Lots of advice

Smith said she has learned the importance of using self-paced, on-demand educational resources for general education, and clinical updates. For more intricate aspects such as workflow, legal considerations, and billing, she said virtual or live workshops have been the most beneficial.

“My most valuable advice for others embarking on scope expansion is to establish a central point of reference for all resources and webinars,” said Smith. Then, dividing the information into distinct chunks—clinical, legal, billing—makes it easier to digest and understand, according to Smith.

An endorsement by the largest payer in the state of Arkansas made it possible for these services in pharmacies to be covered under the medical benefit.

As pharmacists start up services at their pharmacy, Smith advises choosing one or two services based on the population the pharmacy serves as well as existing relationships. She said it’s also important to decide on a start date and create a timeline that includes key steps for planning, preparation, and the launch of the service. And, of course, pharmacies should apply for a CLIA Certificate of Waiver if they haven’t already obtained one.

“Create your operating procedures around scheduling, intake, patient assessment and evaluation, billing, and documentation,” Smith said. “I’ve seen an increase in pharmacies using online appointment scheduling and electronic intake forms to increase efficiency for patients and proactive planning of their appointments. Finally, train your staff on new services offered—all staff should be able to describe and answer general questions regarding the service.”

One final piece of advice from Smith is for pharmacists to become preceptors for student pharmacists and incorporate launching a service as part of the rotation. “Students can help research supplies, organize the workspace, create staff supports—like binders, scripts, flow charts—to help your service get off the ground,” said Smith. ■

APhA offers a Test and Treat Certificate Training Program that prepares pharmacists to provide point of care services. It’s available at apha.us/TestAndTreat. Also, visit apha.us/Paxlovid for more information about implementing testing and treatment services for Paxlovid (Pfizer).

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