9/30/2018 1 9/30/2018 Making Point of Care Testing Work in Your - - PDF document

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9/30/2018 1 9/30/2018 Making Point of Care Testing Work in Your - - PDF document

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9/30/2018 1 9/30/2018 Making Point of Care Testing Work in Your Pharmacy NCPA 2018 Annual Convention Kevin Day, PharmD, Brandon C. Achor, PharmD, Staff Pharmacist Owner / Managing Partner Days Miami Heights Pharmacy Lackie Drug Store

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Brandon C. Achor, PharmD, Owner / Managing Partner Lackie Drug Store NCPA 2018 Annual Convention Kevin Day, PharmD, Staff Pharmacist Day’s Miami Heights Pharmacy

Making Point of Care Testing Work in Your Pharmacy

Disclosure

Brandon Achor declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. Kevin Day declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.

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Learning Objectives

  • Discuss different point-of-care tests that require a CLIA

waiver

  • Outline strategies for establishing collaborative practice

agreements with local providers

  • Explain processes needed to implement POCT in your

pharmacy

Opportunity

  • Millions of influenza and acute pharyngitis cases each year
  • 76 million baby boomers should be screened for Hepatitis C
  • Estimated 162,500 undiagnosed HIV patients
  • 7 million undiagnosed diabetes patients
  • 7,500 urgent care centers across the country
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Overview of Pharmacy POCT

  • Infectious Disease Testing
  • Infectious Disease Screening
  • Chronic Disease Monitoring
  • Chronic Disease Screening

Overview of Pharmacy POCT

  • Consumer Driven Healthcare
  • Pharmacists as Providers
  • Healthcare Destination
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Legal Considerations

  • CLIA
  • CMS Form 116
  • You must be a CLIA Waived facility!
  • State Board of Pharmacy
  • Pharmacists or Technicians? Specifically Restricted?
  • Liability
  • Collaborative Practice

Training

  • Requirements? Options?
  • Comfort Level
  • Protocols
  • Who is going to do what, when?
  • Documentation
  • What is going to be shared with whom, when?
  • Practice!
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Statistics

Specificity

  • Higher this goes… fewer false positives.
  • Rapid Influenza Diagnostic Tests (RIDTs) are generally up to

95% and better (very good) Sensitivity

  • Higher this goes… fewer false negatives.
  • Rapid Influenza Diagnostic Tests (RIDTs) range from 50-70%

(not all that great)

Statistics – Positive Predictive Value

If Influenza Prevalence is… And Specificity is… Then PPV is… False Pos. rate is… VERY LOW (2.5%) MODERATE (80%) VERY LOW (6-12%) VERY HIGH (88-94%) VERY LOW (2.5%) HIGH (98%) LOW (39-56%) HIGH (44-61%) MODERATE (20%) MODERATE (80%) LOW (38-56%) HIGH (44-62%) MODERATE (20%) HIGH (98%) HIGH (86-93%) LOW (7-14%)

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Statistics – Negative Predictive Value

If Influenza Prevalence is… And Sensitivity is… Then NPV is… False Neg. rate is… MODERATE (20%) LOW (50%) MODERATE (86-89%) MODERATE (11-14%) MODERATE (20%) HIGH (90%) HIGH(97-99%) LOW (2-3%) HIGH (40%) LOW (50%) MODERATE (70-75%) MODERATE (25-30%) HIGH (40%) HIGH (90%) HIGH (93-94%) LOW (6-7%)

Who is this guy and why is he up there?

  • Raised in Maumelle, AR
  • Uof A Fayetteville
  • Studied abroad in Dublin, Ireland because they said

it would be free (it wasn’t)

  • UAMS College of Pharmacy Class of 2015
  • 1st Runner-Up in NCPA Business Plan Competition

2014

  • Became co-owner of Lackie Drug Store in 2016
  • Implemented POCT same year
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How I Got Started

  • Wholesaler Annual Tradeshow 2016
  • CLIA Waiver and Device Training for All Employees
  • Meetings with Local Providers (for Marketing and

Quality Assurance)

  • Marketed to Community and School System (good

idea)

  • Waited for Storm to Hit
  • https://www.thv11.com/video/news/health/pharmacists-offering-flu-

tests/91-2902755

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Workflow Integration

Patient requests testing Cashier receives payment Patient is directed to designated testing area to fill out intake form Technician administers test Pharmacist is delivered intake form and counsels patient while awaiting results

38%

Patients visited pharmacy

  • utside normal

clinic hours

54%

Patients did not have a primary care provider

Literature Access to Care

Klepser, D. G., et al. (2018). "Utilization of influenza and streptococcal pharyngitis point-of-care testing in the community pharmacy practice setting." Res Social Adm Pharm 14(4): 356-359.

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Patients screened for streptococcus test positive

16-25%

Patients screened for influenza test positive

11-28%

Minutes of pharmacists’ time per encounter for strep screening

13 ± 3.0

Klepser, D. G., et al. (2018). Res Social Adm Pharm 14(4): 356-359. Klepser, D. G., et al. (2016). J Am Pharm Assoc (2003) 56(3): 323-329 e321. Klepser, M. E., et al. (2016). J Am Pharm Assoc (2003) 56(1): 14-21. Kawachi, A., et al. (2017). J Pharm Health Care Sci 3: 22. Papastergiou, J., et al. (2018). J Am Pharm Assoc (2003). Corn, C. E., et al. (2017). J Pharm Pract (1531-1937): 897190017710518.

  • Initial Investment:
  • Device (free - $260) + 30 StrepTests (~$80) + 30 FluTests (~$350) = $430 –

690.00

  • Break Even: #24 - 38 Flu Tests and/or #16 - 30 Strep Tests

(assuming $30 fee)

Investment

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Brandon C. Achor, PharmD

Owner / Managing Partner Lackie Drug Store lackiedrug@gmail.com

Kevin Day, PharmD

Staff Pharmacist Day’s Miami Heights Pharmacy kcday8@gmail.com

Questions?