J Am Pharm Assoc (2003). 2019 Nov-Dec;59(6):872-879. doi: 10.1016/j.japh.2019.07.011. Epub 2019 Aug 29.
The purpose of this study was to demonstrate the feasibility of implementing a Clinical Laboratory Improvement Amendments-waived real-time polymerase chain reaction (PCR) molecular test into a community pharmacy setting as part of a collaborative influenza and group A Streptococcus (GAS) disease management program.
Two community pharmacy sites in Tennessee.
Patients presenting to the pharmacy with symptoms consistent with influenza or GAS from November 1, 2016, to April 30, 2018.
Influenza and GAS management programs based on previously developed protocols occurred at 2 community pharmacies in Tennessee. Pharmacies used the Cobas Liat testing system (Roche Diagnostics). Based on test results and under a collaborative practice agreement, pharmacists dispensed prescription medications for patients with a positive test: oseltamivir for influenza and amoxicillin for GAS. Patients with negative tests were treated with over-the-counter (OTC) medications or referred. Patients testing negative for GAS were asked to consent to having a second throat swab sent for culture.
Number of patients tested, point-of-care test results, and treatment received.
Two hundred and two patients received care at the 2 pharmacies (116 for influenza, 46 for GAS, and 43 for both). Sixty (38%) tested positive for influenza, with 51 receiving an antiviral prescription, and 16 (18%) tested positive and were treated for GAS. No patient testing negative for either or positive for influenza was dispensed an antibiotic. For patients consenting to a follow-up culture, all GAS cultures sent for confirmatory testing were negative.
A protocol-driven community pharmacy-based disease management program using real-time PCR testing for influenza and GAS was able to offer appropriate treatment to patients without overuse of antibiotics.
本研究旨在展示在社区药房环境中实施临床实验室改进修正案豁免实时聚合酶链反应（PCR）分子检测的可行性，作为流感和 A 组链球菌（GAS）疾病管理计划的一部分。
田纳西州的两家社区药房。
从 2016 年 11 月 1 日至 2018 年 4 月 30 日，患者因流感或 GAS 症状到药房就诊。
田纳西州的两家社区药房实施了基于先前制定的方案的流感和 GAS 管理计划。药房使用 Cobas Liat 测试系统（罗氏诊断公司）。根据测试结果和合作实践协议，药剂师为检测结果阳性的患者开具处方药物：奥司他韦用于流感，阿莫西林用于 GAS。检测结果阴性的患者接受非处方（OTC）药物治疗或转介。检测结果为 GAS 阴性的患者被要求同意再送一个咽喉拭子进行培养。
检测患者数量、即时护理测试结果和接受的治疗。
202 名患者在这两家药房接受了治疗（116 例流感、46 例 GAS、43 例流感和 GAS 均有）。60 例（38%）检测结果为流感阳性，其中 51 例接受了抗病毒处方治疗，16 例（18%）检测结果为 GAS 阳性并接受了治疗。没有任何既未检测出流感也未检测出 GAS 且未开出抗生素的患者。对于同意进行后续培养的患者，所有用于确认检测的 GAS 培养物均为阴性。
基于实时 PCR 检测的流感和 GAS 的协议驱动的社区药房疾病管理计划能够为患者提供适当的治疗，而不会过度使用抗生素。
