Implementation of a method for glucose measurements in community pharmacies

Analytical quality and effectiveness of point-of-care testing in community pharmacies: A systematic literature review

BACKGROUND

Point-of-care tests are characterised through the ability of conducting them near the patient's side without the necessity of a laboratory. They can be applied in different healthcare settings to improve patients' access to testing.

OBJECTIVE

To evaluate the effectiveness and analytical quality of point-of-care tests performed in the community pharmacy.

METHODS

Six electronic databases were systematically searched using a predefined search strategy. Interventional studies that reported on the effectiveness of the point-of-care tests and accuracy studies that investigated their analytical quality were included. The literature search, study selection, and data extraction were performed independently by two researchers.

RESULTS

In total, eleven studies were identified focusing on blood glucose, cholesterol, creatinine, uric acid, liver enzymes, international normalized ratio for anticoagulation therapy, bone mineral density for osteoporosis, forced expiratory volume for chronic obstructive pulmonary disease, and infection with human immunodeficiency virus. The included studies showed that point-of-care tests that were conducted and analysed in community pharmacies had satisfactory analytical quality and that the interventions applying these tests were effective overall.

CONCLUSIONS

Community pharmacies are well suited to deliver a wide range of point-of-care tests. In the future this will allow easier access to various screening and diagnostic tests for patients.

Quality Control of Norwegian Pharmacy HbA1c Testing: A Modest Beginning

BACKGROUND

Many pharmacy services involve laboratory testing using point-of-care (POC) instruments. Our aim was to describe the implementation of quality control of the HbA1c POC instruments and investigate the performance in internal quality control (IQC) and external quality control (EQA) for HbA1c POC instruments in Norwegian community pharmacies.

METHODS

Two project pharmacists from each of 11 pharmacies participated in a training program covering capillary blood sampling, how to use the POC HbA1c instrument (DCA Vantage) and IQC and EQA. The pharmacies were enrolled in an EQA program for HbA1c, and their performance was compared with that of general practitioners' (GP) offices.

RESULTS

Two of 89 (2.2%) IQC measurements were outside the acceptance interval. Seven out of 11 pharmacies sent in results in EQA in all the three surveys during six months. Two pharmacies did not analyze the control material in any of the surveys, one pharmacy analyzed the control material in one of the surveys, and one pharmacy analyzed two of the surveys. Of these pharmacies, 56-100% obtained "very good" evaluation for trueness and 71-100% obtained "very good" evaluation for precision. The corresponding numbers for GP offices were 75-87% for trueness and 84-94% for precision. No pharmacies obtained a "poor" evaluation.

CONCLUSIONS

Norwegian community pharmacies can perform IQC and EQA on a HbA1c POC instrument, and the performance is comparable with that of GP offices. The compliance in the EQA surveys was modest, but the duration of the study and participation in the EQA program was probably too short to implement all the new procedures for all pharmacies.

Quality Use of the Pathology Data in Home Medicines Reviews: A Retrospective Evaluation

BACKGROUND

Laboratory tests can be important tools for the assessment of pharmacotherapy. Nonetheless, there are no previous studies that have explicitly focused on the role of pathology data in Home Medicines Reviews (HMR), an Australian medication review program.

OBJECTIVE

Evaluate pharmacists' recommendations regarding laboratory testing in the medication review process.

METHODS

This retrospective review of HMRs assessed the prevalence of the pathology data provided by general practitioners. Additionally, the pharmacists' recommendations based on these laboratory data were compared with national and international guidelines.

RESULTS

In total, 580 reports were evaluated. Of these, 179 reports did not contain any pathology data. Pharmacists commented on provided laboratory values in 324 reports and recommended further testing in 473 reports. Not all suggestions were related to previous values or were in line with guidelines. Most recommendations were regarding vitamin D and lipids (69% and 62% of medication review reports, respectively). Particularly, regarding renal impairment, pharmacists used their knowledge on dose adjustments and contraindications. In relation to full blood count, vitamin B12, and thyroid function, unjustified screenings were often recommended. In 26% of all reports, the pharmacists requested an array of tests without explaining the necessity for these tests. Conclusion and Relevance: Pharmacists provided useful advice based on the pathology data, which was concordant with national and international guidelines; however, in some cases, there was no rationale for the test recommendations provided. The outcome of the HMR program might be further enhanced if pharmacists had direct access to the patients' pathology data.