Exploring the Adoption of Point-of-care Testing for Acute Respiratory Infectious Diseases in Community Pharmacies
Creators: Ahmed, Omar E
Publisher: name: University of Alberta Library
Year: 2024

<p>Background: Acute respiratory infectious diseases such as strep throat, influenza, and COVID-19 pose significant public health challenges. Community pharmacists in Canada have a broad scope of practice. They have been involved in assessing and prescribing for minor ailments, ordering laboratory tests as well as conducting point-of-care (POC) testing for screening and detection of acute and chronic health conditions. POC testing for acute respiratory infectious diseases represents a feasible approach to healthcare delivery and a strategy for early detection and management of these conditions within community pharmacies. The service has led community pharmacists to offer “test and treat” services for patients with symptoms of these conditions. However, the uptake and sustainability of this service are influenced by a wide range of implementation factors (i.e., enablers and barriers) that impact its widespread adoption in community pharmacies.<br>
Goals and objectives: The overall goal of this thesis is to explore the adoption of POC testing for acute respiratory infectious diseases and inform the development of future studies on the implementation of the service in community pharmacies. Within the two thesis projects, I sought to 1) summarize the literature on enablers and barriers to POC testing implementation for acute respiratory infectious diseases in community pharmacies, 2) explore community pharmacists&#39; experiences, attitudes, and confidence in offering POC “test and treat” services in Alberta, Canada.<br>
Methods: The first project, a theory-informed scoping review guided by the JBI Manual for Evidence Synthesis involved a search strategy of 6 databases from inception to June 28th, 2022. We synthesized the factors influencing the implementation of the service in community pharmacies using content analysis and mapped them to the Consolidated Framework for Implementation Research (CFIR). The second project was an online cross-sectional survey sent to 4,035 community pharmacists in February 2024 and informed by the Theoretical Domains Framework (TDF) and the Capability-Opportunity-Motivation-Behavior (COM-B) Model for behavior change. The survey collected information regarding POC testing provision, pharmacists&#39; experiences as well as the perceived enablers and barriers towards POC “test and treat” services in community pharmacies. <br>
Results: In Project 1, We included 43 studies in the final analysis. The majority of studies originated from the USA (n=24) and investigated strep throat. Thirty-six (84%) studies used quantitative methodology, while 6 (14%) were qualitative. Twenty-three studies were in the testing phase conducted in urban centers (n=17), and only four studies used theory to inform their findings. We identified 124 implementation factors and mapped them onto 21 CFIR constructs covering all 5 domains. The most prevalent domain was “Outer setting”  (n = 35/43; 81%) and construct was “Patient needs and resources” (n = 21/43; 49%). The review explored a wide range of factors influencing the implementation of the service in community pharmacies. <br>
In Project 2, out of 413 responses collected (response rate: 10.2%), 370 were included in the final analysis representing a completion rate of 9.2%. Two-thirds of respondents (65%) were active providers of POC testing for respiratory infectious diseases and strep throat testing was the most commonly provided, performed by 60% of all respondents. Active providers were more likely to hold additional prescribing authorization (APA), be internationally educated, practice in a franchise pharmacy, and be confident in providing respiratory POC testing than inactive providers (all P&lt;0.001; univariate analysis). Inactive providers had significantly lower agreement on important TDF domains including “Knowledge,” “Skills,” and “Organization” than active providers. There was no difference in the proportion of active providers compared by urban and rural status.<br>
Conclusion: This thesis provided a comprehensive exploration of the implementation factors influencing POC testing implementation for acute respiratory infectious diseases in community pharmacies. The use of POC testing was perceived by community pharmacists to be advantageous and supportive of antimicrobial stewardship. Training community pharmacists is essential to ensure successful service implementation. Reimbursement availability plays a crucial role in facilitating widespread service adoption. Understanding pharmacists’ attitudes and confidence toward these services is important for supporting the implementation process. Knowledge of the wide range of barriers and facilitators as well as capturing Alberta pharmacists’ experiences could assist pharmacy managers and future researchers in the selection of appropriate tools and strategies to foster the implementation and sustainability of these services over time. </p>