Given budget cuts and staffing shortages, local health departments (LHDs) are asked to do more with less. Leveraging previously underutilized community resources has become vital to promoting community health. Increasingly, community pharmacies are recognized as one such valuable healthcare resource. Staffed with highly-trained healthcare professionals, community pharmacies are also widely accessible: 93 percent of people in the US live within 5 miles of a community pharmacy. Further, many pharmacies are open after hours and on weekends, when there may be limited options of care available to patients. For the medically underserved especially, pharmacies could fill some of the current gaps in health services delivery.
Recognizing this, the National Association of Chain Drug Stores (NACDS) Foundation and the University of Nebraska College of Pharmacy and Ferris State University College of Pharmacy, have launched an initiative to advance public health by bringing rapid diagnostic testing (RDT) for influenza and group A strep to community pharmacies in Michigan, Nebraska, and Minnesota. This currently ongoing, 9-month study assesses the impact of community pharmacy-based influenza and strep management programs on patient health outcomes. Since people experiencing influenza-like illness or sore throat often visit a pharmacy before seeing a doctor, pharmacist-administered RDT could mean influenza is identified and treated faster. And if influenza is identified quickly, patients can receive antiviral medication in the critical 48 hours of symptom onset, meaning less severe illness and less risk for further transmission.
Pharmacists enrolled in the study receive training to screen, evaluate, and perform CLIA-waived rapid diagnostic tests on patients. When patients present to the pharmacy with symptoms, pharmacists following a specified patient evaluation protocol can order medication for those who test positive, or in severe cases, refer patients to appropriate care settings. Patients can conveniently be tested, receive results, and purchase medication all in one visit to their pharmacy. Potentially, pharmacists could report positive test results to LHDs, strengthening community surveillance.
Pharmacists working under the 9-month study sign collaborative practice agreements (CPAs) with authorized prescribers (physicians). Under CPAs, pharmacists can initiate drug therapy without the patient visiting a doctor or hospital. In some cases, CPAs allow pharmacists to order influenza medications (e.g. oseltamivir, zanamivir) for patients testing positive with influenza.
In late March, NACCHO and the NACDS Foundation held a videoconference with LHDs working in areas involved in the study. LHD representatives weighed in on the study and discussed how pharmacy-based RDT programs could support community surveillance, foster future preparedness efforts, and increase collaboration between LHDs and pharmacies.
What could a community pharmacy-based RDT program mean for your own community, especially in terms of surveillance? What sorts of data could pharmacies and LHDs reciprocate? Can you envision alternative uses for RDT in the pharmacy setting? Let us know in the comments section!
 National Association of Chain Drug Stores. (2011). NACDS 2011–2012 chain pharmacy industry proﬁle. Alexandria, VA: National Association of Chain Drug Stores.
 Rubin, S., Schulman, R., Roszak, A., Herrmann, J., Patel, A., Koonin, L. (2014). Leveraging partnerships among community pharmacists, pharmacies, and health departments to improve pandemic influenza response. Biosecurity and Bioterrorism, 12(2): 8-19.