New professional service in pharmacy – research results

A study funded by the J M O’Hara Research Fund aimed to evaluate the feasibility of point-of-care (POC) C-reactive protein (CRP) testing to support Western Australian community pharmacists’ management of respiratory tract infections (RTIs). 

Currently, community pharmacists make recommendations to patients with symptoms of RTIs based on presenting symptoms and questioning. CRP is an inflammatory biomarker that reliably differentiates self-limiting RTIs from bacterial infections requiring antibiotics. Testing of a patient’s CRP level upon presentation is a service that has been available in many European primary care settings.

Researchers produced a training package, including guidelines for the management of RTIs and protocols for the implementation of a CRP testing service, which was validated by an expert infectious diseases physician. Participating pharmacists made recommendations based on patients’ CRP levels and findings from their routine assessment (RA) through questioning. Pharmacists completed pre/post-training questionnaires, a post-pilot questionnaire and participated in semi-structured interviews. Patients completed post-service questionnaires and were followed up by telephone interviews on Days 3 (by pharmacists) and 5 (by researchers).

Of the 126 pharmacies that expressed interest, five pharmacies were purposively selected. A total of 131 patients were recruited over an eight-week study period. Following the service, 44.3% (58/131) of patients had changed their opinion about the need for antibiotics. Most patients (92.4%) and all pharmacists (100%) agreed that CRP testing should be offered in pharmacies. 

Overall, POC CRP testing was identified as a feasible and acceptable tool to facilitate community pharmacy as a triage point for RTI. These findings form a basis and framework for a large-scale implementation study, including economic modelling, to facilitate pharmacist remuneration for consultations related to RTI which incorporate antimicrobial stewardship.