In the JournalsPerspective

Cost of diabetes tests similar in community pharmacies, medical practices

Costs associated with screening a patient for diabetes and conducting confirmatory testing via community pharmacies in England was comparable to the same services performed in medical practices, according to findings recently published in Pharmacy.

“Early identification and treatment of diabetes is known to reduce the incidence of complications,” David Wright, PhD, School of Pharmacy, University of East Anglia in the United Kingdom, and colleagues wrote. “Screening activity within a population increases the prevalence of diagnosed diabetes, and results in cases being identified 3.3 years earlier on average.”

Pharmacies performed diabetes screenings on 164 residents of an area with an average level of social deprivation and mostly white inhabitants, and 172 residents of an area with an above average level of social deprivation with inhabitants of mixed ethnicity.

Wright and colleagues gathered the costs associated with training the pharmaceutical assistant, advertising the screening, preparing clinical/customer feedback forms, paying the pharmaceutical assistant and pharmacist’s salaries, using the HbA1c test and analyzer, conducting internal quality control and external quality assurance, collecting samples and providing consumables for each resident. The data were compared to previous studies that had ascertained the same costs when a medical practice conducted the screening.

Researchers found that the cost per patient with confirmed type 2 diabetes was estimated to range from £7,638 ($9,809 USD) in areas with above average levels of social deprivation to £11,297 ($14,508 USD) in locations with an average level of social deprivation. These amounts increased to £12,730 ($16,349 USD) in areas with above average levels of social deprivation and £18,828 ($24,180 USD) in locations with an average level of social deprivation when 60% of such patients asked their general practitioner to perform confirmatory testing.

“The estimated cost per test as delivered within the underpinning service was only marginally greater than that reported in other medical practice-based studies,” Wright and colleagues wrote. “Consequently, we can assume that a community pharmacy-based service is likely to provide similar results to that provided from a medical practice.”

“Whilst it would have been preferable to take a whole health system perspective when estimating costs, development of such a model was beyond the project’s remit. A wider perspective would have implied wider costs, but this doesn’t invalidate the perspective adopted,” they added. – by Janel Miller

Disclosures: Wright reports conducting consulting work for community pharmacy companies. Please see the study for all other authors relevant financial disclosures.

Costs associated with screening a patient for diabetes and conducting confirmatory testing via community pharmacies in England was comparable to the same services performed in medical practices, according to findings recently published in Pharmacy.

“Early identification and treatment of diabetes is known to reduce the incidence of complications,” David Wright, PhD, School of Pharmacy, University of East Anglia in the United Kingdom, and colleagues wrote. “Screening activity within a population increases the prevalence of diagnosed diabetes, and results in cases being identified 3.3 years earlier on average.”

Pharmacies performed diabetes screenings on 164 residents of an area with an average level of social deprivation and mostly white inhabitants, and 172 residents of an area with an above average level of social deprivation with inhabitants of mixed ethnicity.

Wright and colleagues gathered the costs associated with training the pharmaceutical assistant, advertising the screening, preparing clinical/customer feedback forms, paying the pharmaceutical assistant and pharmacist’s salaries, using the HbA1c test and analyzer, conducting internal quality control and external quality assurance, collecting samples and providing consumables for each resident. The data were compared to previous studies that had ascertained the same costs when a medical practice conducted the screening.

Researchers found that the cost per patient with confirmed type 2 diabetes was estimated to range from £7,638 ($9,809 USD) in areas with above average levels of social deprivation to £11,297 ($14,508 USD) in locations with an average level of social deprivation. These amounts increased to £12,730 ($16,349 USD) in areas with above average levels of social deprivation and £18,828 ($24,180 USD) in locations with an average level of social deprivation when 60% of such patients asked their general practitioner to perform confirmatory testing.

“The estimated cost per test as delivered within the underpinning service was only marginally greater than that reported in other medical practice-based studies,” Wright and colleagues wrote. “Consequently, we can assume that a community pharmacy-based service is likely to provide similar results to that provided from a medical practice.”

“Whilst it would have been preferable to take a whole health system perspective when estimating costs, development of such a model was beyond the project’s remit. A wider perspective would have implied wider costs, but this doesn’t invalidate the perspective adopted,” they added. – by Janel Miller

Disclosures: Wright reports conducting consulting work for community pharmacy companies. Please see the study for all other authors relevant financial disclosures.

    Perspective
    Stephanie Gernant

    Stephanie Gernant

    Undiagnosed and undertreated diabetes lead to severe morbidity and mortality; screening for early diagnosis is essential to preventing these complications.

    In an effort to increase the availability and accessibility of screening, this U.K.-based pragmatic study determined that diabetes screening costs do not significantly differ between screening conducted by a community pharmacist in a community pharmacy, and the screening conducted in a medical office.

    Models of care like this can and do exist in the United States. Many community pharmacists are trained to complete screenings not only related to diabetes (like A1Cs and blood glucoses), but also point of care tests like cholesterol, anticoagulation and infectious diseases. Community pharmacists can perform rapid strep and flu tests, and under collaborative practice, can prescribe a necessary prescription immediately. Others are even trained to screen and counsel on serious public health issues like HIV and hepatitis. Indeed, community pharmacies are ideal screening locations because with special waivers, community pharmacists can offer patients on-demand tests without an appointment. Further, as nearly 90% of the country’s population lives within walking distance from a community pharmacy (many open nights, weekends, or 24 hours a day), pharmacists’ accessibility makes them the prime point for public health screening. However, all this calls the question: if community pharmacists are ideal for providing public health screenings, why don’t we ever seen pharmacists taking blood tests or a throat swabs?

    The reason we don’t see this model readily implemented across the U.S. is due to our antiquated health care payment and health information sharing systems. Specifically, U.S. pharmacists are not recognized providers under the Social Security Act: Without that recognition, pharmacists have extreme difficulty receiving reimbursement for their services. Further, the financial incentives for medical offices, care organizations and hospitals alike to partner with community pharmacies to deliver better patient care are simply not strong enough to generate substantial change. And without that reimbursement, there’s no service. Further, the U.S. lags behind other industrialized nations in health information technology. Whereas countries like Denmark, Candida and Australia provide patients living with chronic illnesses improved care coordination through health information exchange systems, the U.S. struggles to make these platforms universal. Not surprisingly, the health information exchange platforms the U.S. does have are similarly not readily accessible to community pharmacists.

    More than 30 million Americans are living with diabetes, and another 84 million living with pre-diabetes; this epidemic is more likely to get worse before it gets better. Fortunately, when taken correctly and in combination with lifestyle modifications, diabetes therapies are incredibly effective in helping patient’s lead full, healthy lives. Early diagnosis and prompt treatment can prevent devastating complications and highlights the importance of diabetes screening. By lifting some point barriers, the U.S. could utilize its army of community pharmacists who are ready, trained and prepared to conduct large-scale public-health screenings.

    • Stephanie Gernant, PharmD, MS
    • assistant professor, pharmacy practice department
      University of Connecticut School of Pharmacy

    Disclosures: Gernant reports no relevant financial disclosures.