Observation of a Pharmacist-Conducted Group A Streptococcal Pharyngitis Point-of-Care Test: A Time and Motion Study.

BACKGROUND: Acute pharyngitis is among the most common infectious diseases encountered in the United States, resulting in 13 million patient visits annually, with group A streptococcus (GAS) being a common causative pathogen. It is estimated that annual expenditures for the treatment of adult pharyngitis will exceed US$1.2 billion annually. This substantial projection reinforces the need to evaluate diagnosis and treatment of adult pharyngitis in nontraditional settings. OBJECTIVE: The objective of this research is to quantify the amount of pharmacist time required to complete a point-of-care (POC) test for a patient presenting with pharyngitis symptoms. METHODS: A standardized patient with pharyngitis symptoms visited 11 pharmacies for POC testing services for a total of 33 patient encounters. An observer was present at each encounter and recorded the total encounter time, divided into 9 categories. Pharmacists conducted POC testing in 1 of 2 ways: sequence 1-pharmacists performed all service-related tasks; sequence 2-both pharmacists and pharmacist interns performed service-related tasks. RESULTS: The average time for completion of a POC test for GAS pharyngitis was 25.3 ± 4.8 minutes. The average pharmacist participation time per encounter was 12.7 ± 3.0 minutes (sequence 1), which decreased to 2.6 ± 1.1 minutes when pharmacist interns were involved in the testing (sequence 2). CONCLUSION: Although additional studies are required to further assess service feasibility, this study indicates that a GAS POC testing service could be implemented in a community pharmacy with limited disruption or change to workflow and staff.

Health Care Resource Utilization and Costs for Influenza-like Illness Among Midwestern Health Plan Members.

BACKGROUND: Each year, 6%-20% of U.S. residents are infected by influenza, and more than 200,000 people are hospitalized due to complications related to influenza. In 2003, it was estimated that the direct medical costs for the treatment of influenza were $10.4 billion in the United States.  OBJECTIVES: To (a) assess the current practice associated with the diagnosis and treatment of influenza-like illnesses (ILIs) in inpatient, ambulatory/outpatient, and emergency room settings and (b) evaluate how the use of rapid influenza diagnostic tests (RIDTs) impacts patient health care utilization and cost in these clinical settings. METHODS: For this retrospective cohort study, patients with an influenza-related health care encounter were identified using claims data from a midwestern commercial health insurance plan. In order to select the claims relevant to this study, the corresponding influenza ICD-9-CM codes, GPI codes, and CPT codes for the diagnosis, prescriptions, and procedures were identified and used to detect ILI claims. For the cost analysis of these data, the allowed amount in the billing claims was utilized. Using these data, the median cost, mean cost, minimum cost, and maximum cost were determined for each episode of care. The median costs were compared, and Wilcoxon two-sample tests and Kruskal-Wallis tests with a P value of 0.05 were used as the level of significance. RESULTS: Over 32% of the influenza-like illness episodes identified in this study involved empiric antiviral therapy as either treatment (15%) or prophylaxis (17.1%) without an accompanying medical visit. Of patient episodes with a medical visit, patients with an RIDT for influenza received antiviral treatment in 27.5% of the episodes compared with 55% of the episodes for patients with no RIDT. Episodes with a medical visit and an RIDT had statistically significant (P less than 0.001) lower median 30-day influenza-related health care costs ($62.46) than episodes with a medical visit but no RIDT ($192.83), as well as with empiric therapy but no accompanying medical visit ($105.64). CONCLUSIONS: The results of this analysis for ILI claims over a 2-year period suggest that utilization of RIDTs for influenza may reduce overall influenza-related health care costs and improve proper utilization of anti- influenza medications.