Effectiveness of a pharmacist-physician collaborative program to manage influenza-like illness

This study was designed to examine the effectiveness of a collaborative agreement between physicians and community pharmacists to treat influenza-like illness (ILI). Every year in the US, there are at least 48,000 deaths and 226,000 hospitalizations resulting from influenza. Normally neuraminidase inhibitors are used to treat it by preventing the cleavage of virions from infected cells, therefore halting the spread of the virus within the body. However, this does not eradiate the virus. Studies found that early detection of the disease if critical to achieving optimal outcomes for treatment, but this is challenging. Many people use OTC products to alleviate symptoms instead of seeking immediate medical attention, delaying actual treatment of the infection. When patients come into the pharmacy to obtain OTC products, this is an opportunity for pharmacist intervention. A study conducted during the 2007-2008 and 2008-2009 flu seasons found that a pharmacist-physician collaborative program resulted in more immediate identification and treatment for patients with ILI. This study conducted from October 2013 to May 2014 and examined clinical outcomes and healthcare utilizations.

The study took place across fifty-five pharmacies in Michigan, Minnesota, and Nebraska. The pharmacists screened adult patients that came to pharmacies presenting symptoms of ILI. Then, they carried point-of-care rapid influenza diagnostic test (RIDT), completed a brief physical examination, and provided a corresponding treatment or referral through an established collaborative practice agreement (CPA) with a local licensed prescriber. After the encounter, pharmacists followed up 24 to 48 hours afterwards with the patient to assess their status and if any further intervention is needed. The outcomes measured were the number of patients screened, tested, and treated for ILI.

There were 121 patients screened overall. Of these patients, 75 were eligible for participation, and 8 had a positive RIDT and were managed accordingly. Of the tested patients 38.7% visited a pharmacist outside of normal office hours and 34.6% did not have a primary care physician. Just 3% said they felt worse at the follow-up. This study found that using a CPA enabled pharmacists to provide timely treatment to patients with and without influenza. One limitation of this study is that it did not use confirmatory testing of the RIDT results. Therefore, there was a possibility that patients were misclassified of having or not having influenza. This study demonstrated that the improved performance of CLIA-waved RIDTs and increased clinical training for pharmacists have made an opportunity for pharmacists and physicians to use a CPA to improve early detected and treatment for patients with influenza. Overall, a CPA could improve the number of patients visiting a physician for causes that only require management of symptoms. If more studies regarding this topic are conducted, hopefully this will lead to better management of patients presenting ILI.

Klepser ME, Klepser DG, Dering-Anderson AM, et al. Effectiveness of pharmacist-physician collaborative program to manage influenza-like illness. J Am Pharm Assoc. 2016;56(1):14-21.

Effectiveness of a pharmacist-physician collaborative program to manage influenza-like illness

As we progress further through flu season, it is important to consider different options to prevent contracting it or how to treat it if preventive measures fail. This study looked at the effectiveness of physicians and pharmacists working together as a team to diagnose patients with flu-like symptoms and prescribe treatments to them via established collaborative practice agreements. The study found that only 11% of the 121 patients screened tested positive for the flu, but the pharmacists were able to provide timely treatment to patients with the flu and also those who only required symptomatic treatments.

The study looked at community pharmacies throughout Michigan, Minnesota, and Nebraska that offered rapid influenza diagnostic tests, brief physical assessments, then used results to determine a diagnosis for each patient and recommended treatment or prescribed medications by the collaborative practice agreement. The study concluded that pharmacists using the data collected from the evidence-based collaborative practice agreements provided a very streamlined treatment experience to patients, and could possibly overtake urgent care and emergency room visits for these types of health care problems.

This practice set-up is one way that patients who have a hard time accessing health care providers can easily receive treatment for the flu. 34.6% of the patients included in the study who came to the pharmacy to get screened for influenza didn’t have a primary care physician and would have gone to urgent care or the emergency room to seek treatment, which is much less efficient and much more expensive. This also shows how health care providers working together can streamline a patient’s health care experience significantly, and also how pharmacists can use their accessibility to provide much more health care to patients than they normally do now. If this practice became the norm for pharmaceutical care, how do you think the role and the views of pharmacists would change?

Citation: Klepser ME, Klepser DG, Dering-Anderson AM et al. Effectiveness of a pharmacist-physician collaborative program to manage influenza-like illness. J Am Pharm Assoc. 56: 14-21.