The work described here was presented at the Pharmacy Together 2019 conference.
Between 60 and 78 percent of patients who consult their GP for acute sore throat in the UK receive an antibiotic prescription. Antibiotic prescribing is partly driven by a desire to prevent suppurative complications in sore throats caused by Group A beta-haemolytic streptococcus (GABHS). Throat swabs can help distinguish between bacterial and viral sore throats and guide prescribing, but delays in bacteriology results limit their use in GP practices.
A new Sore Throat Test and Treat service is being piloted in Wales, as part of the common ailment scheme sore throat service, which currently only enables symptomatic treatment. Under STTT, patients with acute sore throat self-presenting to one of the 53 participating community pharmacies are stratified on their likelihood of having GABHS using FeverPAIN or CENTOR clinical scoring. For a FeverPAIN score of more than 3 or a CENTOR score of more than 2, an immediate Point of Care Test is offered. Pharmacists can supply antibiotics to patients with a positive test result, based on predefined dosing schemes.
Our objectives were to explore service outcomes for the first five months of the Sore Throat Test and Treat service. In particular, to calculate:
- Percentage of consultations who met the criteria for a Point of Care Test and subsequent result
- Percentage of patients who were referred to a different healthcare professional
- Overall antibiotic supply during the first five months of the Sore Throat Test and Treat service.
Secondary analysis of data for the Sore Throat Test and Treat service consultations taking place in community pharmacies in Wales between November 2018 (date the service went live) and March 2019, were obtained from the Choose Pharmacy application, an integrated application supporting delivery of services in Wales. Data comprised of clinical information as entered by community pharmacists during the sore throat consultations.
The Point of Care Test positively identified the presence of GABHS and reduced inappropriate antibiotic prescribing
Out of 1725 patients who had the Sore Throat Test and Treat service consultation, nearly three-quarters met the clinical scoring criteria and had a subsequent Point of Care Test. Pharmacists referred around ten percent to other healthcare professionals (primarily GPs), when undertaking the clinical assessment.
Of the patients who received the Point of Care Test, 250 had a positive result. Pharmacists referred four of these patients due to them feeling systemic unwell or when a recurrent infection was reported; a further six patients decided to self-care. A total of 340 patients were supplied with antibiotics (around twenty percent of the total).
Screening of patients before the Point of Care Test identified a population that are asymptomatic GABHS carriers but do not have GABHS infection. The Point of Care Test positively identified the presence of GABHS in the remaining patients and reduced inappropriate antibiotic prescribing.
Even though it was not possible to consider the effect of seasonal variations in the incidence of bacterial sore throats, the overall antibiotic supply of around 1 in 5 with the Sore Throat Test and Treat service is significantly lower to the figures reported as resulted from consultations with GPs. Results further support the NICE Innovation briefing that concluded that the Point of Care Test, in addition to clinical scoring systems, increases diagnostic confidence of a suspected GABHS infection as opposed to carriage of the bacteria, in line with principles of antibiotic stewardship. Future work will explore changes in pattern of use as the service becomes normalised and local GP prescribing data pre- and post- service introduction.
Rebecca Cannings-John, Harry Ahmed & Kerry Hood, Centre for Trials Research, Cardiff University; Andrew Evans, Welsh Government, Cardiff; Cheryl Way & Emma Williams, NHS Wales Informatics Service, Cardiff.
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Competing interest statement:
The author declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.