Flu test with antiviral treatment introduced at Alberta pharmacies
Pharmacists who diagnose flu and sell raise an ethical question, doctor says
Some pharmacists in Alberta have begun using a rapid flu screening tool while also prescribing and selling antiviral flu medication, a Canadian first that infectious-disease specialists say pushes the boundaries on health care.
For $25, Shoppers Drug Mart stores across Alberta offer 10-minute flu screening in store with a nasal swab. If the result is positive, some pharmacists in the province are authorized to start a prescription for the antiviral medication oseltamivir, sold under the brand name Tamiflu for about $66.
"I think what Shoppers is really focusing on is reducing some of the burden on the health-care system and to manage some of those decisions in a more efficient manner," said Ashley Davidson, a pharmacist and owner in St. Albert. "So it may mean somebody doesn't have to be seen right away, they can pick up some products and go home and rest. Or it might mean they are quite contagious with the flu and we do all that we can to contain that and not spread it."
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The screening is just one step in the assessment, which also considers the patient’s symptoms and medical history.
The maker of the screening test, Becton Dickinson and Company, says the BD Veritor system picks up about 80 per cent of true cases of flu.
"If you go in with flu and you're tested, about 15 or 20 per cent of the time, about one time out of five, you may test negative although you really have the flu," said Dr. Andrew Pavia, an infectious disease specialist at the University of Utah Health Care who has reviewed rapid flu tests.
"If you're getting sicker and the test is negative, you may still have flu, and I think people need to be warned to consult a doctor at that point."
Pavia said that if there’s a false negative result, people may get a false reassurance and stay home when they should see a health-care provider, particularly those who are frail and elderly, diabetic or have heart and lung disease.
At best, Tamiflu reduces the duration of flu symptoms by about one day in healthy people. Last week, the U.S. Centers for Disease Control and Prevention sent a reminder to doctors in the U.S. to consider antiviral medications for all hospitalized patients and those who are at high risk for complications.
Davidson said Shoppers will see how the pilot program goes before considering a move into other provinces. Currently only authorized pharmacists in Alberta are able to prescribe antivirals.
Dr. Lynora Saxinger of the infectious diseases division at the University of Alberta’s medical school sees the practical appeal of avoiding a trip to the emergency department. Like Pavia, she wants to see measures in place when the test is offered, since people tend to cough and sneeze when the swab is taken.
It comes down to balancing convenience and safety, Saxinger said.
"I thought it was pushing boundaries a little bit, and it kind of starts bringing us into a situation where we look at where health care is delivered. That's not necessarily bad, but it's a really different way of how we might use, for example, a community pharmacy setting."
As a physician, Saxinger said, she's not allowed to dispense medications. She believes there should be equal scrutiny and oversight for pharmacists.
"I think that any time the same individual can diagnose and sell, there's a potential conflict of interest, and I think that's across the health-care system."
Still, if the test is positive, it might be reasonable to go ahead and buy some antiviral medication when there’s a compelling reason, Saxinger said. "Most people just ride it out."
Saxinger said Tamiflu is the most commonly prescribed antiviral and it is active against the current H3N2 flu strain. It’s been shown to be safe in large trials, but can cause side-effects such as gastrointestinal problems, and doctors are always on the lookout for resistance.
Whether the test is offered at a pharmacy or a doctor’s office, patients should take precautions such as:
- Stay home when sick to avoid spreading the virus to others.
- Be aware of how close you are to others when talking.
- Frequent hand washing or use of hand sanitizer.
- Cough into a sleeve.