Expanding scope: Impact and preferred implementation strategies for statewide test and treat protocols

Abstract

Background: Arkansas Act 503 allows pharmacists to test and treat health conditions performed with waived tests using a statewide protocol. To guide development and implementation of these protocols, this study was conducted after enactment of Act 503 and before protocols were published.

Objectives: The objectives were to determine pharmacy leaderships' perceived impact on point-of-care testing (POCT) services in Arkansas and preferred implementation strategies for expanding scope of practice.

Methods: A cross-sectional electronic survey of pharmacies holding a Clinical Laboratory Improvement Amendments certificate of waiver in Arkansas was conducted. The primary point of contact of 292 pharmacies was invited by e-mail. Chain, regional, or multi-independent pharmacies of the same company completed one survey on behalf of their organization. The questions assessed perceptions of Act 503 on POCT services and preferred implementation strategies. Study data were collected using REDCap and analyzed using descriptive statistics.

Results: One hundred and twenty-five invitations were e-mailed to pharmacy owners or representatives with a response rate of 64.8% (n = 81 surveys). This represented 238 of 292 invited pharmacies (81.5%). In 2021, 82.6% of pharmacies provided POCT services, specifically 27% influenza, 26% streptococcus, and 47% coronavirus disease 2019. Ninety pharmacies (37.9%) reported they are certain or almost certain they will prescribe using the protocol. More pharmacies (63%) reported the youngest age they would prescribe treatment is 6 to 12 years. Most pharmacies (82.2%) do not anticipate or are unsure about increasing their fee once the protocol is adopted. Most pharmacies (> 95%) reported virtual training, online modules, central contact, and a one-page resource with key protocol information would be most helpful in implementing new statewide protocols.

Conclusion: Arkansas pharmacies are willing to use a protocol for 6 years and older and did not anticipate increasing fees to support the expanded service. Pharmacists indicated virtual training and one-page resources would be most helpful. This work highlights implementation strategies that could be most useful as pharmacy scope expands in other states.