by James Morrison B.Sc.Phm. C.D.E.
Select pharmacies in Alberta began administering COVID-19 tests for those who are asymptomatic and have no known exposure to the virus. To learn more about how testing unfolded in Alberta I spoke with Bruce Winston, CEO and owner of Sandstone Pharmacies, of which three locations participated in the initial rollout. I realize that COVID-19 testing in pharmacy remains a controversial topic that is subject to heated debates across our country, however there may be an important role for pharmacies and pharmacists more broadly in public health initiatives that we ought to consider. At the very least it is exciting to learn how Alberta pharmacists continue to lead the way with expanded scope of practice initiatives.
How were pharmacies chosen for the initial rollout?
The Alberta Pharmacists’ Association (RxA) submitted a list of potential pharmacies that would cover the most populous regions of the province to Alberta Health. The proposed sites required pharmacists with Practice Identification Numbers (PracID), prior experience with administering throat swabs, and relationships with local laboratories. Alberta Health then selected the initial twenty pharmacies to participate in the rollout.
How are patients qualified to receive their test at the pharmacy?
Prior to inviting a patient to the pharmacy for a throat swab, the pharmacist first conducts a phone screening with the patient to identify that they are indeed asymptomatic. The pharmacist also confirms that the patient is not high-risk for previous exposure to COVID-19. When both these criteria are met, the pharmacist obtains consent to administer the throat swab and offers the patient an appointment to come to the pharmacy for specimen collection. If the patient is symptomatic or high-risk for previous exposure to COVID-19, then they are referred to an Alberta Health Services testing centre by calling 811.
What PPE is required to administer a throat swab?
The Alberta Health Services standard operating procedure for collecting a throat swab recommends mandatory PPE that includes gloves, mask, and face shield or goggles. The donning of a gown is not required but may be used if the pharmacist wishes. Pharmacies were informed that as long as there was no breach in the pharmacist’s PPE and cleaning protocols, and given the short time period spent with the patient to collect a throat swab, no further action would be required by the pharmacy or staff should the test result be positive for COVID-19.
How are patients notified of their test result?
Patients can sign up for MyHealth Records and review their own test results. Pharmacists must communicate negative test results to the patient and an automated voice message is also being left for the patients with negative results. If a pharmacist receives notification of a positive test result for a patient who was tested at the pharmacy, they must inform the patient, and communicate next steps such as self-isolation and physician follow-up. Public health will be following up directly with the patient for contact tracing.
How are pharmacies remunerated for the service?
The pharmacy may claim $20 for the phone screening and $22 for the specimen collection by throat swab ($2 is included to cover cost of PPE). Pickup and delivery costs to and from the lab are also being reimbursed.
How was asymptomatic COVID-19 testing received by pharmacy teams?
When Bruce approached his three pharmacies participating in the initial rollout, they were eager to offer COVID-19 testing at their locations. He has also met with his other pharmacy teams to assess their interest to offer testing as the program expands and most were also on board. Some pharmacy locations chose not to offer the service for various reasons.
How did the first few days of testing unfold?
Pharmacies asked that the list of testing locations not be disclosed to the public so that they had time needed to operationalize testing into the workflow and ensure testing supply levels to meet demand. Each of the pharmacies had initially been conducting about five tests per day, but due to public demand that number has already quadrupled. Thus far, there have been no positive test results. The list of participating pharmacies will soon be released more broadly, and Bruce expects this will lead to greater numbers seeking the service.
Why should pharmacy embrace this opportunity?
Bruce feels strongly that this is an important opportunity for pharmacy to influence both government and public perception of the profession in a positive light. Although the act of collecting a throat swab may be a technical task, there is a clinical role involved in the screening process. He expects that pharmacies will continue to offer this service at least until the end of the year. Pharmacies already play an important role in the health of their communities and providing asymptomatic COVID-19 testing will only heighten our contribution and expand access to this important service.
James Morrison B.Sc.Phm. C.D.E. is the Director of Pharmacy Excellence, Wholehealth Pharmacy Partners