OSPAP Programme: Screening in Pharmacy

OSPAP Programme: Screening in the Pharmacy

• The OSPAP programme focuses on screening in pharmacies.
• Screening: The systematic process of testing people who have not previously sought medical attention to identify individuals at sufficient risk of a disorder to warrant further investigation.
• Examples of screening include blood testing, physiological testing, microbiology testing, questionnaires, and combinations of these for comprehensive risk assessments. Screening can be population-based, selective, or opportunistic.

Aims of Screening

• Save lives
• Improve quality of life through early diagnosis of serious conditions
• Reduce risk of developing conditions
• Reduce complications of existing conditions
• Requires careful assessment of risks and benefits

Population-Based Screening

• According to WHO (Strong, Wald and Miller, 2005), population-based screening should only be undertaken if:
  • The disease is a significant health problem.
  • The natural history of the disease is understood.
  • There is an identifiable preclinical stage of the disease.
  • Tests are reliable.
  • Treatment benefits from early detection outweigh the delay in treatment.
  • The process is cost-effective.
  • Screening will be a systematic ongoing process.

Screening Opportunities in Community Pharmacy

• Selective screening: Such as chlamydia testing with EHC consultations.
• Opportunistic screening: Includes asthma control tests when providing inhalers, blood pressure checks, and collaboration with primary care.
• Screening participation: Part of a public health campaign, like AUDIT-C for alcohol awareness, responding to symptoms, and identifying "red flags" like weight loss with constipation.

Chlamydia Screening

• In 2021, the focus shifted to reducing reproductive harm from untreated chlamydia in women and others with a womb or ovaries.
• Chlamydia is the most common STI in the UK.
• Chlamydia cases saw a 24.3% increase from 2021 to 2022 and 194,244 in 2023.
• Chlamydia primarily affects people under 25.
• Testing involves urine or vaginal swabs, and treated easily by antibiotics.
• Black 'other,' (non-African or Caribbean) and black Caribbean ethnicity have the highest risk.
• In 2023, pharmacies only performed 0.3% of NHS chlamydia screening, a decrease from 2022 (42.7% online). Clamelle is a private screening service offered through some pharmacies.

Gonorrhoea and Syphilis

• Gonorrhea saw substantial increases in 2022 and 2023, reaching a record high.
• Syphilis also reached record high numbers, increasing 9.4% from 2022 to 2023.

Asthma Control Test

• A survey by Asthma & Lung UK revealed that 24% of respondents had uncontrolled asthma in 2020.
• A substantial proportion of the population is at risk of life-threatening asthma attacks.
• A score under 20 on the Asthma Control Test suggests poorly-controlled asthma.

NHS Health Checks (2009)

• Offered every 5 years to those aged between 40 and 74 and without prior diagnoses.
• The check encompasses various tests (Questionnaire, BMI, Cholesterol level, BP) aimed at identifying CVD, stroke, T2DM, and renal disease risk.
• QRISK-2/3 (cardiovascular risk calculators) are used and communicated to the patient and interventions are planned.
• Estimated to prevent 1600 heart attacks, 650 premature deaths, and 4000 new diabetes cases annually.

Evaluation of NHS Health Checks

• Strong et al.'s (2016) 4-year evaluation showed good uptake in areas of high social deprivation.
• Uptake increased from 2009/10 (5.8%) to 2012/13 (30.1%).
• The checks identified higher risk individuals for hypertension, diabetes, and chronic kidney disease.
• Many individuals started on statins or antihypertensive therapies.

QRISK

• Risk calculators assess 10-year cardiovascular risk.
• QRISK 2/3 are available, and QRISK3 is recommended by NICE.
• Results are updated annually.

Hypertension Case Finding Service 2021

• Aimed to find undiagnosed cardiovascular disease in people over 40.
• If blood pressure is 140/90mmHg or higher (but below 180/120mmHg), ambulatory monitoring is offered.
• Patients are referred to their GPs for treatment.

AUDIT-C (NICE, 2010)

• A tool for identifying and assessing alcohol-related problems.
• Scores of 5 or more indicate increasing or high risk drinking.
• Remaining AUDIT questions are applicable.

AUDIT-C (Davies et al., 2013)

• Pharmacies are identified as suitable locations for screening through 'scratchcards.'