Screening in Pharmacies

Screening in Pharmacies

• Screening is the systematic application of a test to people who have not sought medical attention for a disorder.
• It aims to identify individuals at sufficient risk to warrant further investigation.
• Examples of screening include blood testing, physiological testing, microbiology testing, and questionnaires.
• Screening can involve a combination of tests for a comprehensive risk assessment.
• It can be population-based, selective, or opportunistic.

Aims of Screening

• Screening can save lives
• Improve quality of life through early diagnosis, reduce risks, and reduce complications.
• Requires careful assessment of risks and benefits

Population Based Screening

• According to WHO (Strong, Wald and Miller, 2005), population based screening should be done only if:
  • The disease is a significant health problem.
  • The natural history of the disease is understood.
  • There is an identifiable preclinical stage.
  • Tests are reliable and cost-effective
  • Benefits of early detection are better than delayed treatment.
  • Screening is a systematic, ongoing process.

Screening Opportunities in Community Pharmacy

• Selective screening includes Chlamydia testing with EHC consultations
• Opportunistic screening includes an Asthma Control Test (ACT) when collecting inhalers.
• Collaborative screening with primary care relates to blood pressure checks
• Public health campaigns include AUDIT-C for alcohol awareness.
• Responding to symptoms includes identifying "red flags", e.g., weight loss with constipation.

Chlamydia Screening

• In 2021, the focus shifted to reducing reproductive harm in young women and individuals with a uterus or ovaries.
• Chlamydia is the most commonly diagnosed STI in the UK, increasing from 160,279 diagnoses in 2021 to 194,244 in 2023, with 199,233 diagnoses in 2022.
• The infection affects both men and women and is usually asymptomatic.
• Highest prevalence for this infection is in people under 25
• Testing involves urine samples or vaginal swabs, and treatment is with antibiotics.
• Highest 'at risk' ethnicity is black 'Other' (non-African or Caribbean) ethnicity and black Caribbean ethnicity.
• NHS chlamydia screening program involved pharmacies made up just 0.3% of the total in 2023, which is a decrease of 34.7% from 2022 (42.7% ordered online)
• Clamelle is a private screening and treatment program that is available for pharmacies
• Patients presenting for EHC may have had unprotected sex, so screening alongside EHC can be a targetting tool.
• Northumberland Sexual Health Level 2 service incorporates chlamydia screening.

Gonorrhoea

• In 2022, there were large increases in cases of Gonorrhoea (+50.3% from 54,961 in 2021 to 79,268 in 2022). There were further increases to 85,226 in 2023
• Largest annual number reported since records began.
• Syphilis has highest recorded numbers since 1948. Again increased 9.4% from 2022 to 2023

Asthma Control Test (ACT)

• A 2020 survey by Asthma & Lung UK showed 24% of respondents had uncontrolled asthma.
• Proportionally, 1.3 million people are at risk of a life-threatening asthma attack.
• A score under ≤ 20 shows poorly controlled asthma

NHS Health Checks (2009)

• Involve patients aged 40-74 years old every 5 years without prior diagnosis.
• They use a combination of tests to establish risk of CVD, Stroke, T2DM, and renal disease.
• Tests include Questionnaire, BP, Cholesterol level, and BMI.
• QRISK-3 should be used for CVD, if data is inaccessible, QRISK-2 can be used.
• Higher risk should be communicated, and interventions planned.
• The programme is estimated to:
  • Prevent 1,600 heart attacks and strokes.
  • Prevent 650 premature deaths.
  • Prevent 4,000 new cases of diabetes each year.
• May lead to at least 20,000 cases of diabetes or kidney disease being detected earlier.
• Community pharmacies were commissioned to provide NHS health checks.
• Public Health England pledged to engage community pharmacy more for uptake of NHS Health Checks under Office for Health improvement and disparities (OHID) from October 2021.
• A move is in place to make more use of digital technology without excluding certain patient groups.

Evaluation of NHS Health Checks

• Strong et al. (2016) evaluated the first 4 years of NHS Health Checks with data from one general practice clinical systems (n=655 practices).
• Good uptake in areas of high social deprivation (14.9% eligible patients)
• Increasing uptake from 2009/10 (5.8%) to 2012/13 (30.1%)
• 38/1000 checks identified new hypertension, 9/1000 checks identified new diabetes, 4/1000 identified new chronic kidney disease.
• Of those identified at higher CVD risk (>20%), 19.3% were started on a statin and 8.8% started on a new antihypertensive therapy.

QRISK

• Risk calculators can be found online
• Uses several parameters to work out a patient's cardiovascular risk over the next 10 years.
• QRISK 2 or 3 are available, QRISK3 is recommended by NICE and is updated annually.

Hypertension Case Finding Service 2021

• Aims to find undiagnosed cardiovascular disease in individuals over 40.
• Involves finding elevated blood pressure (140/90mmHg or higher, but lower than 180/120mmHg)
• Ambulatory monitoring is offered
• A follow-up appointment is arranged, and equipment returned, the patient is referred to their GP for treatment.

AUDIT-C (NICE, 2010)

• AUDIT-C stands for Alcohol Use Disorders Identification Test – Consumption
• A score of 5+ indicates increasing or higher risk drinking, in which further AUDIT questions can be asked.

AUDIT-C (Davies et al., 2013)

• Pharmacies have been identified as a place where alcohol screening can be delivered.
• 'Scratchcards' have been developed as part of screening programmes through pharmacies as public health campaigns (essential service).