Doctors urge physical exam to diagnose strep throat
Medical experts says physical exam is best method to diagnose infection
People with sore throats who are worried they could have strep infections can pay $15 for an onthe-spot test at Shoppers Drug Mart pharmacies in B.C.
Just weeks after a 13-year old Vancouver Island girl died from an invasive streptococcus infection, Shoppers Drug Mart has announced it is offering a rapid test to customers as a convenience and because hundreds of thousands of people don’t have a family doctor.
But physicians and other experts caution that pharmacists are neither trained nor allowed to do physical examinations. And they are not allowed to prescribe antibiotics. So, while some health consumers may like the convenience of getting a test result in minutes, rather than waiting 24 hours for results of a throat culture test taken by a doctor and sent to a lab, a positive test will still require a visit to a doctor to determine if antibiotics are necessary.
B.C. pharmacists have asked government to let them prescribe medications to customers for minor ailments including strep throat. Doctors are strongly opposed, maintaining there’s a conflict of interest when those who prescribe medications also sell them. The College of Pharmacists of B.C. says there should be limits to any new powers for pharmacists to prevent conflicts of interest.
Strep throat is an infectious, bacterial infection in the throat and tonsils that causes a severe sore and inflamed throat. Strep infections can also cause serious and even fatal illnesses such as toxic shock and flesh-eating disease. Experts don’t know why, but such infections have been soaring in B.C.
Millions of patients go to doctors each year complaining of sore throats but only a minority get a diagnosis of strep throat.
Usually about 15 per cent of sore throats in adults and 30 per cent in children are caused by strep.
According to a Shoppers Drug Mart study, about 25 per cent of strep throat tests ordered by doctors test positive. Results of the study, led by health economist Nina Lathia and conducted in B.C., Alberta and Nova Scotia, are reportedly to be published in Canadian Pharmacists Journal.
The pharmacy chain says the rapid test could save the health care system about $500,000 annually since individuals who get a negative test won’t have to see a doctor and won’t need antibiotics.
But a duplication of some services is possible since individuals who get positive tests will have to follow up with their doctors and it is possible physicians will still order lab tests if they aren’t 100 per cent confident in the rapid test result. The pharmacy study also estimates that 10 per cent of patients who test negative at a drugstore will still see doctors because of continuing symptoms.
Dr. David Patrick, a University of B.C. and B.C. Centre for Disease Control expert in antimicrobial resistance, said while he doesn’t have a problem with the quality or effectiveness of the rapid test offered by the drug stores, his main concern is that doctors are best suited to diagnose patients.
“What I would say is that this scenario is probably not the best way to use pretty good technology. The diagnosis of strep requires a physical examination.”
That involves doctors feeling the throat and neck for inflammation in the larynx and swollen lymph nodes and looking at the tonsils so see if they are enlarged.
“These are things doctors are trained to look for. Pharmacists don’t have this type of training.”
He said there are a large number of people who are carriers of strep but don’t have an infection.
They would test positive and then likely get antibiotics if pharmacists were allowed the prescribe based on the rapid tests.
That amounts to unnecessary prescribing, he said, and since antibiotic resistance by bacteria is a possibility whenever such medications are used, they must be prescribed judiciously.
Dr. Trina Larsen Soles, president of Doctors of BC, said physicians weren’t consulted about the rapid test and she shared Patrick’s concerns.
“The decision about how to treat any illness should be made after a medical history and physical examination, which pharmacists are not qualified to perform. Our hospital and community laboratory tests are held to a rigorous standard to protect the public and provide the best care to patients in British Columbia,” she said.
She said the conventional throat swab test ordered by physicians is covered by the government so patients don’t have to pay.
Laura Heinze, a spokeswoman for B.C.’s Ministry of Health, said the government is “still evaluating” the use of such rapid tests being offered in pharmacies and
other retail outlets. Analysts are looking at the potential duplication of services and whether any regulations are required.
“The College of Pharmacists of B.C. and pharmacists providing the strep test should ensure that all individuals are informed of the need to seek medical attention and a prescription if test results are positive.
“It should also be made clear that the test is available free of charge to patients who obtain it through a physician or nurse practitioner,” she said,
Anita Webster, a spokeswoman for Shoppers Drug Mart, said the company talked to the College of Pharmacists and the Ministry of Health before the test project that led to the rapid test service and “neither had any concerns” about it.