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News & Trends - MedTech & Diagnostics

Clinicians battle over the future of pharmacy screening in diabetes

Health Industry Hub | March 11, 2024 |

MedTech & Diagnostics News: The Pharmacy Guild of Australia has resubmitted an application to the Medical Services Advisory Committee (MSAC) regarding its Pharmacy Diabetes Screening Trial which is facing staunch opposition from clinicians. The move follows MSAC’s decision to defer funding in 2021, citing the trial’s inability to demonstrate added benefits compared to conventional General Practitioner (GP) screening.

With an estimated 1.7 million Australians living with type 2 diabetes and up to 500,000 undiagnosed cases, the Pharmacy Guild’s initiative aims to bridge gaps in early detection. The Australian National Diabetes Strategy underscores the importance of coordinated community health efforts for timely identification and evidence-based intervention.

Set to be evaluated by MSAC next month, the proposed screening services involve pharmacists conducting opportunistic screenings using the AUSDRISK questionnaire and point-of-care HbA1c testing. Referrals to GPs for diagnostic assessment would follow positive screenings.

However, the Royal Australian College of General Practitioners (RACGP) has voiced reservations. In their recent submission to the Health Technology Assessment (HTA), the RACGP expressed “serious concerns” about the evidence supporting the screening protocol and its potential to fragment patient care.

“Opportunistic screening in pharmacy also creates another cost pillar and potential duplication of services. In addition, opportunities to emphasise lifestyle interventions, screen for cardiovascular risks, and case-find for mental illness are lost if the person does not see their GP,” cautioned the RACGP.

The Pharmacy Diabetes Screening Trial, initiated in 2022, screened over 14,000 individuals in 339 pharmacies, resulting in 136 diagnosed with type 2 diabetes and 338 with prediabetes. Developed in collaboration with the University of Sydney and Deakin University, the trial’s initial clinical results have sparked controversy.

The RACGP’s submission raised specific concerns about the trial participants, all adults aged 35–74 with no history of diabetes or prediabetes, implying annual screening, potentially exceeding recommended guidelines. The submission also questioned the trial’s clarity regarding participants already known to their GPs, recent diabetes tests, and regular monitoring engagement.

In its submission to the Parliamentary Inquiry into Diabetes, the Pharmacy Guild asserted “Community pharmacies are well placed to help screen and refer high-risk patients for earlier diagnosis of diabetes, as people often visit a pharmacy frequently. Pharmacist pathology referral and on-site pharmacy testing, if covered by Medicare, would help many patients to access these timely services and reduce the pressure on pathology labs and hospitals. The Australian Government should strongly consider funding such services in community pharmacies to support them in identifying diabetes in their patients as early as possible.”

Despite the controversy, the Pharmacy Diabetes Screening Trial is just one of several pilot programs underway in Australian pharmacies, addressing issues beyond diabetes, including urinary tract infections (UTIs) and contraceptive pill prescribing. In New South Wales alone, since the UTI trial began in May last year, 11,296 consultations occurred across 937 participating pharmacies.

The outcomes of MSAC’s upcoming evaluation will determine the fate of this ambitious initiative, with implications for the broader landscape of diabetes screening in Australia.

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