Facilitating Integrated Care Between Pharmacies, Laboratories, and Sexual Health Clinics

Background: Chlamydia and gonorrhea are the most reported bacterial sexually transmitted infections (STIs) in North America. Accessible, efficient, and convenient testing mechanisms are essential to identify infections, reduce transmission, access treatment, and prevent complications. This study aimed to implement an integrated care model for pharmacy-based asymptomatic chlamydia and gonorrhea management in Nova Scotian community pharmacies and evaluate effectiveness and patient acceptability.

 

Approach: The study occurred in four community pharmacies in Nova Scotia, Canada. Pharmacists offered chlamydia and gonorrhea testing using patient self-collected swabs and first-catch urine. Specimens were tested at the Central Zone Microbiology Laboratory and reported back to the pharmacist who then provided results to the patient and prescribed treatment for any identified infection(s). An electronic questionnaire and post-testing interview explored patient acceptability. Pharmacist workload was explored in time per encounter and tests per week. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and Theoretical Framework of Acceptability (TFA) informed the study design.

 

Results: Ninety-seven discrete participants were enrolled for 99 testing encounters. Eighty percent (78/97) of participants responded to the sociodemographic questionnaire, of which 64% were between the ages of 25-44 , 26% identified as sexually diverse, and 15% as gender diverse. Many respondents reported never having been tested for chlamydia (23%) or gonorrhea (27%). Of the participants tested, 17% had positive test results; 14% had chlamydia and 3% gonorrhea infections.

 

All participants with positive test results were prescribed antibiotic treatment by the pharmacist. Pharmacists required an average of 21 minutes for testing and 17 minutes for treatment encounters. Participants predominantly reported the service was highly acceptable, should always be available, and they would not have been tested if it was not available. Participants raised concerns regarding privacy, increased workload on pharmacists, and cost of the service.

 

Implications: Community pharmacy-based testing and treatment of asymptomatic chlamydia and gonorrhea was highly acceptable to service users. The model successfully identified new cases and pharmacists efficiently prescribed treatment. This study provides a foundation for creation of integrated care pathways in sexual health that include community pharmacists as central care providers.