Pharmacies disconcerted after Health Department discards them as mass screening points

BarcelonaThe Catalan pharmacists feel disconcerted and disappointed after knowing that it will be the primary attention that will carry out mass screenings in areas most affected by covid-19. After five months preparing jointly with the Department of Health a protocol so the same community offices dispensed and managed PCR self-testing kits, the Department has finally opted to centralise all diagnostic tests in primary care centres. The possible collaboration with pharmacies in the detection of positives, therefore, is suspended, and in the short term, reduces the possibility of extending to the rest of Catalonia the pilot cheme organised in December in the primary care centres of Les Corts.

"It is disappointing, because we had been working with the Health Department since before Christmas and waiting for indications to set up the system. We know that the network of pharmacies can help a lot to decongest health centres and it is a great missed opportunity," says the president of the College of Pharmacists of Barcelona and the Council of Pharmaceutical Colleges of Catalonia, Jordi Casas. The president of the Federation of Pharmacists of Catalonia (Fefac), Antoni Torres, agrees: "It is underusing sanitary resources: pharmacies are excluded, although they are widely spread across the territory and are closest to the population; at the same time, excessive pressure is exerted on primary care, which already takes charge of the vaccinations and is at the limit"

Public Health has decided to launch population screenings with self-sampling kits in areas with an "above-average incidence to corner the virus," starting with Lleida, Central Catalonia and Girona. Citizens younger than 70 years who are not vaccinated can go to their health centre, where they will download an app and collect their self-sampling kit. At home they will take the test and then return the sample to the clinic. The citizen will be summoned to repeat the test every fifteen days later, as long as they are still willing and the Department has not decided to end the mass screening.

Pharmacists, however, question the Department's decision to deploy this strategy through the half thousand health centres in the country and not take advantage of the multiplicity of community offices available, around 3,200. "For the system it is easier to work in 500 outpatient clinics, but if we put the patient at the centre of decisions, who have spent a year without leisure, with little mobility and close to home, it would be fairer to take the tests to pharmacies next to their homes rather than having to make an appointment at the health centre", Torres regrets. Fefac believes that often the pharmacy is the only health agent available in rural and isolated areas. In addition, they emphasise that doing screenings in pharmacies would divert pressure from primary care centres, "as has been demonstrated with the screening for colon cancer".

Casas, meanwhile, points out that the screening program is "complex" and requires "a lot of coordination" and that, at first glance, it might seem that health centres taking over was the least risky alternative. However, he argues that the protocol worked out between the health authorities and the pharmacists is exactly the same as the one that will now be used by the HEADS. "Stopping the screening with self-samples was a decision that could be understood, because in a pandemic things change very quickly, but to now do the same as we had agreed on but in primary care centres is puzzling", Casas insists.

Lack of communication

Pharmacists learned of this change of plans in a press conference last Friday. Before no one of the department told them that the initiative was paralysed. "When the Health Minister announced it, we still had not been told anything. The manner was even worse than the change itself", denounces Casas.

According to health authorities, however, the decision to distribute self-sampling tests at Health Centres responds exclusively to their advantage when coordinating and planning massive screenings in Catalan universities. In this sense, the Secretary General of Health, Marc Ramentol, said that this plan "will not affect the agendas of nurses," but will be a strategy taken on by covid managers.

The president of Fefac, however, stresses that the pandemic has highlighted the importance of promoting public-private collaboration to add all possible resources. "We had written the protocols and we knew that we would have quality results, identical to those offered by primary care. In addition, pharmacies would not earn a penny either, it was a voluntary participation," says Torres

Urge to sell antigen tests

Despite the setback this has meant, pharmacies maintain their willingness to participate in future schemes. "We are part of the health system and we will maintain the collaborative spirit," says Casas. For example, with the sale of rapid antigen tests in pharmacies, widely demanded by pharmacists.

The department was reluctant to hand these tests out, especially during Christmas. It feared people would feel they could ignore recommendations if they took a test. However, the head of the Department, Alba Vergés, has recently complained that the Spanish authorities have refused to allow their sale, which according to Vergés has "hindered the epidemiological control strategy".

The Spanish Agency of Medicines and Health Products (AEMPS) would have to modify the regulations because the tests would become self-diagnostic tests without medical prescription, such as pregnancy or glucose tests. "This would not be anomalous. In fact, many European countries such as the United Kingdom or Germany have already changed this qualification to make life easier for people," says Torres. The population in these states, he says, uses the tests with a commitment to self-responsibility and pharmacists record as much information as possible. "You have to trust the population," Torres insists

Antigen tests detect viral load and, therefore, if a person is negative, it does not mean that they are not infected, but rather that at that time they are not contagious. The results are reliable for up to 72 hours. Pharmacists ensure that more and more specific and approved tests are marketed to avoid false negatives and emphasise that access is "a strong social demand and easy to regulate"

"The need to incorporate these tests in everyday life is already undeniable if we want to open certain sectors and regain normality," says Casas, who says it would be a "regulated and validated" circuit by the authorities. "We would not just be a point of sale, but we would explain how the test is done, contextualise the result and inform the health system of positive results", they defend.

Pharmacists recall that while the AEMPS does not authorise the marketing of tests in pharmacies, encouraging the acquisition by a legal and safe way to maintain epidemiological control and track positives and contacts, the Internet is full of tests of dubious quality which people can easily access.