Conflict of interest concerns over pharmacy-ordered pathology tests

Medical politics

By Tessa Hoffman

6 Jul 2017

A pharmacy chain is selling pathology screening packages direct to consumers, in a move that has angered doctors’ groups.

Amcal pharmacies are offering six “health screening and wellness monitoring” packages under a deal between owner Sigma and pathology giant Sonic Healthcare.

The kits, which screen for ‘fatigue’, ‘general health’, ‘heart health’, ‘kidney health’,  vitamin D levels and diabetes, have recommended retail prices ranging from $54.50 and $219.50 and do not attract a Medicare rebate.

Sigma is spruiking its offering as an early intervention and wellness program “to help those at risk to engage or re-engage with their GP”.

But it’s come under attack from the AMA and RACGP which claim it will lead to unnecessary testing, fragmentation of care and potential conflict of interest concerns.

Under the program, a customer orders the tests at the pharmacy after filling out a pre-screening questionaire.

They return to receive the results in a “one-on-one consultation” with a pharmacist, who will help them understand what they mean and refer on to a doctor “where appropriate” according to a Sigma Healthcare Q and A document.

The pharmacists have undertaken accredited training on tests and interpretation of results, and use the questionaire to deem if the tests are appropriate.

A kit to screen for fatigue includes a full blood count, iron studies and thyroid stimulating hormone test has an RRP of $149.50.

A ‘heart health check’ kit contains HDL/LDL with Ratio, Haemoglobin A1c, Total Cholesterol Fasting and Triglycerides tests for $99.50.

“The available tests were selected due to the chronic nature of the associated conditions and the ongoing need for regulator monitoring to ensure it is being appropriately managed by the patient” the document states.

It also seems to attempt to address the question of pecuniary interests in a section titled “are pharmacists are only providing fatigue testing to sell supplements?” where it concludes that if the test result is “out of range” the patient “is referred to their GP for advice on what their next steps should be including potential supplementation”.

AMA vice president Dr Tony Bartone branded the program “opportunistic, wasteful and bordering on irresponsible”.

He said pharmacists are not trained to assess when a patient needs a pathology test, and claims the program will lead to unnecessary testing and the fragmentation of care.

The criticism was echoed by the RACGP, which says it’s seen no evidence the program meets an unmet need.

“There is also an inherent conflict of interest in pharmacists delivering general practice services,” claimed acting president Dr Edwin Kruys.

The Royal College of Pathologists of Australasia (RCPA) took a softer stance.

President Dr Michael Harrison said while the college doesn’t endorse it, the program appears to conform with RCPA guidelines on how to order and report tests.

Dr Harrison, who declared a conflict of interest as an employee of Sonic, said he personally believed there was a place for the program.

“I support generally testing of the population to identify if they have risk factors like cholesterol, it’s a recommended test to be done on people over the age of 45 every five years.

“If those people are not going to a GP for preventative health, and want to go down this pathway, I think it’s a reasonable thing to do.”

Asked to comment on concerns it could lead to the ordering of unnecessary tests, he said: “I think focus is on overutilisation of tests and no-one cares about underutilisation of tests.”

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