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Here's one way collaborative practice agreements between pharmacists and doctors can make a difference to individuals and communities.
Anita JacksonLyme disease prevention strategies to reduce the risk of tick exposure can have a positive impact on the incidence of the tick-borne illness. However, only 40% to 50% of people aware of these tactics employ them. Antibiotic prophylaxis, delivered by a pharmacist working under a collaborative practice agreement, would be an innovative service for pharmacies to consider in regions with endemic Lyme disease, specifically New England, the mid-Atlantic states, and upper Midwest, said Anita Jackson, PharmD, clinical assistant professor, College of Pharmacy, University of Rhode Island, Kingston, R.I.
Lyme disease, the most commonly reported vector-borne illness in the United States, is a serious public health issue that affects individuals of all ages. In 2013, the Centers for Disease Control and Prevention reported more than 35,000 probable cases of Lyme disease in the United States, with 95% reported in just 14 states: Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, and Wisconsin.
Lyme disease, caused by Borrelia burgdorferi and transmitted by the deer tick, Ixodes scapularis, can be treated prophylactically with a 200-mg dose of doxycycline given within 72 hours of a tick bite.
This prophylactic treatment for Lyme disease has a relative risk reduction of 87% to 91%. Doxycycline prophylaxis is especially important to prevent the systemic manifestations of the illness, including dermatologic, rheumatologic, neurologic, and cardiac abnormalities, said Jackson.
“We feel this therapy would be really great to have available in pharmacies, because there is time sensitivity [for this treatment],” Jackson told Drug Topics. “If a tick is removed on Friday and it’s a holiday weekend, the patient can’t wait until Tuesday to get the antibiotic. That is one reason that we thought pharmacists could have a role in initiation of therapy.”
In 2012, Jackson and three colleagues initiated a pilot study to evaluate a pharmacy service for adult patients who sought prophylactic treatment following a tick bite. She and her collaborators trained the pharmacy staff of an independent pharmacy in Rhode Island to offer this innovative service as a way to improve patient access to timely treatment. The pharmacists received three hours of continuing education credits. Patients were recruited through local advertisements and announcements posted in the pharmacy and surrounding retail establishments.
Pharmacists worked under a collaborative practice agreement with a physician and followed an approved study protocol for screening patients and dispensing the single dose of doxycycline. They also provided counseling to patients about medication dosing and administration, potential side effects and precautions, and education about Lyme disease symptoms and subsequent tick prevention.
Patient satisfaction with the service was assessed 30 days post-treatment and outcomes were also recorded. Patients reported high satisfaction with the pharmacy service and none developed Lyme disease, Jackson noted.
After successful completion of the pilot study, with results published earlier this year in the Journal of the American Pharmacists Association, the investigators obtained additional grant funding through the Community Pharmacy Foundation to expand the study to three Rite Aid pharmacies in 2013.
The study enrolled 18 patients, of whom eight were drawn from the independent pharmacy and 10 from the chain pharmacies. Seventeen patients received the prophylactic doxycycline treatment, two patients reported side effects from the medication, and two sought medical attention within 30 days of treatment. None developed Lyme disease, Jackson said.
The 17 patients who were eligible for treatment completed the patient satisfaction survey from 30 to 60 days post-treatment with an average response range of 8.5 to 9.75 on a 10-point scale.
The small rate of participation in the expanded study was attributed to lack of patient awareness of the new service, the result of a limited advertising budget. Also, the service was limited in scope to only four locations, the investigators noted.
“We believe this service has great potential in an endemic area,” Jackson said. “We are trying to pursue this through legislation. We are hoping that Rhode Island may be one of the first states to do this. We need some of the chain pharmacies to get on board and say that pharmacists should be doing this because we have such access to the public.”