Point of care testing and health parameter assessment in community pharmacy setting

INTRODUCTION

As basic screenings, point of care tests (POCT) have expanded over time encompassing broader scope and applications. They are excluded by the Clinical Laboratory Improvement Amendment, and allow for quick, non-invasive screening at various settings including home and clinical settings.^[1] Following the absence of symptoms at early stages of most chronic diseases, their existence is mostly noticed at onset of complications.^[2] Therefore, regular screening is essential for early diagnosis and care. Point of care screening for communicable diseases have also gained wide popularity and usage.^[1,3] As the most frequent symptoms of communicable diseases (such as COVID-19), elevation of body temperature and respiratory rate (RR) are vital signs for point of care screening for communicable diseases.^[4] It is noteworthy that basic health parameters are determinants of health status of individuals, and require regular monitoring for early detection and management of health-related conditions, particularly chronic diseases.^[5]

Community pharmacists are notably the most accessible health care professionals, and this has positioned them to perform, manage and interpret POCT.^[6] The previous studies have shown that community pharmacies are commonly utilized for various point-of-care screenings.^[7] This has facilitated early detections and management of several potentially life-threatening conditions, and has also increased cost-effectiveness in the management of chronic diseases.^[8] Blood pressure and blood glucose monitoring are most prevalent point of care screenings in community pharmacies.^[9] It is a major means of providing patient-centered care by community pharmacists in Nigeria, who are mostly the first point of call for patients, and sometimes the only health professional seen for minor ailments. Health parameters are essential indicators of health status of the body. They enable the detection of communicable and non-communicable diseases, and provide information on the progress of disease management among patients. Health parameters are therefore essential tools for disease surveillance and assessment of epidemiological changes in disease patterns.

Nigeria is faced with a double burden of communicable and non-communicable diseases, and majority remain undiagnosed until onset of complications.^[2,10,11] More so, the risk and prevalence of diabetes appear to be on the rise following several lifestyle-related factors in the country.^[12] A previous study noted high prevalence of communicable and non-communicable diseases in Nigeria,^[10] showing the need for early screening, for prompt detection and management. However, POCT is not common among residents of rural and sub-urban regions^[13] who may rely on access from the community pharmacies. Given that disease prevention and health protection are important aspects of community pharmacy practice^[14] and are considered essential outcomes of community pharmacy-based screenings, it is essential to document evidence of these screenings. More so, global epidemiological changes of disease distribution warrants study of general populations, including younger persons, for early detection of chronic diseases. The study aimed to illustrate the outcomes of diabetes screening, temperature and pain level screening in a Nigerian community pharmacy, which could be extrapolated to other pharmacies in the country and beyond. The study also assessed: (a) The participants’ health parameters according to standard classifications, and (b) associations between participants’ socio-demographics with observed health parameters.

MATERIALS AND METHODS

RESULTS

A total of 400 adults participated in the study. Mean TT was 36.627°C ± 0.3143. Mean RR per minute was 18.20 ± 3.261.

Almost half of the study participants were between 20 and 39 years old (195; 48.8%), while 60–79 age group (40; 10.1%) were the least represented. The majority (301; 75.3%) were married and over half (212; 53.0%) were females. Among the participants (170; 42.5%) had tertiary, (161; 40.3%) secondary education level qualifications; and (284; 71.0%) were self-employed [Table 1].

Almost all (399; 99.8%) study participants had normal body temperature, (326/400; 81.5%) had normal blood glucose levels, (347/400; 86.8%) had normal RR, and (156/400; 39.0%) did not experience pains [Table 2].

[Table 3] shows association between socio-demographics and RR, and socio-demographics and FBG. Age was significantly associated with RR (P = 0.008) and FBG (P = 0.002). Gender was significantly associated with RR (P = 0.003), while educational level was significantly associated with FBG level (P = 0.001).

Correlation analysis showed a weak negative correlation (r = −0.018; P = 0.713) between participants’ FBG and TT. FBG and pain level also showed weak positive relationship (r = 0.091; P = 0.068). A weak negative relationship (r = −0.010; P = 0.832) was also observed between pain level and TT and this was not statistically significant. Relationship between TT and RR showed a weak positive correlation (r = 0.023; P = 0.637). A weak positive correlation (r –0.041; P = 0.401) was also found between age and RR.

DISCUSSION

The study observed that mean TT and mean FBG were within normal range. Normal RR was also common among participants. Meanwhile, socio-demographic characteristics were associated with FBG and RR. Weak positive correlation was observed for TT and RR. Weak negative correlation was also seen between RR and aging.

Findings from the study show that participants’ health parameters were mostly within normal range. High prevalence of younger persons among study participants is likely responsible for this finding, as most chronic diseases tend to be more prevalent with increase in age.^[22] A previous study in Nigeria found sex-related differences in health parameters of study participants.^[23] These findings may connote socio-demographic-related impact on health parameters.

Socio-demographic characteristics were selectively associated with some health parameters. Age and sex were significantly associated with RR. Age and educational level were also associated with FBG. This corroborates with the findings from a previous study where age was significantly correlated to type 2 diabetes.^[24] Socio-demographics are now widely recognized determinants of health associated variables.^[24-27] This commonly results from social, biological, and functional changes that occur with age and other socio-demographics.

From our results, participants within the age of 20 and 39 did not have elevated FBG; however, the number of participants with elevated FBG increased with increasing age beginning from 40 years. This agrees with the work of Roy et al. which showed that age linearly affects RBG and BMI.^[28] A Chinese study also reported an increase in plasma glucose level with increase in age in persons with no history of diabetes.^[29] The reason for this could be age-related decrease in physiologic function,^[30] particularly, age-related altered glucose metabolism.^[31] This implies a potential significant association between age and increase in blood glucose. Increase in FBG levels is also significantly associated with increased risk of mortality.^[32] Meanwhile, low awareness of diabetes and its symptoms and non-monitoring of FBG among non-diabetic persons as seen in a previous study in Nigeria,^[33] portrays increased need for diabetes education.

Furthermore, a comparison of the FBG of the female and male participants shows that more males were pre-diabetic and diabetic, even though more women were tested. This corroborates the findings from a previous study in Nigeria where males were at higher risk of developing diabetes mellitus.^[34] This study shows that sex might be a predisposing factor for high blood glucose. This sex-based difference in risks may be related to several biological differences in both sexes,^[35] including higher adiponectin in females. Sex variation in blood glucose level could be due to the pattern in which fats are been stored in the different sexes, while men tend to store fats in body organs like liver, women store fat on the body surfaces such as the hips and buttocks. This agrees with the hypothesis that women need to have a higher fat deposit than men to become more predisposed to diabetes.^[36] High FBG in males is associated with negative impact on the lipid profile, adipocytokines, and liver function.^[37]

The study also shows weak positive correlation between age and RR. This corroborates with findings by Takayama et al.^[38] Increase in RR might be a compensatory mechanism adapted by the body to maintain its physiological function. Increase in age is associated with changes in airflow dynamics, lung capacity, and decrease in mechanical characteristics of the respiratory system.^[39] This is because as one ages, there is resultant change in the diaphragms, the chest wall and shape of the lung parenchyma^[39] resulting to an increase in RR.^[40] This dual decrease in physiological functions can be compensated for, by increase in RR.^[38] This age-related respiratory changes are important considerations for health assessment in older adults.

Weak positive correlation was observed for TT and RR. This was consistent with findings from a previous study in Turkey.^[41] Body temperature was reportedly an independent determinant of RR in a UK study.^[42] Increase in body temperature and RR are usually suggestive of microbial infection. As a result of poor environmental conditions and inadequate potable water supply, there is high burden of communicable diseases in Nigeria^[43] which usually present with increase in temperature; however, these parameters may be associated with other disease conditions.

The study has added to the body of evidence on selected health parameters of study participants in Nigeria, and the feasibility of point of care testing in community pharmacies. It has also shown that younger persons may be less associated with abnormal health parameters, irrespective of the global epidemiological changes in the risk of chronic diseases. However, the study was conducted in a single center, which limits its generalization.

CONCLUSION

Health parameters were mostly within normal range and were selectively associated with age, sex, and educational level. These demographic characteristics were mostly associated with blood glucose and RR. The results reinforce the feasibility and relevance of expanded point of care testing and screening in community pharmacies.