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Douglas Fleming, PhD, FRCGP, is director
of the Birmingham Research Unit of the Royal College of General
Practitioners, Birmingham, B17 9DB
e-mail dfleming@rcgpbhamresunit.nhs.uk
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Abstract
Aim
To assess the accuracy with which community pharmacists are able to make
a diagnosis of influenza.
Design
Cross-sectional study. Pharmacists’ diagnoses of influenza in patients
presenting to the pharmacy were compared with results of nasopharyngeal
swab polymerase chain reaction (PCR) viral tests.
Subjects and setting
22 community pharmacists in the UK.
Results
Out of 217 subjects, pharmacists diagnosed 53 with influenza and, of
these, 27 were confirmed virologically (positive predictive value of
51%). A raised temperature measured at presentation did not improve diagnostic
accuracy. 21 (40%) of the 53 diagnosed influenza cases and 69 (32%) of
all 217 subjects presented within 48 hours of symptom onset. In subjects
presenting within 48 hours, a total symptom score exceeding 10 (39 subjects)
was associated with confirmed flu in 38%, compared with a total score
less than 10 (30 subjects) associated with confirmed influenza in only
20%.
Conclusion
Despite a low level of circulating influenza over the study period, community
pharmacists achieved a level of accuracy in diagnosing influenza (51%)
which compares favourably with results achieved in clinical trials of
neuraminidase inhibitors where recruitment was limited to early presentation.
The data suggest that pharmacists could play an extended role in the
management of seasonal influenza. Most patients did not present early
enough to benefit from treatment with antiviral drugs. There is a need
for better public understanding of the benefits of these drugs.
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The
Pharmaceutical Journal