Advances in technology over the past decade have empowered people to take charge of their own health and the use of self-test diagnostic kits is becoming more prevalent. Sexually transmitted infections (STIs), HIV, digestive conditions and even some forms of cancer can now be tested in the privacy of someone’s home. But while these can be a quick, easy and a potentially less embarrassing option for patients, questions have been raised about removing responsibility for testing from healthcare specialists and the risks of buying these tests online.
Some people accessing self-test kits are the ‘worried well’, but there are also people who have genuine concerns about their health and are too busy, embarrassed or worried to visit their pharmacy or GP first. For them, the opportunity to use a convenient self-test kit in the comfort of their home is one to embrace.
Jane Devenish, pharmacist at Well, says self-test kits fit with the customer demographic of people who are increasingly prepared to manage their own health and wellbeing. “These consumers may feel confi dent in purchasing a kit, and the better kits will provide evidence-based information to help them to interpret the results,” she says. “Pharmacy teams are invaluable in helping self-testing kit users to put the results into context and understand the impact that it could have on their individual lives.”
“With around half a million people in the UK currently undiagnosed with coeliac disease, there is an urgent need to diagnose more people earlier,” says Sarah Sleet, chief executive of Coeliac UK. “For anyone with symptoms, we would urge them to discuss the possibility of coeliac disease with their GP. However, for some people self-testing kits can be a useful step on their diagnosis journey.” According to the charity, there is only one clear way of getting diagnosed with coeliac disease – a medical diagnosis with a blood test and gut biopsy – however, self-test kits may be useful in some cases.
Sarah continues: “Anyone taking such a test should be aware that no test is perfect and they must be eating enough gluten for it to work. As a self-test is not conclusive, if someone gets a positive test they will still need to have a discussion with a GP, followed by blood test and biopsy, and people shouldn’t automatically place themselves on a gluten-free diet. If they have a negative result but their symptoms suggest coeliac disease, they need to talk to their GP regardless.”
In the same way, self-test kits can also be an important step in HIV diagnosis. One in seven people living with HIV don’t know they have the infection, according to the Terrence Higgins Trust (THT) and so in November 2017, the charity called for new largescale approaches in HIV testing, targeting those at risk. “There are a number of barriers that people face when wanting to test for HIV at their local sexual health clinic, including distance, opening hours or the fact that they may feel embarrassed or uncomfortable attending these services,” says Dr Michael Brady, THT’s medical director. “Some people fear being seen at a sexual health clinic, whether by friends, family members, colleagues or classmates, and this can lead to them avoiding having an HIV test. Self-testing is therefore a preferred choice for many, and being able to discretely collect the test rather than have it delivered to home or work is often the best option. Pharmacies are places that people trust and frequently use for their healthcare needs. Customers have confidence in the pharmacist, in terms of having accurate knowledge and being able to provide non-judgmental support. While this is possible online, it’s not the same as talking to someone in person when you can guarantee that they know what they’re talking about and can provide you with further guidance and support if needed.”
While self-test kits may be beneficial in some cases, many charities and professional organisations do not recommend using selftest kits to diagnose chronic long-term conditions and instead encourage anyone experiencing worrying symptoms to seek medical advice in the first instance. The British Heart Foundation, for example, always recommends that patients have a heart disease assessment through their GP if they have any concerns.
In the case of diabetes, pharmacy customers can buy fingerprick blood tests to check their blood sugar levels and assess whether or not they have diabetes – these are separate products to the blood glucose monitors that people with diabetes use to manage their condition on an ongoing basis. However, Kathryn Kirchner, clinical advisor at Diabetes UK, says that the results of the finger-prick diagnostic tests can be misleading. “Blood glucose levels can vary in all individuals during any given day,” she says. “These tests don’t take into account other risk factors for developing type 2 diabetes, such as being overweight or a family history of the condition. People with one or more risk factors may be falsely reassured if they have a normal glucose reading.
“In addition, a positive diagnosis can cause anxiety if someone doesn’t have access to information and advice provided by a trained healthcare professional at hand. If customers think they are experiencing diabetes symptoms, including being thirsty, tired, going to the toilet to pass urine a lot and drinking more water than usual, they should speak to a doctor.”
Some pharmacy customers may wish to access in-store diagnostic services, such as blood pressure, cholesterol checks and chlamydia testing, but others may prefer to do a test themselves at home. If pharmacy customers are going to use self-test kits, it’s important they know how to use them properly. This is one of the main benefi ts of buying the tests in store from a pharmacy, where they can receive appropriate advice at point of sale.
“One of the key pros of buying testing kits from a pharmacist is that customers are accessing the kits via a trusted source, so they know what they are getting is the real deal,” says Stuart Gale from the Frosts Pharmacy Group. “Pharmacists are extremely knowledgeable and on hand to provide advice and guidance. The increased availability of kits like this on the high street ensures that if customers are worried, they can take charge of their health in the privacy of their own home – something that is particularly valuable for those who are reluctant to discuss their healthcare needs with a third party. If customers are concerned, a negative test can allay their fears and if the results are positive then they are armed with the knowledge that something needs to be done. In a pharmacy environment, the patient can speak directly to a healthcare professional who can advise on potential next steps. However, when carried out at home, there is the danger that the results will be misinterpreted or ignored, something which should be a consideration at the point of sale.”
With more and more people taking to Google to research their symptoms, its not surprising that their next step may be to order a self-test kit for their potential condition online, if available. Self-test kits are certainly widely available via the internet, however, as with all online purchases, customers need to proceed with caution and ensure they know the exact provenance of the product and that they are buying from a reputable source, such as a pharmacy. Encouraging customers to look for products marked with the CE symbol is also important as this indicates the product has been properly assessed and meets EU safety, health and environmental protection requirements.
The NHS Choices website clearly states that people can buy selftest kits for a range of health concerns, but also stresses that before buying a self-test kit, it’s best to talk to a healthcare professional, such as a pharmacist. When selling a self-test kit, the pharmacy team should go through the instructions with the customer, explaining how to use it properly and how to interpret the results.
“Self-testing kits sold through pharmacies are quick, discreet and easy for patients to access and provide quick results,” says Janky Raja, a Boots UK pharmacist. “The pharmacist can be accessible outside usual working hours – late nights and weekends too – often without appointments. Self-testing kits are generally easy to use at home, but occasionally customers may not interpret results correctly.”
Each testing kit may be slightly different in terms of how to use it, so pharmacy staff may wish to try kits out themselves before recommending them to customers.
“There are clear instructions on the HIV testing kits and they are very simple to do, but it’s important for pharmacists to be aware of how to use the test so they can advise customers who aren’t sure,” says Dr Brady. “It is important to have an understanding of HIV window periods, so pharmacists can advise if a re-test is required.”
The pharmacy team also plays an important role in making sure each test is right for that particular customer and is suitable for their needs, and also in discussing the importance of advice once they have the results. “Buying a test as an impulse purchase could mean that consumer hasn’t considered whether the test will give them the information they really want about their health, the impact that the results may have on their future and what to do next once the test results are in,” says Jane. “Advising customers to come back into the pharmacy to discuss the results is a great way to relieve anxiety, support the customer to make healthy choices and build customer loyalty.”
Discussing individual results is essential, as is putting these in context with risk factors for chronic conditions, such as smoking, weight, physical activity and diet. Even negative results may need to be confi rmed with a GP appointment. “Ensuring that customers follow the instructions carefully is a must,” says Jane. “Customers may not realise that most tests are not 100 per cent accurate, meaning that some will get a false positive or false negative result, so it’s important for pharmacy teams to explain this and that the risk of this happening is usually increased if instructions are not followed closely.”
Dr Michael Brady, medical director at the Terrence Higgins Trust (THT), says it is vitally important that pharmacists offering HIV self-testing kits know the basic facts about HIV and the importance of testing, both to identify undiagnosed infections and as an HIV prevention measure to support people to stay HIV negative.
“Treatment of HIV has improved dramatically in recent years, such that early access to treatment means people living with HIV can expect to live a life as long and as healthy as anyone else,” he says. “When they are on effective treatment with an ‘undetectable viral load’, they can’t pass the virus on to sexual partners. Knowledge around what being undetectable means, and campaigns like THT’s ‘Can’t Pass It On’, are really important as it’s a message and information that still so many people are unaware of. Pharmacists already have wide-ranging experience of health promotion, and these are skills they could apply to HIV testing and prevention. For those who receive a reactive test result, pharmacists should signpost customers to sexual health services for confi rmatory testing and, if required, to appropriate support services, such as THT Direct (0808 802 1221).”
Not all customers will come back to the pharmacy after they have performed the test, so signposting to further advice and support should be done at point of sale. “Pharmacists can provide advice and guidance on what the results mean and what the next steps might be in terms of treatment, if you get the result you weren’t expecting,” says Stuart. “It is crucial to provide training for staff so they can answer patient queries with confi dence. Ideally, pharmacies should be able to offer a private consultation room, as well as advice leafl ets and access to YouTube videos which can guide patients through the process.”
If pharmacy customers are going to use self-test kits, it’s important they know how to use them properly