When education isn’t enough: Barriers to POCT

A recently published study sheds light on both the promise and limits of point-of-care testing (POCT) by pharmacists.

In 2022, with funding from the Canadian Foundation for Pharmacy’s Innovation Fund, Dr. Kelly Grindrod and her research team at the University of Waterloo set out to determine whether computer-based education (CBE)—using the Pharmacy 5in5 platform—could encourage pharmacists in Ontario to perform more POCT.

While the results show that pharmacists gained valuable knowledge and skills through the online education program, they also revealed how regulatory and logistical barriers—including the fact that pharmacists’ POCT services are not publicly funded in the province—continue to restrict how beneficial POCT can be.

“Our participants definitely came out of the study knowing more about how to do these tests than when they started, but we couldn’t change the practice,” says Grindrod, Associate Director, Clinical Education, and Associate Professor at the University of Waterloo’s School of Pharmacy.

The reality is that pharmacists in Ontario can perform certain tests, like cholesterol checks, but they can’t prescribe treatment if the results are abnormal. “Without being able to act on the result [of a POCT], it just isn’t that beneficial for patients,” she says. “Why would a patient pay for the service if the pharmacist can’t do anything about the result?”

The study also uncovered logistic challenges, such as access to testing devices varying widely across practice settings. Large chains with manufacturing agreements in place could more easily equip their pharmacies with test devices, while independent pharmacies often struggled. Even when devices were available, there were technical hurdles. “Some tests, like lipids, require a fair amount of blood,” Grindrod notes. “If you don’t get enough from the finger prick, you get an error reading—and that’s expensive because you’ve wasted a $15 strip.”

Perhaps most importantly, the study results highlighted the impact of government policy on new technologies. Whereas regulations in provinces like Alberta allow pharmacists to both order tests and prescribe treatments within their scope of practice, the options in Ontario are much narrower. In Ontario, pharmacist can’t prescribe cholesterol medications in response to a high lipid level or add a new diabetes drug for a high A1C. “When we roll out testing regulations without considering the associated treatment regulations, we make it very hard to implement clinical services,” says Grindrod. “The current regulations make prescribing and lab test ordering very piecemeal and it’s difficult to adapt to changing technology.”

If the goal is to help people better manage their cholesterol, then pharmacists need the authority to both test and treat, says Grindrod. “Otherwise, you end up with a ripple that has almost no effect.”

Looking forward, Grindrod sees opportunities to refine educational approaches and study how broader regulatory changes influence pharmacist behaviour. Online modules proved useful for boosting knowledge, but changing practice may require additional supports, such as physician partnerships, in-person mentorship, and stronger workflow integration.

Ultimately, the study shows that while pharmacists are interested in using POCT and are eager to learn, meaningful adoption will only occur when regulations, resources and education are aligned. As Grindrod puts it: “Just being allowed to do the test isn’t enough. You have to ensure the provider has the ability to act on the results.”

Find further results from the study here.