Table 2

Common reasons for pharmacists referring patients to other healthcare professionals when undertaking clinical assessment during a sore throat test and treat (STTT) consultation. Main themes with illustrative reasons are presented

ThemeExample note(s) in Choose Pharmacy
High results from scoring tool but pharmacist unable to complete effective RADT“Patient has symptoms for test but could not undertake due to gagging.”
“Unable to fully assess patient due to inability to tolerate swab. tonsils have exudate bilaterally. Patient is generally unwell.”
“(name of patient) tested negative for strep A however he has considerable ear pain with a sensation of pressure. Tonsils were inflamed and had visible exudate. Due to discomfort and poor gag reflex I cannot say that I effectively swabbed his throat.”
“Tonsils not visible as jaw unable to be opened fully (?trismus). Severe inflammation of left submandibular lymph. 5/7 history with worsening symptoms.”
“Worsening throat pain…He (patient) has a Hx of symptoms for 5/7…some submandibular swelling. He has a temperature of 36.6C without antipyretics. He does not have any red flags other than trismus. Due to this I am unable to perform an examination or to obtain an uncontaminated swab. He is self-reporting an inability to swallow food or drink.”
Recurrent infections“…patient presented 6 week history of sore throat, intermittent symptoms for 1 week then resolving for approx. 2 days. Low FP score, no symptoms suggestive of infection, light smoker and drinker, symptoms not associated with lifestyle. No reflux.”
“Not scored high enough on FEVER PAIN to offer a point of care test but concerned that patient has had a sore throat since November and has tried various treatments.”
Symptoms indicative of other infections/conditions“… one tonsil a lot worse than the other and blood present - negative for strep A so referral for possible quinsy.”
“…patient who mentioned to the receptionist she was coughing up blood, before being referred to the pharmacy for common ailments. She has been suffering with cough and cold symptoms, but now has a moderately sore throat, however, has coughed up blood on two consecutive days…”
“…potential glandular fever. Stomach pain, viral symptoms, severe sore throat.”
“Patient presenting for sore throat test but exhibiting symptoms of URTI - green, thick mucus being coughed up and rattling on chest noticed by partner during nights.”
“Suspected throat abscess. Temperature 37.4, very swollen right side of the throat.”
“…as patient has had symptoms for 3 weeks, cough with pain under rib cage probably stemming from the cough. Sore throat present for 3 weeks despite using cough and cold medicines including Paracetamol. I think possibly the patient may be suffering with acid reflux, due to the length of the time the patient has had the sore throat.”
Challenges associated with young age“…patient was unable to swab (due to age) and kept closing mouth when the swab was near mouth. “
“Patient reluctant to have swab taken, unable to swab tonsil area to get sufficient sample. Patient unwell, history of fever, poor appetite.”
“…tonsil inflamed only on one side, very, very painful for patient almost on risk of chocking.”
“fever point 1, swab not required, when looked into patient mouth tonsils are both very inflamed to the stage that patient struggles to breathe, some difficulty breathing in the morning.”
“Concerned about the possibility of scarlet fever - no rash present but does have the 'strawberry tongue' associated with scarlet fever.”
  • RADT, rapid antigen detection testing; URTI, upper respiratory tract infection.