Angina: ANSM's state of play on TRODs available in pharmacies

Angina: ANSM's state of play on TRODs available in pharmacies
As stipulated in amendment 18 to the National Pharmaceutical Convention, the ANSM publishes the first report on rapid diagnostic orientation tests (TROD) for the detection of group A beta-hemolytic strep throat.

This document is intended for pharmacists to help them refer to one or more tests for the detection of group A streptococcal antigen, with a view to their realization and their assumption by the Health Insurance as of January 1st, 2020.


In its report, the ANSM presents 14 tests marketed in France in 2019 and specifies:
the practical information of these tests (from the data provided by the manufacturing laboratories): name of the device, name of the manufacturer, indication, mode of use, time of realization;
the performance indicators of these tests: analytical sensitivity and specificity, diagnostic sensitivity and specificity.
According to Health Insurance, less than one in two GPs (40%) ordered a TROD angina in 2017 (illustration).
According to Health Insurance, less than one in two GPs (40%) ordered a TROD angina in 2017 (illustration).


The ANSM has published an inventory of fixative rapid diagnostic tests (TROD) for the detection of group A streptococcal tonsillitis present on the French market in 2019.

This document is drawn up for pharmacists in the framework of addendum 18 to the National Pharmaceutical Convention which organizes the management of the rapid diagnostic orientation tests (TROD) angina pharmacy from 1 January 2020.

This report is presented as a tool to help pharmacists make "informed choice" when referencing these tests.

A test to limit the use of antibiotic therapy in the management of tonsillitis
In 2016, the Government put the fight against antimicrobial resistance as a priority. The more systematic use of TROD to differentiate between viral angina and bacterial angina and to limit the prescription of antibiotics is one of the flagship measures of this program and should be encouraged (see VIDAL Reco "Angina").

Indeed, in 8 out of 10 cases, angina is viral and antibiotic treatment is useless. On the other hand, in the case of bacterial angina, antibiotic treatment is necessary, especially in cases of Group A beta-hemolytic Streptococcus because of the potentially serious complications (rheumatic fever, acute glomerulonephritis).
By differentiating between viral angina and bacterial angina, TROD angina guides the conduct of health professionals concerned and the choice of care with or without antibiotic therapy.

Despite the availability of this test for several years in medical practices, the health authorities note a low adherence of GPs to the realization of this test. According to Health Insurance, less than one in two general practitioners (40% of general practitioners) ordered it in 2017.

The TROD in the pharmacy: the impetus by the refund
Since the order of 1 August 2016, the pharmacist is authorized to carry out in the dispensary (in a confidentiality area) a TROD to diagnose group streptococcal tonsillitis.
Currently, this act is not refundable by Health Insurance. The purchase of the test and the act of realization are the responsibility of the patient.

To promote the TROD in pharmacy, an amendment (addendum 18 to the National Pharmaceutical Convention, not yet published in the Official Journal) was signed on 18 September between the Health Insurance and unions representing community pharmacists (Union of Trade Unions). pharmacists (USPO) and the Federation of pharmaceutical unions of France (FSPF).
This rider organizes the reimbursement, from January 1, 2020, TROD angina when performed by the pharmacist.

Two care circuits: spontaneous request at the pharmacy or referral by the attending physician
The amendment defines 2 types of support, corresponding to 2 different remuneration amounts:
The patient presents himself spontaneously to the pharmacy and is directly supported by the pharmacist: the performance of the test by the pharmacist has priced 6 euros HT (6,30 euros HT in the departments and regions of overseas):
if the result is positive, antibiotic treatment is indicated and the pharmacist directs the patient to his doctor with the result of the test;
in the event of a negative result, the pharmacist gives the patient the appropriate advice to better manage the symptoms and invites him/her to contact the doctor in case of persistence and aggravation of the symptoms.
The patient is referred to the pharmacy by his treating physician for the

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