Pharmacy treatment of UTIs becoming an ‘unfortunate’ pattern

Pharmacists will permanently be allowed to treat women’s’ urinary tract infections (UTIs) across New South Wales from 1 June, but the RACGP says this change ‘flies in the face of antimicrobial stewardship’.
 
The change comes as a comprehensive evaluation of the program is yet to be completed.
 
The NSW Government announced on Tuesday that its $6 million trial across 1118 pharmacies had helped more than 16,000 women access UTI treatment ‘quickly and conveniently’.
 
But RACGP NSW&ACT Chair Dr Rebekah Hoffman said pharmacists are not trained to diagnose a UTI and are not required to have the same level of clinical reasoning as GPs.
 
‘It just puts the cure before a diagnosis,’ she told newsGP.
 
During the trial, the NSW Government provided $20 per patient to pharmacies but now, as it is being implemented statewide, pharmacies will set their own price.
 
The initiative was announced in 2023, with pharmacists taking walk-ins through a 10-minute consultation using a computer program to follow a clinical guidance document known as the PATH-UTI clinical management protocol.
 
Dr Hoffman said this change to UTI treatment is becoming an unfortunate pattern across Australia but ‘is not the right way to approach this problem’.
 
‘Governments have been told that this is an easy win for them based on convenience and lobbying,’ she said.
 
‘The New South Wales Government knows it has workforce challenges, including of pharmacists, and it should tackle the root causes rather than trade safety and quality for an easy headline.
 
‘This risks misdiagnosis, worse health outcomes, and flies in the face of antimicrobial stewardship.’
 
GPs have previously flagged a number of ‘concerning’ clinical incidents during a UTI pharmacy prescribing trial in Queensland.
 
‘We still have genuine concerns about the lack of supporting evidence for patient safety given the potential for adverse events, as well as cost effectiveness, and appropriate communication back to the GP,’ said Dr Hoffman.
 
‘Symptoms of a UTI might actually be symptoms of a more serious health problem and people may then present to their GP much later and their health condition has worsened.
 
‘It also means a patient may have completed a course of antibiotics to no benefit.’
 
Dr Hoffman added that there are stronger referral pathways in this NSW program that have not been present in other states.
 
‘But our members have told us that they aren’t receiving much communication about UTIs,’ she said.
 
NSW Health Minister Ryan Park said the go-ahead for the trial to become permanent shows the Government ‘is committed to taking pressure off GPs and primary care services’.
 
‘We are constantly evaluating ways we can deliver healthcare more efficiently as well as safely,’ he said.
 
‘Ensuring continuity of care will be crucial as pharmacy service offerings increase, including strengthened communications between pharmacists and doctors about a patient’s treatment.’
 
Pharmacy Guild of Australia NSW Branch President David Heffernan said the UTI trial has so far been a demonstratable success and that ‘pharmacists are ready to step up and take some of the pressure off GP clinics and hospitals’.
 
But Dr Hoffman said UTIs are not clogging up general practice waiting rooms.
 
‘It’s not correct to link this approach to demand for general practice services,’ she said.
 
‘This is a matter of accurate diagnosis, appropriate use of antibiotics, and continuity of care – it’s vital that a patient’s care team and GP know about health issues and treatments.’
 
A NSW Health spokesperson told newsGP a comprehensive evaluation of the trial is still underway.
 
They said it will include ‘a review of service satisfaction levels, how often antibiotics were supplied, how often women were referred to other services and what, if any, medical and pharmacy services the trial participants required after the consultation’.
 
Dr Hoffman said it would be positive if the evaluation holds up against the litany of concerns raised.
 
‘But this is now being implemented before the results have been published – so any claim it will reduce pressure on practices is speculative,’ she said.
 
The NSW Health spokesperson said the University of Newcastle-led consortium worked closely with GPs and other medical practitioners ‘to deliver a robust clinical trial with safety monitoring a key feature throughout’.
 
‘A final report will be provided to the NSW Ministry of Health in early 2025,’ they said.
 
Dr Hoffman said the RACGP participated on the trial steering committee and will be ‘inside the tent’ to recommend improvements for patient safety.
 
She also highlighted that, with the NSW Government no longer subsidising the service, there could be a change in demand.
 
‘Now, patients will be out of pocket because this is not eligible for Medicare rebates or bulk billing,’ Dr Hoffman said.
 
‘That may mean the clinical trial indicates higher pharmacy utilisation than will be happening post-trial.’
 
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antimicrobial stewardship pharmacy scope of practice urinary tract infection UTI treatment UTIs