Queensland pharmacy study ‘really worrying’

The research, conducted by Queensland University of Technology (QUT), investigated the supply of morning-after pills and treatment for conjunctivitis in an effort to determine whether over-the-counter medication dispensing followed practice standards and guidelines.
 
According to co-author Professor Uwe Dulleck, both scenarios led to mixed results.
 
‘When our ‘consumer’ presented saying they were within the 72 hours [of sexual activity], all the pharmacists adhered to the therapeutic guidelines,’ Professor Dulleck said.
 
‘However, in the case of those who said it had been more than 72 hours, only one of every two followed the guidelines, with 47.7% cent of pharmacists selling the pill despite there being limited evidence of its effectiveness in such a timeframe.
 
‘Many also referred the research assistant to a doctor, but not all.’
 
Professor Dulleck added that the emergency contraceptive findings mirrored researcher experiences when requesting help for either viral or bacterial conjunctivitis.
 
‘Data collected from the visits to 205 pharmacists in the wider Brisbane area showed only 57.6% followed dispensing behaviour compliant with the protocol, while 31.3% involved some form of overtreatment or overselling of medication,’ he said.
 
RACGP Queensland Chair Dr Bruce Willett told newsGP the results are ‘really worrying’, especially given the context of a proposed state-wide trial that will allow pharmacists to prescribe some antibiotics and the contraceptive pill.
 
‘It renders this Queensland prescribing trial redundant before it starts because regardless of what is said, we know this is what’s already happening,’ he said.
 
‘You can do all of these things under “laboratory” conditions in a trial where you hand-pick practices and pharmacists and tell them they’re being watched, but it will elicit different behaviour than what’s going to happen in the real world.
 
‘The opportunity for creating antibiotic resistance and future ‘super-bugs’ is much higher when we’re talking about dispensing oral antibiotics, and we really expect to see the same behaviour as displayed in the study.’
 
Dr Willett likened the proposed pharmacy dispensing trial to the conflict of interest highlighted by the Royal Commission into the Banking and Financial Services Sector, whereby financial advisors were profiting from the advice they gave to clients.
 
‘We’re creating exactly that situation in the pharmacy sector,’ he said.
 
‘We’re looking at an area where this situation has been disastrous, and now it seems we’re replicating the disaster.’
 
Aside from concerns of potential conflicts of interest, Dr Willett also said the study highlighted clinical issues surrounding fragmentation of care. While supporting the availability of emergency contraceptive pills over-the-counter at pharmacies, he was worried that many patients were not advised to seek follow up treatment.
 
‘You have women who have been given inadequate treatment [supplied emergency hormone contraception post 72 hours] and nearly a third have not been told to seek follow-up, one assumes the patients were largely unaware the treatment was inadequate. It demonstrates what we mean by fragmentation of care,’ he said.
 
‘That means those women received inadequate treatment and basically weren’t told to follow up on the fact that there was still a reasonably good chance that they could become pregnant.
 
‘Even when emergency contraception was appropriately prescribed roughly half the women did not receive follow-up advice, missing out on the opportunity to receive more appropriate long-term contraception.
 
‘It shows that even in areas where it’s appropriate for pharmacists to prescribe, there is a cost, and that cost is getting proper, long-term advice about effective contraception. We can expect that problem to worsen if pharmacists are allowed to prescribe the pill more generally.’

antibiotics contraception fragmentation of care pharmacy prescribing