Virtual EDs to offer ‘top-up’ ADHD prescriptions

Victorian patients will be allowed to ‘top up’ their attention deficit hyperactivity disorder (ADHD) medication without seeing a GP or psychiatrist – a move that has left medical colleges seething.
 
The RACGP says it has been blindsided after the Victorian Government announced the shake up to the way the medications are dispensed, sounding the alarm on patient safety.
 
Under the change, patients with an existing ADHD diagnosis and treatment plan who ‘urgently’ require a new prescription and are unable to see their regular doctor can dial into the state’s free Virtual Emergency Department (ED) for an online consultation.
 
The doctor will verify their current medication and dosage and provide clinical support, with the prescription being sent directly to their local pharmacy.
 
It comes just one day after the State Government expanded GPs’ scope for diagnosing and treating ADHD, with training to be rolled out by September.
 
RACGP Victoria Chair Dr Anita Muñoz said together with the state’s College of Psychiatrists (RANZCP), she is ‘extremely disappointed to hear this news’.
 
‘We are totally blindsided. We have worked in good faith with the Government to work together to produce a framework based on safety, quality use of medicines and good clinical governance,’ she told newsGP.
 
‘We made that commitment ... and to have the Government deliberately keep the details from us and then announce this with no warning and no consultation, is extremely disappointing.
 
‘We’ve not been consulted as experts about whether taking that step could lead to any harms for Victorian patients with ADHD.’
 
Premier Jacinta Allan says the one-off refill will be for at least 30 days and up to six months, allowing people ‘a supply of medication to cover them’ until they see their GP, paediatrician or psychiatrist.
 
‘No adult or child with ADHD should be left without essential medication when they need it,’ she said.
 
‘This is about making the system work for busy Victorian families, not the other way around.’
 
But Dr Muñoz argues this decision opens a raft of concerns.
 
‘We have a Government that says for GPs to independently prescribe ADHD medications, they need to undertake arduous training, and yet 24 hours later, they are saying for a Virtual ED clinician, no training is required,’ she said.
 
‘I cannot see how in a single phone call, a Virtual ED clinician is able to conduct the necessary physical assessment, including blood pressure, heart rate, and weight, and also conduct the appropriate mental health examination that is required.’
 
‘The Government is basically suggesting to ADHD patients, “You can get your script anywhere”, and continuity of care is not important.’
 
Under the new plan, Victorian ADHD patients can ‘urgently replace a lost, expired or depleted prescription’.
 
But with existing issues of pharmaceutical drug diversion into the black market being sold and used inappropriately, Dr Muñoz warns the Government is sending the wrong message to the public.
 
‘Now we have the Premier saying, “Don’t worry, if you lose a script, the state will make sure that you get a new supply”,’ she said.
 
‘And “If your script has expired or you’ve run out of medications, you do not need to bother with the appropriate checks and balances to ensure these medications are being used safely and are not causing you harm”.’
 
The Victorian Virtual ED states its services are for ‘non-life-threatening urgent care’ and not for routine care or chronic condition care.
 
With the State Premier now announcing the service can be used for routine scripts and routine care, Dr Muñoz is concerned it will confuse the public.
 
‘A decision has been made where there’s not been any opportunity to explore whether this could cause harm, or if there are going to be unintended consequences,’ she said.
 
‘Now we’re potentially also going to see the public asking themselves, why can’t they get other scripts from what’s essentially an emergency service?
 
‘We have spent years trying to educate the Victorian community that emergency services are for emergencies only, so the fact the Government didn’t consult us, suggests they wanted to avoid hearing our expert opinion on the potential harms of this policy.’
 
RANZCP Victorian Branch Chair Associate Professor Simon Stafrace said that without strong safeguards, the new model risks fragmenting care, inappropriate prescribing, and unmonitored side effects.
 
‘We know accessing ADHD care is hard for many Victorians,’ he said.
 
‘But the answer is making sure people can see psychiatrists, paediatricians and GPs, and building specialist ADHD care capacity and accountability within the public health system.’
 
‘We’re calling on the Government to work with RANZCP, RACGP and other stakeholders to create safe pathways so people with ADHD get treated by someone they trust, someone who knows them and their health.’
 
Log in below to join the conversation.
 

ADHD attention deficit hyperactivity disorder medicine safety quality care Victorian Government virtual ED