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Alarm raised after study finds pharmacy UTI treatment inconsistent


Chelsea Heaney


24/07/2024 4:08:36 PM

Controversial pharmacy prescribing trials have once again raised scope of practice concerns, with new research finding significant protocol inconsistences.

A pharmacist holds two different medications.
Only one out of six Australian jurisdictions scored above 60% on a review of pharmacy UTI treatments.

A new review of clinical protocols for community pharmacist‑led management of urinary tract infections (UTIs) has drawn the ire of GPs, who say the pilots are creating a ‘real potential for harm’.
 
Its release comes as pharmacy prescribing trials continue to gain momentum across Australia, with many pharmacists granted autonomous prescribing powers for a range of conditions.
 
The literature review and appraisal looked at 40 protocols in the United Kingdom, Canada, the United States, New Zealand, and Australia – all of which have allowed for community pharmacists to manage acute uncomplicated UTIs in women aged 16–65 years.
 
Nine of the protocols examined were from Australia, including in Tasmania, South Australia, Victoria, Western Australia, New South Wales, and Queensland.
 
Only four of the protocols studied were deemed high-quality, including one from NSW, and just four provided recommendations on antimicrobial resistance.
 
Fifteen of the protocols were deemed low-quality and scored less than 50%, including ones from WA and from the Australasian College of Pharmacy.
 
‘The findings highlight a deficiency in the quality of most clinical management protocols governing pharmacist-led urinary tract infection management,’ the study concludes.
 
Dr Michael Bonning, a member of the RACGP Expert Committee – Funding and Health System Reform, said any treatment in Australia must be evidence-based and raised concerns about variations in treatments.
 
‘Patients should know that the standard of healthcare being provided is based on consistent and contemporaneous evidence, and if it’s not, then you know that should be a concern to the public,’ he told newsGP.
 
Pharmacists across NSW were green lit to treat UTIs permanently as of June 1 this year, despite significant concerns that this ‘flies in the face of antimicrobial stewardship’.
 
The review focused on 10 key components including common signs and symptoms, differential diagnosis, red flags or referral, and choice of empirical antibiotic therapy.
 
‘The fact that we see a substantial number, if fact the great majority, unlikely to meet those kind of evidence standards is concerning,’ Dr Bonning said.
 
‘And given the challenges of antimicrobial resistance, that only 10% of the study protocols include any reference to antimicrobial resistance is alarming.’
 
In 2022, GPs flagged a number of ‘concerning’ clinical incidents during a UTI pharmacy prescribing trial in Queensland.
 
The new research, which released earlier this month, was led by Dr Mitchell Budden from the University of Newcastle’s School of Biomedical Sciences and Pharmacy, who also worked on the NSW Pharmacy Trial.
 
Dr Bonning said the findings highlighted a litany of problems.
 
‘The first is that there is real potential for harms in the delivery of this healthcare,’ he said.
 
‘The second is just the loss of confidence from the public in the delivery of healthcare through any of these trials, especially if it becomes clear that it is not being delivered up to the standards I think the community would expect.
 
‘And the final one is about the hastening of a pathway to more common antibiotic resistance in our community, because we find that many of our antibiotics are less successful than they previously have been.’
 
These problems, Dr Bonning suggests, need to be addressed by authorities.
 
He said regulators must take heed of the review’s findings and ‘incorporate best practice standards into all of the trials all around the country’.
 
‘I think with any piece of review research like this, it gives an opportunity for improvement,’ Dr Bonning said.
 
‘If we’re going to have these trials, then they should at least be conforming to the best principal standards with their protocols.’
 
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Dr Jonathan Conway Lloyd   25/07/2024 7:00:49 AM

What if anything is the RACGP actually doing about this constant and progress intrusion of Pharmacy into General Practice. These are allied health professionals who receive no clinical training in their degree for diagnosis and management now performing a clinical role. It really does feel like this is being taken laying down.


Dr Robert Douglas   25/07/2024 9:42:41 AM

Let me share an anecdote. Women in her mid-20s, sxs of cystitis. Goes to Pharmacy, sold TMP 300 nocte, WITHOUT a urine sample being collected/sent to lab. Takes two doses, but then develops BILATERAL flank pain - see her in ED, and admit her with BILATERAL pyelonephritis - but GUESS WHAT - probably can't determine cause., and there's no way to know what was there before. NOT examined at teh Pharmacy either. Worse than Third World.


A.Prof Christopher David Hogan   25/07/2024 10:33:02 AM

GPs help patients lead healthier lives
Their super power lies in long term continuity of care- when patients see the one GP or one small group of GPs their health outcomes (depending on the study) are 10-30% better than inconsistent / fragmented primary care.
With the very poor communication these studies represent fragmented care


Dr Milton Arthur Sales   25/07/2024 3:05:36 PM

I have been very disturbed by this move towards a less quality of care from our PHARMACY colleagues. Our practice takes a proactive approach. We have fast track for UTIs to be seen on the day initially by our nursing staff who will check the urine and take a brief history. Then they are reviewed by a GP and we stock our own supply of trimethoprim cefalexin and amoxicillin which we sell directly to the patient if needed. The combination of appropriate urine testing, avoiding antibiotics if normal, checking for antibiotic sensitivities for those which we prescribe and dispense, asking about the risk of this being a SEXUAL HEALTH encounter, all adds to the value we can supply to these patients in GP that is sadly lacking in PHARMACY. We sell the medication at cost. Pensioners can opt for a PBS prescription at a pharmacy if they so wish. It is gratifying that so many people would prefer not to have to attend PHARMACY after seeing the doctor for a UTI


Dr Abdul Ahad Khan   25/07/2024 5:14:46 PM

What Dr. Lloyd & Dr. Douglas say, are SERIUOS LEGITIMATE CONCERNS.

There is a saying that ' Half a Physician is a Danger to the Community. '

* AHP s ( llied Health Professionals ) have not gone through an Intense Study required to obtain a MBBS Degree .
* AHPs have not gone through an Intense Internship Training.
* AHPs have not gone through an Intense GP Registrar Training.

What appears easy to diagnose by a full-fledged GP, is ONLY because this GP has an Encyclopedia of Medical Knowledge / rich Clinical Experience / thorough Knowledge of Anatomy & Physiology / Pharmaco-Therapeutics.

Equipped with all of the above, a full-fledged GP is able to swiftly exclude a Plethora of Differential Diagnoses / Pitfalls & is able to provide SAFE MANAGEMENT.

Lurking behind many a Simple Clinical Presentation, is a Sinister Clinical Condition.

AHPs taking on the Role of a ' PRETEND GP ', are a DANGER to the Community.

DR. AHAD KHAN


Dr Allan Roy Ingpen   26/07/2024 3:46:22 AM

While I absolutely agree with all above comments, what do patients do? Presently I work in ED and 30 - 60% of my daily patients are those stating unable to access GPs within an acceptable timeframe (up to 3 weeks for an appointment). Perhaps mandatory logging with a treatment pro forma for all pharmacy led treatment on MyHealthRecord. While this is not the solution, it may provide a better safety network, and could be used by other doctors in a patient's journey to keep their GP informed of treatments.


Dr Peter James Strickland   26/07/2024 10:46:45 AM

The great danger here is inadequate investigation of (sometimes) recurrent UTIs in young people by pharmacists, and I have had several cases of serious reflux problems of bladder to kidney, and double ureters etc, and with the consequence of renal damage in time from actual pyelonephritis over time, and the consequences of that for life.


Dr Abdul Ahad Khan   27/07/2024 5:21:58 PM

We cannot attract Fresh MBBS Graduates to enter in General Practice, because the Financial Rewards are not there.

Solutions :
1. Up the Medicare Rebates right across the board, by 25 to 30 %
2. Reward working on Saturdays by making each Saturday GPM Consultation as an
After-Hours Consultation - remember, no Govt. Employee / Specialists work on Saturdays

Once the Rewards for becoming a GP are FINANCIALLY ATTRACTIVE, fresh MBBS Graduates will take up GP as their Career Choice..

DR. AHAD KHAN


Dr Abdul Ahad Khan   28/07/2024 4:58:31 PM

Dr. Ingpen's Statement : " Presently I work in ED and 30 - 60% of my daily patients are those stating unable to access GPs within an acceptable timeframe (up to 3 weeks for an appointment.
This is a Statement most Patients will give, in order to justify their E.D. Presentation - Remember, it costs Patients ZERO Dollars to be seen in E.D. & that is the Reason.

I do not know of any GP Surgery / Medical Centre which will not squeeze in these Patients & by-pass the 3 weeks Waiting Period.

I believe that your Statement will only apply to < 10% of Presentations.

DR. AHAD KHAN