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Alarm raised after study finds pharmacy UTI treatment inconsistent
Controversial pharmacy prescribing trials have once again raised scope of practice concerns, with new research finding significant protocol inconsistences.
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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