AMAQ survey cites ‘alarming’ complications from pharmacy pilot

Jolyon Attwooll

9/05/2022 6:29:12 PM

At least 239 patients have had complications after seeing a pharmacist involved in the Queensland UTI prescribing trial, according to a new report.

Pharmacist handing over prescription
The AMA Queensland survey took place in March, with doctors expressing serious concern about the UTI pharmacy prescribing trial.

More concerns have been raised about a UTI pharmacy pilot, following the publication of results from an Australian Medical Association Queensland (AMAQ) survey.
In the online questionnaire, which was carried out in March, doctors based in the state responded to a series of 11 questions about the UTI pharmacy pilot, as well as the proposed ‘Full Scope of Practice Pilot’ planned for Northern Queensland.
The results, now published on the AMAQ website and reported on in The Australian newspaper, suggest that as many as one in five GPs could be treating patients with complications following their participation in the UTI pharmacy pilot.
AMAQ states there were ‘at least’ 239 patients with post-trial complications seen by the doctors surveyed.
The most common issues reported were misdiagnosis, with the AMAQ survey highlighting 73 apparent cases where conditions such as chlamydia, herpes and gonorrhoea and an ectopic pregnancy were allegedly mistakenly categorised as UTI.
Pregnancy was misdiagnosed as UTI on at least six occasions, the AMAQ also claims, with the organisation saying patients were prescribed antibiotics that are unsafe in the first 12 weeks of pregnancy.
According to the respondents, the inappropriate use of antibiotics was almost as common, with 67 examples of ‘problematic’ prescribing identified as part of the analysis of the results.
Doctors also reported concerns about patients reluctant to disclose relevant clinical information and being ‘upsold’ products, the AMAQ states.
‘Our survey shows that the Urinary Tract Infection Pharmacy Pilot has failed. Women did not receive the care they needed and an alarming number became more ill due to their participation in the trial,’ AMAQ President Professor Chris Perry said in the report summarising the survey results.

The AMAQ report also describes eight cases where patients with urosepsis or pyelonephritis were reportedly admitted to hospital following misdiagnosis or ineffective treatment carried out as part of the pilot scheme.
RACGP Vice President, and Queensland Chair Dr Bruce Willett, said the survey reinforced the college’s strong opposition to the trial, and a lack of transparent reporting mechanisms.
'There are no significant clinical endpoints on this trial,’ he told newsGP. ‘There's no way of reviewing diagnoses to see if they’re accurate.
‘I think it really highlights that there’s a problem with the UTI trial. It’s not a real trial if it doesn’t have a genuine mechanism to feed back the results of the project.’
Responses were gathered from doctors in range of different fields, with AMAQ stating that survey, which was distributed to medical mailing lists, received 1307 responses from across Queensland, with 52% of the respondents described as GPs.
Among the other groups, 36% said they were specialists and 12% said they were GPs in training.
Of those who took part, 15% reported caring for patients with complications, including 148 GPs.
That total that would comprise more than 20% of the GPs who reportedly took part.
An AMAQ spokesperson told newsGP that the results were analysed by an independent biostatistician and academic from the University of Queensland.
A spokesperson for the Queensland branch of the Pharmacy Guild of Australia, however, said the AMAQ’s survey report contained ‘hearsay allegations’.
They also described a reference in the survey results, which found that three men were treated as a result of the UTI pilot, as ‘totally false’.
‘The uncomplicated Urinary Tract Infection Pharmacy Pilot… continues to be a success, which is why the state government has extended the trial,’ the Guild spokesperson said in a statement.
‘Pharmacists follow the same UTI protocol as doctors. As part of the protocol, if someone has unresolved symptoms 48 hours after commencing treatment, they are referred to a GP.’
The UTI pilot began in June 2020, allowing pharmacists across Queensland to provide treatment to women with a suspected UTI, including diagnosis and the option to prescribe trimethoprim, nitrofurantoin or cefalexin.
Queensland Health since outlined plans to expand pharmacy prescribing in a proposed trial known as the North Queensland Pharmacy Full Scope of Practice pilot.
The college withdrew from a steering committee for that pilot in February, with Dr Willett citing concerns over patient safety as the principal reason for the move.
Four other medical organisations also disassociated themselves from the committee.
There have since been questions raised about potential conflicts of interest in the North Queensland Primary Health Network where the pilot would be based, which led to the resignation of two GPs from the board.
A Queensland Health spokesperson told newsGP on Monday the full detail of the proposed trial has not yet been confirmed, nor has the start date.
If the pilot proceeds, pharmacies in North Queensland are likely to be allowed to diagnose and prescribe medication autonomously for a much wider variety of different conditions. The Guild has stated that significant training would be given to pharmacists wishing to join the pilot.
Dr Willett, however, believes enough queries have been raised about the UTI pharmacy pilot to give pause to health authorities.
‘When we’ve seen this trial being conducted without proper clinical endpoints [and] proper follow-up with sufficient power to show the issues, that really does raise concerns about the vast and more extensive changes for the North Queensland pharmacy trial,’ he said.
He also stressed concerns about antimicrobial resistance.
‘The World Health Organization has for the last 10 years been warning us about two major health issues looming on the horizon,’ he said.
‘One was that we’re at risk of developing a pandemic. And the other one… possibly even more long-running in its possibility for causing significant loss of life across the world – is the issue of antimicrobial resistance.
‘We’ve now seen one of them, and we’re still really faced with a very real possibility of the other coming to fruition.’
The college has called for both the UTI and North Queensland Full Scope of Practice pilots to be abandoned.
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Dr Mai Huynh Thi Tran   10/05/2022 8:14:16 AM

Antibiotic resistance to Cephalexin and Trimethoprim is increasingly common in UTI.
Nitrofurantoin has a lot of side effects.
Diagnosis and investigation of UTI requires Dipstick Urinalysis and urgent MSU test.
Otherwise patients may have been taken antibiotic that does not work and they may develop complications of UTI such as pyelonephritis and sepsis

Dr Charles Y. Piao   10/05/2022 12:03:15 PM

I think we all see that coming, just a matter of timing. But does anyone here really think things will change?

Dr Veronika Marie Kirchner   10/05/2022 12:18:58 PM

Allowing pharmacists to "prescribe" antibiotics for UTI's is one of the most IRRESPONSIBLE ideas I've come across. The results of this survey should come as no surprise to any ethical healthcare provider. Obvious pitfalls:
1/ MISDIAGNOSIS - how can anyone without a medical degree be sure about the diagnosis, particularly if symptoms are atypical? What of differential diagnosis? Can they investigate re other conditions? Do they care?
2/ INAPPROPRIATE PRESCRIBING - Doctors are warned about the dangers of antibiotic overuse. We've been criticised & cautioned about the issue, & have to explain to patients why they don't need antibiotics. This takes time & patience. And now, suddenly it's OK for pharmacists to have free rein to splash antibiotics about? Are they aware of antibiotic resistance in UTI?
3/ CONFLICT OF INTEREST - if you sell the stuff, you'll lean towards prescribing it.