Crackdown on ‘unsafe’ online prescribing underway

Jolyon Attwooll

15/02/2023 5:31:06 PM

The Medical Board of Australia has already imposed restrictions on some individuals against issuing prescriptions through telehealth.

Doctors were warned last year to not prescribe medication to first-time telehealth patients.

Action is already being taken against unsafe online prescribing, the Medical Board of Australia (MBA) has said, with consultation on telehealth changes aimed making it harder to prescribe without proper assessment due to close this week.
In particular, AHPRA and the MBA have begun clamping down on practitioners for online prescribing ‘found to have been undertaken unsafely, and who have engaged in practice below the standards set out in the Codes of Conduct’.
‘Through our investigations we have seen some online models of patient care that fail to ensure the same standards of care are provided that we would expect in traditional face-to-face consultations,’ an MBA spokesperson told newsGP.
The spokesperson said the MBA has acted against practitioners for prescribing to a patient who has not been adequately assessed.
‘In some cases, this has led to restrictions preventing practitioners from prescribing or conducting appointments via telehealth,’ they said.
It follows media reports of investigations against practitioners prescribing drugs of dependence using telehealth.
In draft MBA guidelines, which were released for consultation in December after an earlier round of feedback was sought last May, doctors are warned not to prescribe to first-time telehealth patients.
‘Prescribing or providing healthcare for a patient with whom you have never consulted, whether face-to-face, via video or telephone is not good practice and is not supported by the Board,’ the draft guideline reads.
This week, the RACGP submitted its response to the MBA consultation, in which it stated that ‘the revised guideline is helpful, clear, relevant and workable’.
In its submission, however, the college recommends a change in wording.
‘If this guidance were followed, practitioners would cease to consult with new patients entirely, which we don’t believe to be the intent of the Board with this statement,’ it reads.
‘Such advice would also undermine the service models of virtual ED and afterhours locum services.
‘We suggest the line could be re-worded to “Asynchronous requests for prescriptions or medical advice where the practitioner, or other practitioner from the same practice, has not previously consulted with the patient in real-time, is not good practice and is not supported by the Board.”
‘The RACGP agrees with the subsequent statements, that requests for medication via text, email or online where a face-to-face or real-time telehealth consultation with that patient have not occurred prior, are not good practice.’
In the previous round of consultation, the college had warned about potential disruptions to care.
‘The RACGP has raised concerns about on-demand telehealth services that bypass a patient’s usual general practice, thus creating fragmentation and risking continuity of care,’ that submission read.

‘The RACGP’s position statement on on-demand telehealth services outlines further risk such services pose to patient care.’
In a response to a newsGP inquiry, the MBA said there are ‘increasing reports’ from patients as well as ‘other concerned members of the public’ flagging concerns about the ease with which prescriptions can be obtained online, either via automated services or telehealth.
These include patients not having to consult or see a prescriber before a prescription is given, without needing to provide a relevant medical history.
Another concern is described as ‘prescribing processes that feel like they are managed by an algorithm, or AI process, as opposed to being undertaken by a prescriber only after carefully considering the clinical need for a medication’.
Other issues cited by the MBA include not having drugs’ side effects or contraindications explained, with pharmacists reporting that drug interactions with other medications were not being considered or discussed by a prescriber.
Medication cost was also raised, with the MBA giving the example of private prescription services that do not offer patient rebates under the PBS.
The MBA and AHPRA spokesperson said the focus behind the revised guidelines is patient safety.
‘We recognise that telehealth has quickly emerged as a vital, growing and convenient part of the health system, and the safeguards for traditional consultations must now evolve in-line with the new technology,’ they stated.
‘Prescribing cannot be a tick-box exercise and the Medical Board of Australia does not support questionnaire-based asynchronous prescribing, because there is no real-time doctor patient conversation.’
They said a text-based patient health questionnaire then read by a doctor later ‘is not a doctor–patient consultation’.
‘In order to keep patients safe while using telehealth – particularly when prescriptions are being [issued] – the guidelines seek to close the gap between some new online prescribing business models and good medical practice,’ they stated.
The MBA consultation is open until 17 February, with details available on the organisation’s website.
The college’s guide to providing telephone and video consultations in general practice is available on the RACGP website.
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Dr Sampoi   16/02/2023 7:12:32 AM

So can we still work for Instantconsults?

Dr Bradley Arthur Olsen   16/02/2023 9:23:34 AM

Are the pharmacists allowed to do it??!!!!!!