Doctors again voice opposition to pharmacy prescribing

Matt Woodley

27/01/2022 5:06:00 PM

The decision to extend a UTI pharmacy prescribing pilot program has prompted a warning from the RACGP and Urological Society of Australia.

Pharmacist prescribing medication.
Allowing pharmacists to prescribe antibiotics could have wide-ranging adverse health repercussions, the RACGP and USANZ have said.

Two weeks before an international study revealed nearly 1.3 million people had died in 2019 alone due to antimicrobial resistance, the Pharmacy Guild was hailing a Queensland Government decision to extend a controversial pharmacy prescribing trial under the guise of prioritising ‘women’s health’.
That decision meant an additional 1895 antibiotic prescribers will continue to operate in Queensland until at least 30 June – potentially permanently – at a time when Australian prescribing rates remain double those of some European countries.
However, these are not the only concerns raised by the RACGP and Urological Society of Australia and New Zealand (USANZ).
In a joint release, the two medical bodies warn that allowing pharmacists to prescribe antibiotics without medical review or investigations for urinary tract infections (UTI) in women could have wide-ranging adverse health repercussions, including the delayed diagnosis of cancer.
For Professor Helen O’Connell, Vice President of USANZ, the health and safety of patients must come first, especially given the serious potential consequences associated with misdiagnosis.
‘It does not represent best practice for women to simply attend a pharmacist with symptoms which may or may not be due to bacteria and receive antibiotics which may not treat the bacteria present due to resistance,’ she said.
‘The symptoms of a UTI are common to a number of serious health issues, including bladder cancer, which is why a correct diagnosis of an UTI is necessary to rule out other potential serious health issues.
‘More than 3000 people are diagnosed with bladder cancer each year, a significant number of these are women. This cancer is treatable if detected early but delayed diagnosis and treatment can compromise outcomes, and at worst may mean someone cannot be cured.’
When asked for the rationale behind extending the trial, a Queensland Health spokesperson told newsGP the pilot program is part of ‘a suite of regulatory changes’ that was undertaken to improve and support the health of Queenslanders.
‘Over 6000 women have accessed the service throughout the state and received immediate review and management or a referral to a general practitioner if required,’ they said. 
‘Over the next six months, the Department of Health will consider the outcomes of the [trial] evaluation, including whether the service should continue. Findings from the evaluation of the pilot will be provided to the Queensland Government in due course.’
However, while the spokesperson described the trial as a ‘great success’, RACGP President Dr Karen Price said there is no evidence to support its extension.
‘The RACGP has deep concerns about moves by the retail pharmacy sector to push through policy changes that put financial gains ahead of patient care and safety,’ she said.
‘The trial in Queensland of pharmacists prescribing antibiotics for urinary tract infections is concerning.
‘One of the main problems here is that this trial is effectively an implementation trial. It’s not research on best practice and the results of the trial should be made publicly available.’
RACGP Queensland Chair Dr Bruce Willett, who opposed the scheme before it even began due to concerns over the trial’s design, believes making the pilot a permanent fixture of Australia’s healthcare system would be a recipe for disaster.
‘One of the greatest challenges our healthcare system faces is antimicrobial resistance caused by the misuse and over-use of antibiotics,’ he said.
‘GPs are actively working to reduce the prescription of unnecessary medicines and extending this pilot is certainly a step in the wrong direction.
‘Introducing multiple prescribers – particularly those who stand to gain financially from handing out more medicines – will jeopardise global efforts to reduce antimicrobial resistance.’
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Dr Michael Charles Rice   28/01/2022 8:45:33 AM

I suggest that we speak not of pharmacy "prescribing" (heaven knows we have enough colleagues who talk about patients coming for a "script") and instead speak only of "diagnosis and treatment"

As in "shop-front diagnosis and treatment", "over-the-counter diagnosis and treatment" and so on

Dr Ian   28/01/2022 11:31:17 AM

In an Emergency it is ok but you have to exclude STDs as well as other conditions .

Dr Rodney Paul Jones   28/01/2022 11:35:36 PM

STI, pregnancy, and PID need to be excluded .... and then all the rabbit holes that come with those diagnoses

Dr Jacqueline Barry   31/01/2022 9:28:18 AM

I estimate that about half the women who present to me having self diagnosed a UTI ultimately have other causes for their symptoms, only assessed by thorough history, physical examination, urine dipstick test and review of previous similar presentations and (hopefully, and in most cases) corresponding urine m/c/s results.
There are numerous other conditions where patient's self diagnose, obtain treatment from pharmacy without further assessment, then present when this all fails. Thrush is one example, although I am not opposed to the availability of topical/vaginal antifungal without prescription. Unfortunately I find the assessment of the problem then becomes longer and more difficult, having to factor in the treatment(s) and their possible impact on the delayed presentation (potentially positive and/or negative)