ED presentations for UTIs surge in wake of pharmacy prescribing

When pharmacy prescribing for ‘uncomplicated UTI’ was first introduced in Queensland, a main rationale often cited by supporters was its potential to reduce hospital presentations.
 
However, figures released this week by Queensland Health Minister Shannon Fentiman have raised further doubts about the scheme’s ability to fulfil this goal, with the new statistics showing that UTI hospital presentations have increased since UTI pharmacy prescribing was rolled out.
 
According to the Queensland Health data, almost 37,000 patients with UTIs presented to state emergency departments between 2022 and April 2023.
 
This compares to around 25,000 emergency presentations for UTIs throughout 2020, when pharmacy prescribing was first rolled out under a pilot scheme that has since been made permanent.
 
While emergency department presentation data in recent years can be influenced by multiple factors, doctors say the significant increase demonstrates that pharmacy prescribing is not reducing the burden on the health system and putting the community at risk.
 
‘The simple fact is UTI presentations at EDs have increased, not decreased, since the UTI pilot began in Queensland. That shows it is not working,’ AMA Queensland President and GP Dr Maria Boulton told newsGP.
 
The figures have been released in the same week that the Queensland government announced an expansion of pharmacy prescribing to now include additional medications to treat asthma, nausea and vomiting, nasal congestion, skin conditions and heart disease, along with pharmacists providing prescriptions for contraceptive pills and smoking cessation treatments.
 
‘Like all medical groups, we were completely blindsided by Health Minister Shannon Fentiman’s decision to expand the North Queensland scope of practice pilot to the entire state,’ Dr Boulton said.
 
‘This was announced by media release on World Pharmacist Day, with no consultation or advance warning for anyone but pharmacy lobby groups.
 
‘This is a reckless decision and an experiment with patient safety that will do nothing to address regional workforce shortages or reduce emergency department presentations.’
 
Dr Boulton added that important details on exactly how many conditions will be treated under the expanded pilot or how it will be monitored and evaluated have still not been released.
 
Last year, the AMA surveyed more than 1300 Queensland doctors and identified 240 complications as a result of the UTI prescribing pilot. Commonly, this was a misdiagnosed sexually transmitted infection that was treated as an uncomplicated UTI.
 
There were also six cases of pregnancy misdiagnosed as a UTI, including one patient who had a life-threatening ectopic pregnancy, with these patients being given prescriptions for antibiotics that are not safe to use in the first trimester.  
 
‘This is not a criticism of our hardworking pharmacist colleagues, who we work with every day to get the best outcomes for our patients,’ Dr Boulton said.
 
‘It is a criticism of short-term, short-sighted political band-aids that will not resolve our health workforce shortages.
 
‘[We need] all sides of politics to work together to recruit, train and retain our own healthcare workforce, and to scrap dangerous experiments with patient health.’
 
Dr Cathryn Hester, Deputy Chair of RACGP Queensland, told newsGP the commercial interests of those promoting the pilot have compromised patient care.
 
‘Unfortunately, the pharmacy prescribing trials were embraced by the Queensland Government based on some very poor advice from wealthy lobby groups with vested interests,’ she said.
 
‘We can quite clearly see from emerging data that role substitution of allied health workers for experienced clinicians is not an acceptable solution for our communities.
 
‘It has not addressed access issues, nor patient safety concerns, and in fact seems to have had a number of detrimental outcomes.’
 
Dr Hester also says she is not surprised by the new emergency department figures.
 
‘Selling medications is in no way equivalent to the expert communication, diagnosis, management, continuity, and safety-netting that a GP can provide,’ she said.
 
‘While it is admirable to try new and creative potential solutions for emerging health challenges, we should also not feel afraid to drop interventions which clearly have not been beneficial.
 
‘Retail pharmacy prescribing should be wound back before it causes more harm, and our efforts directed to more helpful, evidence-based programs.’
 
Meanwhile in South Australia, a parliamentary committee has released a final report recommending the State Government to follow Queensland’s lead and commence UTI prescribing in pharmacies, along with endorsing an expanded pilot whereby pharmacists can prescribe 25 additional medications.
 
AMA South Australia President and GP Dr John Williams said he is ‘disappointed’ in the outcome of the committee and expressed concerns that the scope of community pharmacists continues to expand without appropriate training.
 
‘More than ever, it seems that the state governments don’t understand what general practice does,’ he said.
 
‘We are the backbone of the health system, and we keep people out of EDs and out of hospitals.’
 
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