Evidence of ‘protocol deviation’ in Queensland UTI pilot

Matt Woodley

4/05/2023 6:06:03 PM

The full evaluation of the UTI pharmacy prescribing pilot shows 192 women who received antibiotics should have been referred to a GP.

Woman receiving antibiotics from pharmacist.
Almost half of the women who accessed the service more than once did so despite meeting the definition of a recurrent infection or relapse.

The final service evaluation report for the Urinary Tract Infection Pharmacy Pilot - Queensland (UTIPP-Q) has revealed ‘evidence of treatment protocol deviation’, after nearly 200 women were given antibiotics despite not being eligible to participate.
According to the report, released last month on the Queensland University of Technology website, almost half of the 410 women who accessed the service more than once did so despite meeting the definition of a recurrent infection or relapse, which should have triggered a GP referral.
RACGP Vice President and Queensland Chair Dr Bruce Willett told newsGP the results call into question the safety and effectiveness of the pilot and should have implications for similar trials around the country, especially the north Queensland pharmacy prescribing pilot.
‘If pharmacists are struggling to stick to the criteria in situations that are comparatively simple like emergency contraception or UTIs, it does call into question how they will handle more complex things around managing heart disease and diabetes, in particular,’ he said.
‘This is not in any way a criticism of the pharmacists. It’s the conditions that they have been placed in by pharmacy owners.
‘Pharmacists will be exposed to increased risks of litigation and complaints because of being forced to work in an environment that’s not appropriate.
‘I would strongly urge the Queensland Government hit pause on the North Queensland trial … and also ask other jurisdictions to have a close look at these findings before they go down the pharmacy prescribing path.’
The final report confirms that of the 10,270 participants who agreed to provide data as part of the evaluation, 96.6% were prescribed an antibiotic, but only 28.9% were able to be contacted later to determine whether their treatment had been successful.
Of the fewer than one in three pilot participants who were able to be contacted for follow up, 87.6% reported having had their symptoms resolved. One hundred and sixty two of the 209 patients who received a follow up and had not had their symptoms resolved visited a GP and five presented to hospital – one of whom was subsequently diagnosed with a ‘superbug’, while another was recorded as having appendicitis.
Forty-six of the patients with unresolved symptoms who visited a GP (28.4%) received a treatment other than antibiotics, which increased to 35.2% among those for whom a urine test was performed.
The report states that the reasons why 5320 of the participants were lost to follow-up are ‘unknown’, but Dr Willett believes it was a result of inadequate trial design.
He also said the findings ‘vindicate’ the concerns raised by the RACGP and AMA, while adding that more women also likely received inappropriate treatment.
‘The poor follow up was built into the protocol – it was just a phone call,’ he said.
‘The other thing is that none of this information is direct from the patient. It’s all filtered through the pharmacists who provide the service, which is just extraordinarily poor study design and would never be accepted in any academic paper.
‘We would really confidently feel that this is only capturing the tip of the iceberg.’
The paper also reaffirms that participating pharmacists were only required to complete a two-hour online training module, followed by a multiple-choice test to complete their certification.
For Dr Willett, this level of assessment is inappropriate when considering successful participants were subsequently able to prescribe antibiotics.
‘Ten years ago, the World Health Organization identified two main health threats. One was a pandemic and the other, more serious, and long-lasting danger is antimicrobial resistance,’ he said.
‘It truly is a huge threat and this is undoing all of the good work that we as a college have done in terms of helping GPs prescribe fewer antibiotics – which we are.
‘These pilots are the equivalent of opening five new coal mines in the face of global warming. It’s just head in the sand stuff.’
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Dr George Burkitt   5/05/2023 10:25:58 AM

The conflict of interest in pharmacists prescribing and then dispensing for a fee plus profit on the medication should have ruled out this proposition before it even got to first base. The same applies to potential over servicing by doctors who provide investigations and procedures that profit them financially. This also needs more scrutiny.

A.Prof Christopher David Hogan   5/05/2023 4:54:31 PM

General Pracctice is a lot more complicated than most people consider.
These articles of ours demonstrate that & explain why delegation to other health professionals without GP oversight is very problematic.