Misdiagnosis ‘inevitable’ as WA widens pharmacy prescribing

The West Australian Government is paving the way for pharmacists to prescribe and treat a greater range of conditions, as the list of jurisdictions allowing the contentious practice continues to grow.
 
Pharmacists in the state will soon be allowed to autonomously prescribe for shingles, acne, dermatitis, musculoskeletal pain, nausea and vomiting, and wound management – all without the involvement of a GP.
 
That is in addition to pharmacy prescribing for uncomplicated urinary tract infections (UTIs) and the oral contraceptive pill which was introduced in WA last year, with the UTI program already treating 7000 patients.
 
It is the latest state to make significant expansions in pharmacy-based treatment.
 
Just last week, Queensland extended its hormonal contraceptive pilot, New South Wales is ploughing ahead with trials, and the Northern Territory Government entered into public consultation earlier this year on what conditions should be treated at pharmacies.
 
This latest move has again raised significant concerns, as GPs say they have not been consulted on the decision and there has been no ‘clear communication or evaluation process’ on the actual health outcomes of existing pharmacy prescribing programs.
 
RACGP WA Chair Dr Ramya Raman says despite the college advocating for and recommending an evaluation of the program, this was not carried out before the state landed on what ‘seems like a politically driven outcome’.
 
‘There isn’t a clear communication or evaluation process for any of these programs that are coming up,’ she told newsGP.
 
‘This is ultimately going to increase the risk of fragmentation of care and increase risk of worsening patient outcomes and complications.’
 
Dr Raman says the move will ‘break down’ patient care and leave GPs to treat conditions that have been exacerbated.
 
‘Diagnosis is complex and requires years of training – specialist GPs train for over 10 years to understand the difference between a minor ailment and something more sinister,’ she said.
 
‘Misdiagnosis is inevitable, because pharmacists or other health professionals are likely to not have all of the medical history and circumstances in front of them or know about it before administering a treatment.
 
‘If there’s a condition that has been misdiagnosed and has been treated with a certain medication, but in fact the diagnosis is incorrect, then it’s leading the patient down the pathway for more complex care that would be needed, which would end up with the GP.’
 
Similar concerns over the effectiveness of pharmacy prescribing for health outcomes were raised in Queensland, with its program expanding six months ahead of schedule and without any evidence.
 
WA Health Minister Amber-Jade Sanderson said ‘enhancing the scope of pharmacists in Western Australia helps patients access timely, appropriate and convenient treatment for certain conditions’.
 
‘Expanding the role of community pharmacy is practical and common-sense policy that will ease cost of living pressures for people across the state,’ she said.
 
‘Ultimately, this approach will enhance primary care, freeing up time for GPs to support more complex patients in need of more urgent care.’
 
But Dr Raman is concerned the policy will instead ‘contravene national regulations for medicines, which exist to keep patients safe’.
 
‘The TGA determines the rules for medicines to protect the health of Australians and has transparent processes in place for safety,’ she said.
 
‘Treating things like shingles and eczema, there can be a lot of misunderstandings for that.
 
‘Diagnosis in itself is a complex process, and that needs to be in a private setting and understood in an appropriate fashion.’
 
The WA Health Department told newsGP it will now consult ‘to ensure the program is appropriately scoped and evaluated’, as well as having universities involved in upskilling pharmacists.
 
‘Design, development and implementation will take place over the next two years, with the aim for pharmacists to deliver advanced care by 2027,’ it said.
 
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Government pharmacies pharmacy pharmacy prescribing scope of practice treatment Western Australia