Permanent extension of UTI prescribing pilot slammed by doctors

The decision by Queensland Health to permanently extend its UTI pharmacy prescribing pilot has been met with outcry from medical groups, including the RACGP and AMA.
 
The pilot, which allows pharmacists to independently prescribe antibiotics for UTIs, has raised numerous concerns related to misdiagnosis, conflicts of interest and antimicrobial resistance.
 
Much of its existence has also been shrouded in secrecy, with Queensland Health repeatedly refusing to answer questions related to the pilot since it began in June 2020 – a decision that was itself made before an evaluation trial into the controversial program had even been begun.
 
RACGP Vice President and Queensland Chair Dr Bruce Willett believes the permanent extension of the pilot will endanger patients for years to come.
 
‘This is not just a step in the wrong direction, it’s locking in permanently a pilot that should be immediately scrapped and subject to a comprehensive independent inquiry so that we can get to the bottom of what harm it has already caused to women in Queensland,’ he said.
 
‘As I have said many times before – we should not have non-medical health professionals in a cramped retail setting providing services they are not trained to provide to unsuspecting patients.
 
‘This is a recipe for disaster and the college will continue to speak out about the dangers it poses.’
 
Under the terms of the now permanent program, pharmacists need only undertake two hours of online training before diagnosing and selling antibiotics to women with potential UTIs. To help justify its decision, the Queensland Government pointed to a recently released 118-page evaluation report – which it inexplicably sat on for months after receiving it from the Queensland University of Technology (QUT) – that stated pharmacists and consumers were generally pleased and supportive of the scheme.
 
The evaluation was conducted by QUT’s Professor Lisa Nissen, a pharmacist who also led the implementation of the UTI pilot, for which she received ‘the highest honour that The Pharmacy Guild of Australia’s Queensland Branch President can bestow’ at an event in October last year.
 
GP and AMA Queensland President Dr Maria Boulton criticised Health Minister Yvette D’ath’s reliance on the report to justify the scheme’s permanent extension and pointed to a number of findings that appear to undercut its apparent endorsement of the program.
 
‘Every medical group in Queensland opposes this plan. The Commonwealth opposes this plan. The Pharmaceutical Society of Australia [PSA], which represents pharmacists not pharmacy owners, opposes this plan,’ she said.
 
‘The evaluation report shows that 65% of women who took part in the pilot were never followed up with. Of those who were contacted, more than 300 said they had sought further assessment and treatment. Four ended up in emergency departments.
 
‘That is even more than the cases we discovered after surveying Queensland doctors in March about the UTI trial, when we found 240 cases of complications from this trial and nine hospitalisations.’
 
Dr Boulton also noted that the ‘satisfaction rate’ referred to in the report is based on just 68 women who filled out an online survey sent to them by the pharmacist who provided their service.
 
‘Virtually every woman under this scheme was sold antibiotics, whether she needed them or not,’ she said.
 
‘One in two pharmacists said they would have found it difficult to ask women for the $19.95 service fee without also selling them antibiotics.
 
‘Pharmacists themselves are unwilling to take part – 817 pharmacies enrolled, but more than one-third reported offering no services at all during the 18-month trial, and only five provided more than 100 services.
 
‘Our argument is not with pharmacists or pharmacy owners. It is with the Health Minister, who withheld the evaluation report for months despite our repeated Right To Information applications, and has now decided not just to make the UTI pilot permanent, but to expand this to at least 23 more serious medical conditions across North Queensland.’
 
For Dr Willett, the ‘warning signs’ regarding how ‘dangerous’ the pilot is have long been obvious.
 
‘We have previously warned about several alarming incidents to emerge so far and these are realistically only the tip of the iceberg,’ he said.
 
‘One of the main problems with this pilot is that the opaque process for reporting.
 
‘Put yourself in the shoes of the patient. If the only person that they can report adverse outcomes to is the pharmacist responsible for seeing them in the first place, you can see why many people will be reluctant to step forward and report problems.
 
‘We still haven’t had a proper and thorough assessment of this pilot, which is putting patient wellbeing at risk every day.
 
‘Enough is enough, this permanent extension shows that the [Queensland] Government isn’t listening to the expert health bodies, including the RACGP. The pilot should be immediately binned, and an independent assessment conducted without delay.’
 
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