Pharmacists raise UTI prescribing concerns

Jolyon Attwooll

17/03/2023 4:46:56 PM

A state union has flagged potential issues surrounding medical indemnity, overwork, and the separation of prescribing and dispensing.

Pharmacist dispensing
Concerns have been raised over managing the potential conflict of interest between prescribing and dispensing medications.

A submission to a South Australian Parliament committee has outlined a series of concerns about expanding pharmacist roles to include diagnosis and prescribing for urinary tract infection (UTIs).
This month, Professional Pharmacists Australia (PPA) gave its views to the state’s Select Committee on Access to Urinary Tract Infection Treatment
While the organisation – a union and professional association with more than 7000 pharmacist and pharmacist technician members – endorses the expansion of pharmacists’ scope of practice in principle, it also outlines concerns familiar to many GPs.
In a press release accompanying the submission, the union’s South Australian director Paul Inglis flagged workforce shortages and doubts over the capacity of existing employee pharmacists to absorb further demands, particularly in regional and rural areas.
‘This shortage, coupled with an increasing demand on pharmacists’ time is resulting in high levels of work stress and burnout,’ Mr Inglis said.

‘Any additional work demands on pharmacists will increase their already high workloads, further adding to work-related stress and risks to workplace health and safety in community pharmacy settings.’

The submission goes further, raising the oversight of separate prescribing and dispensing roles.
‘We are concerned about how the potential conflict of interest between prescribing and dispensing medications will be managed,’ it reads.
‘We are also concerned that employee pharmacists could face pressure from their employer to prescribe, adding to the risk of accelerating antibiotic resistance in the community and propagating unethical practices.’
It also raises fears about increases to professional indemnity insurance premiums for pharmacists if their expanded scope goes ahead.

‘Any increased insurance costs will unfairly fall on working pharmacists,’ Mr Inglis said.

RACGP President Dr Nicole Higgins, who has long voiced concerns about pharmacy prescribing in her home state, Queensland, said pharmacists have previously raised workforce issues directly to her.
‘They’re rightly concerned that they don’t have the capacity to do this,’ Dr Higgins told newsGP.
‘Community retail pharmacy, like all other healthcare professions, is having a workforce crisis, and there’s a significant shortage.
‘My local pharmacist, who I work with closely, has been trying to recruit a pharmacist since before COVID.
‘This will be an increased burden on those pharmacies, and on those pharmacists.’
The RACGP President also recognises the indemnity issues raised.
‘Many of the pharmacists that that I speak to, both locally and further afield, are very concerned about diagnosis and prescribing for the UTI trials,’ Dr Higgins said.
‘They’re concerned that they’ll be put at risk. They are doing new tasks that we know carry significant risks.
‘The skill of general practice is knowing when not to prescribe, having the ability to examine the patient, and be able to investigate for other causes.’
According to Dr Higgins, the push for changes to UTI treatment access is being driven by the Pharmacy Guild and not by the interests of either pharmacist employees or patients.
‘The Pharmacy Guild are the pharmacy owners, not the workers,’ she said.
‘Employee pharmacists are among the lowest paid health professionals in Australia and are often under immense pressure.
‘GPs have a very good relationship with our local pharmacists, and we don’t want to see them put at risk because of commercial imperatives.’
South Australia is among a number of jurisdictions actively looking into expanding the scope of practice for pharmacists, including adding prescribing responsibilities, following the controversial Queensland trial UTI pilot, which is now permanently in place.
As well as looking at access to UTI treatment, the South Australia Parliamentary committee is considering the applicability of the Queensland trial to the state.
The PPA raised some pointed criticisms of that process, saying there had been ‘inadequate consultation’ with employee pharmacists in its design and implementation.
It also raised the cost of additional training to diagnose and treat UTIs for individual employee pharmacists, and raised concerns around ‘the adequacy of the training, and the need for refresher training for those pharmacists who have not treated UTIs for some time’.
Such concerns are shared by Queensland GP Dr Mark Raines, who works with Dr Higgins in Mackay, and has also previously worked as a hospital pharmacist.
‘The easiest way to overcome this dilemma presented …. to employee pharmacists is to either put trimethoprim on the supermarket shelf or maintain the status quo: that is, restrict prescription of antibiotics to health practitioners who are already trained in diagnostics, able to consider a wide differential, order the appropriate test and are indemnified,’ he told newsGP.
He also highlighted the definition of the term ‘full scope of practice’, a phrase that has often been heard in connection to reforms put forward by the Strengthening Medicare Taskforce.
‘No one knows what “full scope” is,’ Dr Raines said.
‘It is just an ever-expanding beast. It’s almost like a toddler pushing parental boundaries.’
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Dr Drake   18/03/2023 10:13:18 AM

All it takes is one event. A patient takes some antibiotics, goes home and something related or unrelated happens. Then you hear from AHPRA. Not saying but just saying they need to understand the concerns GPs have is not even regarding money. Or are they going to start keeping medical records, take a history etc etc? And if that UTI turns out to be mycoplasma or cancer what then happens? Who takes the blame? Shared blame?

Dr Afsaneh Moradi Latreiee   18/03/2023 10:48:13 AM

Hi as I’m mainly focusing on womens health now, working in the rural area, a lot of times UTIs are not just a simple UTI, but has had a link to something else…( I.e lack of estrogen, excessive washing and wrong toiletaey habits, anxiety …high BP even etc etc) ABSOLUTELY wrong to give AB just OTC since we miss future prevention and also proper counseling around it which is very important. UTI shouldn’t be taken lightly!

Dr William James Hare   18/03/2023 4:30:32 PM

Yes, I have always been worried about the conflict of interest if the prescriber is the dispenser. It's in the pharmacist's interest to always prescribe an antibiotic for urine frequency. Has a a chiropractor ever said "you've got nothing out" or a health food shop (or pharmacist) "you don't need anything"

Dr Peter James Strickland   22/03/2023 1:46:26 PM

UTI diagnosis is NOT in the realm of the pharmacist, and if it becomes so then they will have to increase their indemnity insurance. Over 50 years of practice it often needs actual examination of the genital area, as local irritation in the vaginal area can frequently give burning and frequency, and thus irritate the urethra. Many times I have investigated especially young fit female patients with recurrent mild urinary frequency and found that they have ureteric reflux, and sometimes congenital abnormalities like double ureters that require further investigation and surgery etc. All this is serious stuff, and totally out of the realm of the pharmacist, isn't it? I would recommend legal action against any pharmacist who mis-managed cases like this - they have not got the training or experience.