News

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Pharmacy pilot evaluation revealed

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As pharmacy prescribing becomes increasingly common practice across Australia, an evaluation of the controversial program has been released, offering a glimpse into just how it is working.
 
Last week, the Victorian Government announced greater prescribing powers for the state’s pharmacists as a pilot was given the greenlight to be made permanent. Expanded prescribing powers cover 22 conditions during free consultations, without the need for a GP prescription.
 
Commencing in October 2023, Victoria’s Community Pharmacist Statewide Pilot had an independent evaluation conducted in late 2024.
 
Now, a summary report on key findings from the evaluation is available – released three days after the State Budget funded the expansion and permanency of pharmacy prescribing.
 
The Victoria Government report offers one of Australia’s few insights into pharmacy prescribing pilots, following a review of Queensland UTI prescribing released in 2022.
 
The report details that 800 Victorian pharmacists provided more than 23,000 services in the first 12 months of the pilot, with ‘no serious safety concerns’ and ‘consistently high’ levels of patient satisfaction reported during that period.
 
Patients from all 80 Victorian Local Government Areas accessed the services, with 93% of those surveyed reporting they were able to access care within 24 hours, and 97% reporting satisfaction with the services provided.
 
Around 41% identified a shorter waiting time for an appointment as a key reason for choosing services at a pharmacy. Of the patients who responded to a survey, 87% said they would have used a GP service if the pilot was not available.
 
But RACGP Victoria Chair Dr Anita Muñoz said it is ‘disappointing’ that the evaluation of the pharmacy trial has been known for some months but was only publicly released three days after the State Government announced the pilot’s services were here to stay.
 
‘It’s not given us as healthcare stakeholders much time to digest the information,’ she told newsGP.
 
‘While the report suggests no serious safety concerns, it’s still a worry that this is based on a rather high threshold of levels of harm, such as life-saving medical intervention, permanent physical harm, or permanent loss of function.
 
‘The kinds of harms we need to know about are missed diagnoses, the need for care from a GP due to missed diagnoses, medication contraindication errors, rates of antibiotic prescriptions per presentation, and the maintenance of patient privacy within the pharmacy environment.’
 
Dr Muñoz labelled the pilot’s new permanency as ‘deeply disappointing and a step backwards’ and reiterated the college’s longstanding concerns of fragmented care and patient safety.
 
Safety and quality were the highest priorities in the pilot’s design, the report states, with participating pharmacists using evidence-based clinical guidelines and completing specified training to deliver certain Schedule 4 medicines and vaccines:

• Resupply of select oral contraceptive pills without a prescription
• Treatment for uncomplicated urinary tract infections (UTIs)
• Treatment for shingles and flare-up of mild plaque psoriasis
• Vaccinations for travel, hepatitis A, hepatitis B, poliomyelitis and typhoid

With the majority of services provided for UTIs (46%) and resupply of the pill (27%), the Victorian pilot delivered 84% of services to women. Twenty-six per cent of services were for travel health and other vaccination services, and 1% for treatment of mild skin conditions.
 
Of the issues that were raised during the pilot via complaints or audit checks, reviewed by Safer Care Victoria and the State Government’s Health Department Regulator, none were identified as posing ‘serious harm to the public directly caused by the delivery of pilot services’.
 
Out of the more than 23,000 services delivered during the 12-month pilot period, 49 ‘complaints and feedback’ were received. There were no reported adverse patient safety events that resulted in serious harm or death, and issues of non-compliance were minor.
 
The report also cites ‘improved information sharing’ with GPs. The pilot did not mandate that pharmacists share details of patient visits with the patient’s usual GP, with privacy laws preventing this without patient consent, and there was no automated system in place to securely share patient data.
 
The pilot instead allowed pharmacists to generate a summary letter for patients to give to their GP, with 68% of pharmacists surveyed saying they generated this letter for patients. In some instances, pharmacists could upload details from the patient consultation to My Health Record.
 
But Dr Muñoz has some concerns with this design.
 
‘A reliance on patients to share details with their GPs can potentially have a huge impact on continuity of care – we can’t put that onus on patients to hand over a letter from a pharmacist to their GP,’ she said.
 
‘We need optimal information sharing with a patient’s usual care provider, as part of a collaborative team care arrangement.’
 
Regardless of whether more pharmacy prescribing powers are rolled out across Australia, Dr Muñoz says the RACGP will stand firm on ensuring patient safety and optimal clinical outcomes remain a priority, and that GPs’ scope is not diminished.
 
‘We can’t be putting convenience before quality care, and having patients opt for fragmented care over care from a GP who knows them and their history best,’ she said.
 
‘These services can confuse and fragment healthcare for patients, and lead to a two-tiered health system.
 
‘Coordinated and continuous holistic care improves health outcomes and keeps people out of hospital.’
 
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coordinated care evaluation report patient harm pharmacy prescribing scope of practice Victoria community pharmacy pilot

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