Queensland Health and Pharmacy Guild stonewall queries about UTI pilot evaluation

Both Queensland Health and the Pharmacy Guild of Australia have refused to answer newsGP queries about the independence of an evaluation into the state’s UTI pharmacy prescribing trial.
 
It follows the release of results from a survey carried out by the Australian Medical Association Queensland (AMAQ) this week, in which a significant number of doctors reported having to treat patients who were allegedly misdiagnosed during the trial.
 
Anecdotal reports from college members earlier this year had previously raised queries on the same theme.
 
As an assessment of the pilot, which began in June 2020 and allowed pharmacists to diagnose and provide antibiotics for uncomplicated UTI infections, neither those reports nor the AMAQ survey could be described as definitive.
 
However, in the absence of official detail, there is little else to go on to analyse the pilot beyond the number of prescriptions made and customer satisfaction ratings.
 
The AMAQ questionnaire was online for 10 days in March, with respondents able to contribute anonymously. An AMAQ spokesperson told newsGP the link was ‘only distributed to medical mailing lists’.
 
‘There was an option for doctors to leave their details if they were prepared to be contacted for more information – about 30 did and all were genuine,’ they said.
 
According to the AMAQ, of the 1307 survey answers, 52% were from GPs. They were then analysed by an independent biostatistician and academic from the University of Queensland and the results presented in a 12-page report including a foreword from AMAQ President Professor Chris Perry.
 
The Pharmacy Guild swiftly described the findings in the report as ‘hearsay allegations’, as well as rejecting one claim that three men were treated as part of the women-only pilot.
 
A spokesperson for its Queensland branch previously told newsGP that ‘in contrast with the online survey … the Queensland University of Technology [QUT] has been commissioned by the State Government to undertake an independent evaluation report of the clinical UTI pilot’.
 
‘The Guild understands the independent evaluation report has found the UTI pilot met all the safety standards required,’ the spokesperson continued.
 
When approached by newsGP to fact check the Guild’s claim about meeting all the safety standards required, the QUT did not address the query.
 
‘The evaluation study of the pilot was reviewed by the QUT Human Research Ethics Committee,’ a spokesperson said in an emailed statement provided to newsGP.
 
‘The pilot itself was not submitted as a research study for review by QUT. We are in discussion with the AMA about their concerns with the pilot study.’
 
They also said the assessment has still not yet gone to Queensland Health, despite the pilot being extended for a further six months in January.
 
‘QUT will be forwarding the evaluation report to Queensland Health shortly. Questions relating to this report should be referred to Queensland Health,’ the QUT spokesperson said.
 
This statement appears to contradict comments made in January by QUT’s Professor Lisa Nissen, who is spearheading the trial and told Australian Doctor that a full report on outcomes was being reviewed by the Queensland Government ahead of its release into the public domain.
 
Questions remain as to how the Pharmacy Guild has gained an understanding of the contents of what it describes as an ‘independent evaluation’ that has not yet been publicly released and may not have even been reviewed yet by Queensland Health.
 
That question was put to the Guild by newsGP, but it declined to provide any further comment.
 
Queensland Health was also approached with a series of questions about the independence of the report, when it was due, and if it would release the results publicly.
 
A spokesperson for the state health authority said it had already provided ‘comprehensive’ previous responses about the trial, including that ‘overall consumer satisfaction with the service was very high’.
 
‘We have nothing further to add beyond the statements we have previously provided,’ the spokesperson stated.

RACGP Queensland Chair Dr Bruce Willett says the evaluation report should be released to the public in full immediately.
 
In the absence of official details, newsGP sought analysis from academia about the trial’s evaluation.
 
Dr Mina Bakhit is a Postdoctoral Research Fellow at Bond University’s Institute for Evidence-Based Healthcare. He said he has looked for details about the pilot, but remains unclear about the evaluation process, as well as the consideration of risks and benefits and the intended outcomes.
 
Dr Bakhit referenced reports in which the statewide pilot was described as a ‘success’. Upon announcing the six-month extension of the pilot earlier this year, for example, the Pharmacy Guild said more than 1800 pharmacists had signed up to take part, and more than 6300 women had been treated as a result.
 
‘Is usage one of the evaluation criteria that is being considered in this pilot trial?’ Dr Bakhit told newsGP.
 
‘We are not sure about the harms or the adverse events that occurred as a result of that.
 
‘And it’s not clear as well, what is the primary outcome they are looking at, if the outcome is admission to hospitals [for example].
 
‘There’s no clear information available for me to decide or to assess if the trial is effective or not.’
 
While Dr Bakhit said he did not draw any definitive conclusions about the pilot, he believes there are many unaddressed concerns about misdiagnosis, as well as the use of antibiotics.
 
‘What is the actual number of those who suffered from any side effects?’ he queried.
 
‘I’m not saying that the initiative is a bad thing. I’m just saying that there is no clarity around the design protocol. What is the model of care and what is actually happening in real life?
 
‘Right now, there are lots of question marks and lots of concerns, specifically in the area of overuse of antibiotics.’
 
Dr Bakhit also said his work at the institute includes research into possible alternatives for antibiotics for those with UTI infections, but that it is not clear if those treatment options have been given to patients as part of the pharmacy pilot.
 
‘I’m waiting for the evaluation reports, to be honest,’ he said.
 
RACGP Vice President and Queensland Chair Dr Bruce Willett also said he would like to see them.
 
‘It is very much time to release the details of this report,’ Dr Willett told newsGP.  
 
‘I think there is a public safety issue at hand here. And it’s interesting that the Guild appears to have knowledge of the report that others don’t, which also calls into question [its] independence.’
 
Addressing previous references to customer satisfaction with the pilot, Dr Willett described the study as ‘really all about convenience, rather than safety or efficacy’.
 
‘If this pilot was conducted at a supermarket where people could just go in and buy [the antibiotics] then the measures would be even more strongly positive,’ he said.
 
In the meantime, the timeline of a proposed pilot to further extend pharmacy prescription capabilities in North Queensland – an area where there is a well-documented shortage of GPs – is still unclear.
 
The North Queensland Pharmacy Scope of Practice Trial, which has prompted significant upheaval within the Primary Health Network where it is slated to take place, was originally scheduled for June according to documents leaked to Australian Doctor.
 
That timeline now seems less clear, with a Queensland Health spokesperson saying earlier this week that neither the scope nor the timing of the trial have been confirmed.
 
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