Review exposes ‘weak’ evidence for pharmacy prescribing

Much of Australia’s pharmacy prescribing rollout is underpinned by ‘weak’ and ‘insufficient’ evidence, according to a new RACGP-commissioned report.
 
Released on Monday, the Sax Institute report evaluates existing evidence relating to the outcomes of independent pharmacist prescribing within community pharmacy settings, both nationally and internationally.
 
It comes as governments across Australia continue to push pharmacy prescribing as a way of easing pressure on hospitals, with all Australian states and territories allowing prescribing for around 20 conditions each.
 
The RACGP says the results of the review are ‘troubling to read’, but it has drawn strong criticism from the Pharmacy Guild of Australia.
 
Eighteen studies were included in the rapid review of international research, and 122 documents were examined in the grey literature evaluation of Australian initiatives.
 
The report found ‘there is an opportunity to improve access to medications through independent pharmacist prescribing in community pharmacy settings compared with the status quo’.
 
But added ‘substantial uncertainties’ exist both in international research and Australian grey literature in terms of clinical effectiveness, safety and health service implications.
 
‘There is limited evidence to inform the development of robust policy relating to independent pharmacist prescribing in community pharmacy settings in Australia,’ it said.
 
‘Evaluation outcomes have been reported internationally but are not sufficient to cite as evidence for positive effectiveness or safety outcomes of independent pharmacist prescribing in community pharmacies in Australia.
 
‘This is because of weak study designs, limited number of conditions evaluated, limited health settings in which evaluations took place, and limited types of outcomes evaluated.’
 
The review also found both international research and Australia-based evaluations are limited.
 
‘Of the small number of studies available in the past five years, most are based on weak study designs and report no clinical, health service [including economic] or safety outcomes,’ the report found.
 
‘Furthermore, existing evaluations have targeted a limited set of conditions, the results of which may not apply more broadly to a wide range of common and minor conditions.
 
‘In Australia and internationally, there remains a need and opportunity for well-designed evaluations of quantitative outcomes for a range of conditions alongside the implementation of independent pharmacist prescribing policies.’
 
The Sax Institute concludes that transparent reporting of study findings is important to ensure safe, high-quality patient care and positive health system outcomes in the future.
 
RACGP President Dr Michael Wright described the report’s findings as ‘alarming’.
 
‘We’ve got to put patient safety first – that’s non-negotiable,’ he told newsGP.
 
‘Putting measures in place without assessing the risk to our patients is frankly dangerous.
 
‘This is unproven and with major risks. It’s not what our patients need and it’s not what our health system needs.’
 
But Pharmacy Guild National Vice President Simon Blacker said while the review has a ‘narrow scope and acknowledged limitations’, it also shows pharmacist prescribing improves access to medicines and care.
 
‘For patients, improved access means receiving treatment sooner, avoiding unnecessary delays and preventing minor conditions from becoming more serious health problems,’ he said.
 
‘What the report doesn’t fully reflect is the extensive recent evidence demonstrating pharmacist prescribing is safe, effective and highly valued by patients.
 
‘Australia now needs a nationally consistent approach to improve access, reduce delays and help more people get the care they need when they need it.’
 
Last month, the Pharmacy Guild released the Rewriting the Script report, which was not evaluated as part of the Sax Institute analysis as it was published after its cut-off date.
 
Rewriting the Script, which was prepared by HTANALYSTS, found pharmacist prescribing will create $1 billion in annual health system savings, free up more than 10 million GP appointments, and prevent 30,000 hospitalisations annually.
 
But Dr Wright said the RACGP-commissioned report draws a very different conclusion.
 
‘The college was really concerned that we don’t have the evidence to support this rapid rollout of pharmacy prescribing around the country, and when we asked the governments and the Pharmacy Guild for that information – they declined or didn’t have it,’ he said.
 
‘So, we commissioned the Sax Institute to find some researchers to run an independent report.
 
‘And it found that for the majority of conditions that have been proposed for expansion, there’s no international evidence, let alone Australian evidence, to support this.’
 
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Pharmacy Guild of Australia pharmacy prescribing