Shingles management added to pharmacy prescribing pilot

More than 700 pharmacists across Victoria will be allowed to treat shingles and mild psoriasis from early March, as the state’s pilot program continues to expand.
 
Victorian Premier Jacinta Allan announced the next phase of the state’s Community Pharmacy Pilot on Tuesday, with pharmacies now undertaking additional training to treat the two conditions.
 
Two new management protocols have also been published ahead of the change, both of which make it clear that GPs should not be excluded from a patient’s care.
 
They say in the treatment of shingles, a pharmacist must immediately refer a patient to a GP in a range of circumstances, including when a diagnosis is unclear, if they have a rash in certain areas of the body, or have a more serious infection.
 
When treating psoriasis, a GP must be contacted if the condition covers a significant body surface area, if the patient is immunocompromised, or has other medical conditions such as diabetes.
 
RACGP Victoria Chair Dr Anita Muñoz told newsGP the pilot’s expansion does not allow for pharmacists to make new diagnoses of the conditions.
 
‘Success in a situation like this is about walking a very fine line and making sure the protocols are safe, that they can have some utility in the community, but they need to be really appropriately evaluated to check they’re doing what is intended,’ she said.
 
‘You still need a GP for more complex cases and for more complex patients, so I don’t think it would be right to say it replaces the role of the GP, but I think it is more about access in low-risk situations.
 
‘We need to be walking the middle ground and not closed off to opportunities for improvement, but also not be renegade about the things that we undertake.’
 
According to the State Government, pharmacists must successfully complete the specific training course related to the services they have chosen to provide – the ‘skin clinical stream’ in the case of shingles and psoriasis.
 
The patient’s usual GP is also expected to be provided with information on the patient’s condition and treatment, and pharmacists may provide each person with a printed consultation record to share with their usual GP.
 
New data from the Victorian Government reveals more than 3700 Victorians have accessed care at a pharmacy since the start of the pilot in October last year.
 
Around 2000 women have sought care and antibiotics to treat uncomplicated urinary tract infections (UTIs), and 1300 have received a script refill for the oral contraceptive pill.
 
However, similar trials in other states have drawn the ire of GPs, who raised concerns about patient safety.
 
In Queensland, UTI hospital presentations have surged since UTI pharmacy prescribing was rolled out.
 
In that state, pharmacists can also prescribe additional medications to treat asthma, nausea and vomiting, nasal congestion, skin conditions and heart disease, as well as provide prescriptions for contraceptive pills and smoking cessation treatments.
 
In New South Wales, its pharmacy prescribing trial has now expanded to more than 1000 pharmacies, allowing patients access to treatments for uncomplicated UTIs for women aged 18–65 years.
 
Dr Muñoz said in terms of the Victorian expansion, the most important thing will be a robust evaluation process.
 
‘The health system as we know it is not meeting the needs of the community, it’s not fit for purpose, so if there are ideas that are being suggested, and they’ve had a lot of input from very senior, very experienced clinicians including GPs, the most important thing that will happen is a robust and independent, frank and fearless evaluation,’ she said.
 
‘And if something doesn’t work, move on from it, if something needs improvement, commit to those improvements, and if something is safe and it works, allow us to let innovative thinking into the medical zeitgeist.
 
‘We are in a time of change and where there is change there is opportunity, but there is also the scope for error.’
 
The Victorian Government has promised any recommendations from the trial will be listened to and inform longer-term decision making.
 
But Dr Muñoz said, ‘the devil is in the detail’.
 
‘There is a recognition that there are some particularly vulnerable people in the community who feel there is a role for this protocol because of limitations of access,’ she said.
 
‘We want to make sure the protocols protect patients, but also protect pharmacists because pharmacists don’t want to be asked to treat conditions out of their scope of practice.’
 
The year-long pilot is due to end in October this year.
 
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pharmacy prescribing shingles UTI