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‘Tip of the iceberg’: GPs highlight pharmacy UTI prescribing incidents


Jolyon Attwooll


21/03/2022 4:53:34 PM

One instance involves a patient allegedly being incorrectly diagnosed with a UTI when she had a 15-centimetre pelvic mass.

Pharmacist picking up medication.
A number of clinical incidents have emerged from the north Queensland pharmacy prescribing trial.

GPs have raised a number of ‘concerning’ clinical incidents emerging from a pharmacy prescribing trial for urinary tract infections (UTIs), which operates without general practice input.
 
Reported incidents linked to the trial in Queensland include a patient in her 50s who was allegedly incorrectly diagnosed with a UTI when she had a 15-centimetre pelvic mass.
 
A separate story involved a patient in their 20s who was reportedly asked about their symptoms at a pharmacy counter within earshot of other customers and then prescribed antibiotics for a UTI. She was later diagnosed with chlamydia.
 
Another patient in their 60s with a recurrent UTI, which would render them ineligible for antibiotics, was reportedly prescribed trimethoprim despite having a recognised resistance to the drug. Antimicrobial stewardship is one of the key concerns GPs have expressed about the pilot program.
 
The reports have emerged from general practices where patients have gone after using the pilot.
 
Cairns-based GP Dr Aileen Traves said she has witnessed the pilot’s fallout first-hand, having seen a patient who was mistakenly diagnosed with a UTI.
 
‘A patient in their 20s with chlamydia was misdiagnosed with a UTI and prescribed the incorrect antibiotic as a result,’ Dr Traves said.
 
‘She had a history of recent unprotected sex, but the pharmacist did not consider the possibility of pregnancy or recommend a GP referral to discuss contraception or testing for STIs.’
 
According to Dr Traves, the woman had an undiagnosed pregnancy and was prescribed trimethoprim, a category B3 medication not recommended for use in the first trimester of pregnancy.
 
‘She came to see me when the symptoms did not resolve after taking the antibiotics and I had to take it from there,’ Dr Traves said. ‘I shudder to think how many others like her have been misdiagnosed.’
 
Dr Traves also says GPs are not able to report concerns adequately.
 
‘These incidents were brought to the attention of GPs; however, we are not part of the management pathway, so there is no way of feeding this information into the pilot,’ she said.
 
‘How safe and effective can the pilot really be if there is no way to notify the pilot organisers of adverse outcomes?’
 
‘Every day I think to myself – how many more cases like this are out there? These are just the patients that have come to the RACGP’s attention, but there must be so many other people whose health and safety have been compromised by this dangerous UTI pilot.’
 
A spokesperson for the Pharmacy Guild of Australia’s Queensland branch told the Sunday Courier Mail that all health professionals could report any concerns about patient care through the Health Quality and Complaints Commission.
 
In the meantime RACGP President Dr Karen Price has urged the Queensland Government to ‘change course’ on a proposed pilot that would allow pharmacists in North Queensland to diagnose and prescribe medications for 20 different common ailments. She also called for an inquiry into the ongoing UTI trial, which was recently extended.  
 
‘I suspect that the incidents uncovered so far are just the tip of the iceberg,’ Dr Price said.
 
‘If the Government is to proceed with the pilot, we should be looking at pharmacists working as part of a team in the hospital or medical practice setting, rather than in an unsupervised retail space.’
 
The RACGP President believes running the North Queensland Pharmacy Scope of Practice pilot in retail pharmacies could mean training and supervision are compromised, with the focus placed on generating profits rather than looking after patients’ needs.
 
The Pharmacy Guild of Australia meanwhile has said pharmacists involved in the trial are adequately trained. According to a recent press release, the Guild has said community pharmacists would need to undertake further post-graduate study over 12—16 months to take part in the pilot program.
 
However, RACGP Rural Chair Dr Michael Clements holds concerns that the proposed pharmacy prescribing pilot will see general practices and pharmacies working in greater isolation. 
 
‘If the pilot proceeds in its current form, continuity of care, which is particularly important for patients with complex health conditions, will be disrupted and the GP won’t be aware of what the pharmacist is doing and vice-versa,’ he said.
 
‘This is unimaginably dangerous when you consider what has happened already during the UTI pilot. There is also the conflict of interest that exists.
 
‘It’s important to keep in mind that pharmacists will not only be diagnosing conditions, but then also selling patients medications based on that very diagnosis.’
 
A Queensland Health spokesperson told the Courier Mail that more than 7000 women had accessed the UTI prescribing trial service since it began in June 2020, with no significant adverse events or safety concerns reported.
 
They also said that of the women who accessed the follow-up service, 87% reported their symptoms were resolved.
 
The RACGP, along with four other medical bodies, have resigned from the steering committee of the wider Scope of Practice pilot over serious concerns about patient safety.
 
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Dr Ian   22/03/2022 10:07:25 AM

The trial is driven by the lack of General Practitioners in the Northern Queensland Area and this has to be solved .
Lack of Doctors in areas is the cause of Governments seeking to distribute care but Demarcation Disputes develop .
A trial involving both pharmacist and doctors communicating is going to be better .
Aggravation in areas of need is disrupts good care .


Dr Christa Elisabeth Schmitt   22/03/2022 3:11:04 PM

One of my patients was diagnosed and treated as UTI on basis of dysuria
She presented 3 days later to me and had typical genital herpes on examination , confirmed on viral swab
Appropriate treatment was delayed and inappropriate antibiotics were prescribed


Dr Susan Margaret McDonald   22/03/2022 11:13:06 PM

There is such a thing as Telehealth which could be linked to the remote pharmacy sites
A questionnaire for patients to complete, drawn up by experienced GP's might sort out the simple UTI from a bigger problem. One course of triprim only would be given with strict instructions to see a doctor if symptoms persist as without a urine culture the diagnosis is presumptive only.


Dr Bruce Phillip Maybloom   23/03/2022 9:01:43 AM

It is a bit concerning when the representative of the Pharmacy Guild essentially says go complain to the Health Quality Complaints Commission, an organisation I have worked for. I am not concerned that this is a transparent stalling tactic. I am concerned that their spokesperson does not know that the HQCC is defunct and has not existed for years!!!