‘Very disappointing’: UTI pharmacy prescribing pilot extended indefinitely

The Queensland trial allowing pharmacies to prescribe antibiotics for uncomplicated UTIs will continue, the state’s health department has confirmed.
 
Queensland Health told newsGP on Monday that the scheme will continue while work takes place ‘determining the future of the scheme’ – a move that was described as ‘very disappointing but not unexpected’ by RACGP Vice President and Queensland Chair Dr Bruce Willett.
 
When asked by newsGP about the length of the extension and the details of work looking at the future of the pilot, the state health authority said there are no further details to share.
 
At the same time, it also pointed towards a 118-page evaluation report on the scheme, which has been made public for the first time.
 
Some of the contents of the report, which was compiled by the Queensland University of Technology, had previously been reported on after a copy was leaked to in The Australian in May.
 
The official version of the evaluation confirms previously reported details, including that there were 6751 treatments offered during the time of the evaluation report, treating a total of 6531 women aged between 18 and 65. The median age is reported as 35.
 
Just over a third of the cases treated (2409 in total or 35.7%) were able to be contacted after their consultation.
 
The evaluation indicates 87% of patients who were contacted reported their symptoms as resolved, while 13% said they were unresolved.
 
Of those patients who had not had a resolution of their symptoms 184 (7.6%) had already sought care elsewhere, with 144 saying they had attended a GP for their follow-up.
 
Another 86 patients who said their symptoms had not resolved were verbally referred to their GP by the pharmacist, while the report says four of the patients contacted made a subsequent hospital visit.
 
All had been prescribed trimethoprim, with one reporting an allergic reaction, two reporting unresolved symptoms – with one later diagnosed with a ‘superbug’ – and a fourth was admitted with appendicitis four days after starting her treatment.
 
However, Dr Willett believes the adverse outcome figures reported are likely to under-represent the issues encountered.

‘The only person that the patient could report their adverse outcome to was the pharmacist responsible and they’re reluctant to do that,’ Dr Willett told newsGP.
 
‘This is not a proper assessment and the RACGP will continue to vigorously oppose this measure that is putting patients’ wellbeing at risk.
 
‘This sham trial needs to be scrapped and a proper scientific assessment of this as a new treatment regime needs to be conducted, as would be the case of any new treatment regime.’
 
In May, Australian Medical Association Queensland (AMAQ) published the results of a doctors’ survey with 1307 responses, of whom 52% were described as GPs.
 
It suggested as many as one in five GPs could have treated patients with complications resulting from their involvement in the pharmacy pilot, with ‘at least’ 239 patients reported with post-trial complications among the doctors surveyed.
 
The most common issues raised in the survey were misdiagnosis, with reported cases of conditions such as chlamydia, herpes and gonorrhoea, as well as an ectopic pregnancy allegedly taken as a UTI.
 
Pregnancy was labelled UTI on least at six occasions, the AMAQ said.
 
The Pharmacy Guild has repeatedly rejected the AMAQ’s report. In remarks to pharmacists, the Guild called the further extension a ‘clear endorsement’ of the pilot and said there has been ‘no clinical evidence of adverse outcomes forthcoming’.
 
The evaluation report also indicates where the service was most used. It shows that more than 85% of women accessed the service in urban areas, with pharmacies classified as Modified Monash Model 1 (MMM1) making up 61.7% of the total, and those making up MMM2 accounting for 25.1%.
 
Queensland Health reported more than 9000 women in total had accessed UTI treatment through pharmacies up to 30 June 2022. It said the continuation of the scheme will allow women ‘to receive immediate advice and treatment for uncomplicated’.
 
The UTI pilot was first introduced in June 2020 and was then extended until 30 June 2022 at the end of last year.
 
The timing of a more extensive trial, the North Queensland Pharmacy Scope of Practice Pilot, has not yet been confirmed.
 
Last week Queensland Health confirmed to newsGP that the ‘scope of the pilot is not yet finalised’.
 
Recently, both Dr Willett and RACGP President Adjunct Professor Karen Price described the proposed pilot as seeking ‘to address a workforce issue that does not exist’, as well as an ‘ill-founded experiment on an unsuspecting and vulnerable population’.
 
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