The Royal Australian College of General Practitioners (RACGP) has called on Queensland's new Health Minister Shannon Fentiman to immediately halt unsupervised pharmacy prescribing.
It comes following a recently published updated evaluation of Queensland's Urinary Tract Infection Pharmacy Pilot, which found 192 patients were treated by pharmacists despite being ineligible due to having recurrent or relapsing infections. The controversial pilot, which ran from June to September 2020, was made a permanent fixture of the state's health system against the advice of medical groups including the RACGP, after the release of an interim evaluation report last year.
RACGP President Dr Nicole Higgins said that final report reveals alarming new details about the troubled pilot.
"We have a brand-new Health Minister in Queensland in Shannon Fentiman and a fresh opportunity to put patient safety first," she said.
"The more we learn about this pilot the clearer it becomes that the Queensland Government should terminate unsupervised pharmacy prescribing of UTIs. At the end of the day, employee pharmacists are under the pump and under pressure from pharmacy owners, who are represented by the Pharmacy Guild, to undertake this work. These pharmacists are working in stressful conditions with minimal training and support.
"The final report found 'some evidence of protocol deviation' and it's only when you dive into the finer details you realise many patients were put at risk. Under this pilot, patients paid $20 per consultation with a pharmacist for diagnosis and treatment of 'uncomplicated' UTIs; however, they were strictly ineligible if they had certain risk factors or a self-reported history of recurrent UTIs.
"Now we find out that 192 patients were treated by a pharmacist despite being ineligible under the pilot's protocol because of recurrent or relapsing UTIs. 156 women consulted pharmacists for UTI treatment twice within six months, while another 30 patients received three services within one year. In an even more stunning revelation, a further six consulted a pharmacist twice in two weeks. Not two months, two weeks. Not one of these patients were flagged as having a recurrent UTI."
RACGP Queensland Chair Dr Bruce Willett said that enough was enough.
"The Queensland Government should not need any further proof that this pilot was fundamentally flawed," he said.
"Unsupervised pharmacy prescribing for UTIs should never have been made a permanent fixture of the state's health system. These figures show that pharmacists are being over-worked and asked to provide services in an inappropriate setting under pressure for the pharmacy owner's lobby group the Pharmacy Guild.
"One of the co-authors, Professor Lisa Nissen, has since publicly stated that the treatment of recurrent UTIs only became evident as they compiled the final report, which involved analysing 29 months of data. This is very troubling as the decision to make the pilot permanent was made after the interim report was released following researchers crunching just 19 months of data. So, clearly the Government jumped the gun and made this decision without having all the information they needed.
"The researchers also noted something that has concerned the RACGP and other medical groups from the outset – the pilot relied on patients disclosing their treatment history including self-reporting of recurrent UTIs and the researchers didn't have access to dispensing records from the pharmacies. So, the researchers were, to a significant extent, flying blind. This is why we can't be certain why the 'deviation' occurred. It could be that patients didn't fully disclose previous treatments, pharmacists didn't accurately record previous treatments, or a combination of the two. What we do know is that people received treatment for UTIs when they shouldn't have according to the pilot's own protocols.
"It almost seems like the Government had a self-determined outcome in mind and just wanted to make pharmacy prescribing for UTIs permanent regardless of the pilot's outcomes. My message to Minister Fentiman is simple - patient safety must come first."
The RACGP has also called on the Queensland Government to learn the lessons from the UTI pilot and abandon the North Queensland Pharmacy Scope of Practice Pilot, which allows pharmacists to prescribe for a range of conditions in a retail setting.
~
