Despite hostile opposition from doctor groups, Queensland is reportedly just weeks away from allowing pharmacists to prescribe antibiotics for urinary tract infections (UTIs).
This expansion of pharmacy responsibilities is initially confined to a trial that will run until the end of 2021.
The trial was announced in April last year, following a 2018 parliamentary enquiry convened to investigate the need for a pharmacy council in the state. The trial was a recommendation of that enquiry.
This week, the Queensland Health Minister Steven Miles, according to a loaded report in Australian Doctor, for the first time “attempted to justify the experiment”.
Mr Miles told the industry publication: “I have been contacted by countless women who have experienced painful UTIs outside of GP business hours and have been left with no choice but to suffer through the night or visit an emergency department.”
Responding to the trial’s announcement a year ago, the Royal Australian College of General Practitioners (RACGP) in a statement declared pharmacists “do not have the healthcare training required to safely deliver healthcare services”.
It further said: “No amount of training, other than the completion of a medical degree and specialist training, would be sufficient to support autonomous pharmacist prescribing.”
The RACGP has said it would fight any proposed model of pharmacy-provided scripts.
RACGP Queensland chair Dr Bruce Willett, who appeared before the inquiry to argue against letting pharmacists prescribe antibiotics, partly on the basis that it would further contribute to the emerging catastrophe of microbial resistance. (See our report on the issue here.)
“In a world careening towards an antibiotic crisis, where everybody is saying we need to be more careful, to free up antibiotic scripts is bordering on irresponsible,” Dr Willett reportedly said.
The pharmacy script-writer experience overseas
The UK’s National Health Service has been running a perpetual trial on pharmacy-supplied scripts since 2016 – a project known as the NHS Urgent Medicine Supply Advanced Service (NUMSAS).
According to a June 2019 report from the Royal Pharmaceutical Society, the service is catering to hundreds of thousands of referrals – with an increasing number of people asking for antibiotics. The report notes that the growing amount of antibiotics being supplied through the scheme had raised a red flag with the NHS – the most pressing concern being mircrobial resistance.
In 2008, Canada began a program where pharmacists could write scripts. A 2019 report in the Canadian Pharmacists Journal found that pharmacists were prescribing “seven times more antibiotics than physicians did for query urinary tract infection.”
The authors wrote: “Are the data suggesting pharmacists can better detect UTI than physicians do, even without physical examination and investigations? Or are the data suggesting pharmacists prescribe more due to better financial incentives?”
How will the Queensland trial work?
The AMA and RACGP have refused to take part in the design of the Queensland trial – their main reason being the risk of microbial resistance.
The advisory group responsible for writing of the rules of the trial reportedly met for the first time in December – and there have been few details .
According to the Australian Doctor report, it will be mandatory for pharmacists to conduct consultations in private rooms to protect patient privacy and only registered pharmacists who have undergone additional training will be involved.
Prescribing will be based on the therapeutic guidelines, meaning pharmacists will have the option of prescribing and dispensing a three-day course of trimethoprim or, if there are any contraindications, a five-day course of nitrofurantoin.
If neither option is appropriate, pharmacists will be free to prescribe and dispense a five-day course of cephalexin.
What education will be required before a pharmacist can participate in the trial and what tests will be used to diagnose UTIs reportedly remain unclear.
In terms of costs, patients will pay between $20 and $30, including both the consult and any subsequent script, although, again, details have not yet been finalised.
Follow-up is likely to be a phone call to the patient, one or two weeks after the pharmacy consultation.
If the patient’s condition remains unresolved, they will then be advised to see their GP for treatment.
Australian Doctor said it is not yet clear how many pharmacists will be involved in the trial or the number of patients who will access the service, but the trial is expected to start in March or April.