AMAQ survey cites ‘alarming’ complications from pharmacy pilot project


According to a new report, at least 239 patients experienced complications after seeing a pharmacist involved in the Queensland UTI Prescribing Trial.

The AMA Queensland Inquiry took place in March, with doctors expressing serious concerns about the UTI pharmacy prescription trial.

Further concerns have been raised about a UTI pharmacy pilot project, following the publication of the results of an investigation by the Australian Medical Association Queensland (AMAQ).

In the online questionnaire, which was conducted in March, state-based physicians answered a series of 11 questions about the UTI Pharmacy Pilot Project, as well as the “Full Scope of Practice Pilot” project. planned for North Queensland.

The findings, now published on the AMAQ website and reported in the Australian Journal, suggest that up to one in five GPs may be treating patients with complications following their participation in the UTI pharmacy pilot.

The AMAQ says there were “at least” 239 patients with post-trial complications seen by the physicians surveyed.

The most common issues reported were misdiagnoses, with the AMAQ investigation highlighting 73 apparent cases where conditions such as chlamydia, herpes and gonorrhea and ectopic pregnancy were mistakenly classified as urinary tract infections.

The pregnancy was misdiagnosed as a UTI on at least six occasions, AMAQ also claims, with the organization claiming patients were prescribed dangerous antibiotics during the first 12 weeks of pregnancy.

According to respondents, the inappropriate use of antibiotics was almost as common, with 67 examples of “problematic” prescribing identified as part of the analysis of the results.

Physicians have also reported concerns about patients being reluctant to disclose relevant clinical information and being “sold out” products, the AMAQ says.

“Our investigation shows that the pharmacy pilot project on urinary tract infections has failed. Women did not receive the care they needed and an alarming number became sicker as a result of their participation in the trial,’ AMAQ chairman Prof Chris Perry said in the report. summarizing the results of the survey.

The AMAQ report also describes eight cases in which patients suffering from urosepsis or pyelonephritis were admitted to hospital following an erroneous diagnosis or ineffective treatment carried out within the framework of the pilot program.

RACGP vice-chairman and Queensland chairman Dr Bruce Willett said the investigation reinforced the college’s strong opposition to the lawsuit and lack of transparent reporting mechanisms.

“There are no clinically meaningful endpoints in this trial,” he told newsGP. “There is no way to review diagnoses to see if they are accurate.

“I think that really highlights that there is a problem with the UTI trial. It’s not a real trial if he doesn’t have a real mechanism to report the results of the project.

Responses were collected from doctors in different fields, with the AMAQ saying the survey, which was distributed to medical mailing lists, received 1,307 responses from across Queensland, with 52% of respondents described as GPs .

Of the other groups, 36% claim to be specialists and 12% claim to be general practitioners in training.
Of those who participated, 15% said they had cared for patients with complications, including 148 general practitioners.

This total which would include more than 20% of general practitioners who would have participated.

A spokesperson for the AMAQ said newsGP that the results were analyzed by an independent biostatistician and academic from the University of Queensland.

A spokesperson for the Queensland branch of the Pharmacy Guild of Australia, however, said the AMAQ investigation report contained “hearsay allegations”.

They also described a reference in the investigation results, which found that three men were treated as a result of the UTI pilot, as “totally false”.

“The pharmacy pilot project for uncomplicated urinary tract infections…continues to be a success, which is why the state government has extended the trial,” the Guild spokesperson said in a statement. communicated.

“Pharmacists follow the same UTI protocol as doctors. As part of the protocol, if a person has unresolved symptoms 48 hours after starting treatment, they are referred to a GP.

The UTI pilot began in June 2020, enabling pharmacists in Queensland to provide treatment to women with suspected UTIs, including diagnosis and the option to prescribe trimethoprim, nitrofurantoin or cephalexin.

Queensland Health has since outlined plans to expand pharmacy prescribing in a proposed trial known as the North Queensland Pharmacy Full Scope Pilot.

The college withdrew from a steering committee for this pilot project in February, with Dr. Willett citing patient safety concerns as the main reason for the move.

Four other medical organizations have also disassociated themselves from the committee.

Questions have since been raised about potential conflicts of interest in the North Queensland Primary Health Network where the pilot would be based, leading to the resignation of two GPs from the board.

A Queensland Health spokesperson said newsGP As of Monday, full details of the proposed trial have yet to be confirmed, nor has the start date.

If the pilot continues, pharmacies in North Queensland are likely to be allowed to diagnose and prescribe medication autonomously for a wider variety of different conditions. The Guild said that substantial training would be given to pharmacists wishing to participate in the pilot project.

Dr. Willett, however, thinks enough questions have been raised about the UTI pharmacy pilot project to give health authorities pause.

“When we saw this trial proceed without proper clinical parameters [and] proper follow-up with enough power to show the issues, it really raises concerns about the broad and more extensive changes for the North Queensland pharmacy trial,’ he said.

He also highlighted concerns about antimicrobial resistance.

“The World Health Organization has been warning us for 10 years about two major health problems looming on the horizon,” he said.

“The first was that we risk developing a pandemic. And the other…perhaps even longer in its potential to cause significant loss of life across the world—is the issue of antimicrobial resistance.

“We’ve now seen one of them, and we’re still really faced with a very real possibility of the other coming to fruition.”

The college requested that the UTI and North Queensland Full Scope of Practice pilots be dropped.

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