RACGP: Urgent Course Change Required for Pharmacy Scope of Practice Pilot and Launch of UTI Pilot Survey
The Royal Australian College of General Practitioners (RACGP) has urgently warned the Queensland Government to abandon the North Queensland Pharmacy Scope Pilot in a retail setting over concerns that it does not fragment care and lead to poorer health outcomes for patients.
This follows heartbreaking details about Urinary Tract Infection Pharmacy Pilot – Queensland, which saw pharmacists allowed to prescribe antibiotics for UTIs. GPs reported many concerning incidents, including:
· A patient in his twenties being questioned about his symptoms at the counter within earshot of several customers. It turned out that the patient had chlamydia (i.e. later diagnosed by a GP) but had been prescribed antibiotics for a urinary tract infection and the pharmacist had sold products, including cranberry tablets.
a patient in his 50s was prescribed antibiotics for a suspected UTI which turned out to have a 15 centimeter pelvic mass causing severe urinary symptoms
· a patient in his 60s with a recurrent urinary tract infection, who therefore should not even have had access to antibiotics, being prescribed the antibiotic trimethoprim despite known resistance to the drug.
The RACGP and other medical bodies have resigned from the pilot scope of practice steering committee to the middle serious concerns regarding patient safety. the controversial pilot will allow pharmacists to diagnose 23 conditions, including asthma and type 2 diabetes, without any consultation with a GP.
RACGP President Dr Karen Price said the government needed to change course on the pilot and launch an independent investigation into the UTI pilot.
“I urge the Queensland Government in the strongest possible terms to immediately change course on the North Queensland Pharmacy Scope of Practice Pilot,” she said.
“If the government wants to start the pilot, we should consider pharmacists working as a team in a hospital or doctor’s office, rather than in an unsupervised retail space. The Royal Australian College of GPs has pushed before to team models of care, including general practice pharmacists.
“Conducting the pilot in retail spaces means there will be insufficient training and supervision for pharmacists. The pilot project must focus on community needs, rather than generating profits for pharmacy owners at the expense of their customers and pharmacists.
“The health and well-being of patients must come first. Our communities deserve safe, quality health care from properly qualified health care professionals. The incidents resulting from the UTI pilot highlight how dangerous it is to allow non-medical healthcare professionals to provide services for which they are simply not trained in an unsupervised retail environment.
“Furthermore, the government should arrest the UTI pilot and launch an independent investigation as I suspect the incidents uncovered so far are just the tip of the iceberg.
“We just don’t know how many patients have suffered health issues as a result of this pilot project, as the details are not made public and we need to get to the bottom of it right away. The fact that this pilot project has been extended without any evidence being published regarding patient health outcomes is deeply concerning. »
RACGP Queensland chairman Dr Bruce Willett said the pharmacy scope of practice pilot is riddled with risks.
“As for this driver, one of the main concerns we have with the way he is currently set up is training,” he said.
“Ultimately we want pharmacists to work within our practice and there may be times when they can prescribe under the supervision of the GP. However, under this pilot, pharmacists will operate unsupervised in a separate retail space from other healthcare professions, including general practitioners.
“Pharmacists simply don’t have the proper training to diagnose or manage complex health conditions, including asthma and type 2 diabetes, on their own in a retail setting. All GPs are trained for at least 10 years to diagnose and treat patients without any supervision.
“Pharmacists will diagnose, treat and prescribe serious conditions, without any control, after only the equivalent of three weeks of training. Patients will provide pharmacists with their personal medical information at the pharmacy counter with other customers a few feet away.
RACGP Rural President and Townsville GP Dr Michael Clements warned the pilot could fragment care.
“If the pilot project continues in its current form, the continuity of care, which is particularly important for patients with complex health conditions, will be disrupted and the general practitioner will not be aware of what the pharmacist and vice versa are doing. versa,” he said.
“It is incredibly dangerous when you consider what has already happened during the UTI pilot.
“There is also the conflict of interest that exists. It is important to keep in mind that pharmacists will not only diagnose conditions, but will also sell medications to patients based on that diagnosis. If pharmacists operate independently in a retail space, this can lead to prescribing choices influenced by profit margins and we may see an increase in prescriptions as there is evidence that this is happening overseas. In Britain, for example, when pharmacists were allowed to prescribe antibiotic eye drops, the number of prescriptions increased dramatically.
“So, the RACGP urges the Queensland Government to put patient safety first and change course on this pilot project, as the long-term health outcomes for many patients are at stake.
“Some communities in North Queensland lack GPs and this is a problem in many parts of Australia, particularly in rural and remote areas. This is something the Royal Australian College of GPs n “is all too aware, and we are working with national, state and territorial governments to ensure a better distribution of specialist GPs across the country. However, this pilot project is not a solution to workforce challenges. work of GPs; we need more than bandage solutions for rural and remote healthcare.
Cairns-based GP Dr Aileen Traves said she had spoken to many patients whose health and wellbeing had been put at risk during the UTI pilot.
“The incidents that came to my attention during the UTI pilot project will send shivers down the spine of all medical professionals, including GPs,” she said.
“A patient in his twenties with chlamydia was misdiagnosed with a urinary tract infection and was therefore prescribed the wrong antibiotic. She had a history of recent unprotected sex, but the pharmacist did not consider the possibility of pregnancy or recommend a referral to a GP to discuss contraception or STI testing.”
“It turns out that the woman had an undiagnosed pregnancy and yet she received trimethoprim, a category B3 drug that is not recommended for use in the first trimester of pregnancy. She came Seeing me when the symptoms didn’t go away after taking the antibiotics and I had to take it again from there.I shudder to think of how many more people like her have been misdiagnosed.
“A patient in her 50s was misdiagnosed with a urinary tract infection, when she actually had a pelvic mass of 15 centimeters. This is of particular concern as it would have been discovered if a physical examination had been carried out by a GP in the first instance. This is why patients should consult a GP rather than a pharmacist, as the symptoms of a UTI are similar to many other serious conditions and can easily be misdiagnosed.
“The case of a woman in her sixties is also incredibly disturbing. She had a recurring urinary tract infection, which GPs know is a risk sign that the patient could have an antibiotic-resistant infection. This patient should never have been prescribed the antibiotic trimethoprim. GPs perform urine tests to determine antibiotic resistance and this patient was shown to have resistance to trimethoprim antibiotics on several previous urine samples. Her condition deteriorated so badly that she ended up in the emergency room of a hospital with urosepsis, which is severe sepsis caused by a urinary tract infection.
“These incidents have been brought to the attention of GPs; however, we are not part of the management pathway, so there is no way to feed this information into the pilot. How safe and effective can the pilot be if there is no way to inform pilot organizers of undesirable results?
“Every day I think to myself – how many cases like this are out there? These are just the patients who have come to the attention of the RACGP, but there must be so many other people whose health and safety have been compromised by this dangerous UTI driver.
/Public release. This material from the original organization/authors may be ad hoc in nature, edited for clarity, style and length. The views and opinions expressed are those of the authors.