Doctors claim Australia throws ‘caution to the wind’ in pharmacists’ prescriptions
Doctors claim Australia is throwing ‘caution to the wind’ in allowing pharmacist-prescribing trials as urologists raise misdiagnosis concerns.
Pharmacists have dismissed claims that chemists prescribing for urinary tract infection might result in the misdiagnosis of a suite of life-threatening conditions, labelling doctors’ groups’ objections an impediment to healthcare system reform.
The war between pharmacists and peak doctors’ groups has ramped up as pharmacist prescribing rolls out steadily around the country and the nation’s peak GP college pushes for an increase to medication pack sizes.
Urologists hold concerns that pharmacists are not equipped to diagnose simple UTIs because symptoms of the condition such as stinging upon urination may be indicative of other serious health conditions.
South Australian urologist Ashani Couchman, a surgeon on the board of directors of the Urological Society of Australia and New Zealand, said she was concerned patients might not divulge to a pharmacist the full extent of their symptoms and circumstances.
“UTI is perceived as a really simple thing, particularly in women; if there’s burning or stinging, it’s easy to say ‘Oh, look, you must have a UTI’. That is a knee-jerk response to a group of symptoms which can present in ectopic pregnancy, they can present in cancers, they can present in inflammation, and in other organs of the pelvis it can be an STD.
“So there is a range of things it can be, and the problem is in discerning that. Our concern is if you believe you’re treating a UTI, then the response is an antibiotic, and there may be an error in diagnosis and certainly treatment.”
Pharmacist-prescribing for UTIs is in place in Queensland, where a wider north Queensland trial in which pharmacists would be authorised to diagnose and treat 23 conditions is under way.
NSW and Victoria plan to follow Queensland.
Hundreds of pharmacists are already in training in Queensland and NSW in the lead-up to the health system reform, which has also been championed by federal Health Minister Mark Butler.
The Australian Medical Association is lobbying hard against the expansion of pharmacist-prescribing trials, which it says “threaten safety, fragment care, and undermine Australia’s world-class health system”.
“What we’re particularly concerned about is that various state and territory governments are … bypassing other regulatory systems in place, like the TGA, scheduling of medicines, and going rogue on the ability for non-medical prescribing, without any medical oversight, without clinical governance and safety frameworks,” AMA vice-president Danielle McMullen said.
“We’ve looked around the world and there aren’t other examples of this autonomous prescribing. Yes, there are some places around the world where non-medical people do some prescribing but that is by and large in structures where there is medical oversight, it’s very limited, and it’s very structured.”
Pharmacy Guild of Australia president Trent Twomey said the comments were untrue and there were only three conditions included in the trials for which pharmacists could prescribe autonomously.
“This trial has 23 specific conditions that pharmacists are limited to providing services in. There is no limitation in the UK, in Canada. This doesn’t go anywhere near as far as system reform in other highly developed countries. This has appropriate safety mechanisms, appropriate training, it is patient-centred,’’ he said.
“This Chicken Little approach by these lobby groups just deals them out of the conversation on healthcare system reform,” Mr Twomey said.
The debate comes as the Royal Australian College of GPs lobbies for a doubling in prescription lengths to 60 days, as the Pharmacy Guild pushes for further reductions on the cap on medicine payments from $30 to $19.
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