‘Harrowing’ incidents during the Queensland pharmacy prescribing pilot prompt another call for its suspension.
Diagnostic and other errors that have occurred during Queensland’s UTI pharmacy pilot (UTIPP-Q) reflect exactly the kinds of concerns the RACGP and others predicted, prompting renewed calls for it to cease.
In response to “many concerning incidents”, reported by GPs and revealed by the college today, the RACGP has called on the Queensland government to halt the trial, establish an independent inquiry and “change course” on the proposed wider North Queensland Pharmacy Scope of Practice Pilot.
The incidents include, in the college’s words:
- a patient in their 60s with a recurrent UTI – who therefore should not have even been eligible to access antibiotics – was prescribed trimethoprim despite known resistance to the drug
- a patient in their 50s, who had been prescribed antibiotics for a presumed UTI, turned out to have a 15cm pelvic mass causing serious urinary symptoms
- a patient in their 20s was interviewed about symptoms at the counter within earshot of multiple customers; they were prescribed antibiotics for a UTI and other products including cranberry tablets, but a GP subsequently diagnosed chlamydia
“The incidents emerging from the UTI pilot highlight just how dangerous it is to authorise non-medical health professionals to provide services they simply are not trained to provide in an unsupervised retail setting,” RACGP President Dr Karen Price said in a statement.
“The government should halt the UTI pilot and launch an independent inquiry because I suspect that the incidents uncovered so far are just the tip of the iceberg.”
The guild’s Queensland branch has hit back, claiming none of the incidents has been verified.
“The doctor groups should report any alleged cases to the Health Quality and Complaints Commission (HQCC), so that the alleged case can be investigated and independently assessed against the therapeutic guidelines and pilot prescribing rules,” a spokesperson said.
“Until such time as the cases have been independently verified by the HQCC they are simply unverified claims from a doctor lobby stuck in an ancient turf war.
“Sadly, doctor groups have misled the public before, by claiming heart disease is part of the [North Queensland] pilot – their alleged cases can’t be believed and they can’t be trusted.
“The uncomplicated UTI pharmacy pilot continues to be a success, which is why the state government has extended the trial.”
The RACGP also called for the Queensland government to stop the proposed Scope of Practice trial being conducted in retail settings.
“If the government is to proceed with the pilot, we should be looking at pharmacists working as part of a team in the hospital or medical practice setting, rather than in an unsupervised retail space. The Royal Australian College of GPs has previously pushed for team-based models of care, including general practice-based pharmacists,” Dr Price said.
“Conducting the pilot in retail spaces means that there will be insufficient training and supervision for the pharmacists. The pilot needs to be focussed on the needs of the community, rather than generating profits for pharmacy owners at the expense of their customers and pharmacists.”
Opponents of the UTI pilot’s expansion to 30 June 2022 are currently petitioning the Queensland parliament, including calling for a “full and transparent evaluation”, which should then be made public. This evaluation should, among other things, include the number and percentage of GP presentations that occurred following a consultation with a pharmacist but where symptoms remained unresolved, and the number of patients provided treatment for a UTI that were subsequently discovered to have been misdiagnosed.
Queensland GP, Dr Stephanie Dawson-Smith – who has raised similar concerns in a separate petition opposing the controversial North Queensland Pharmacy Scope of Practice Trial – said the evaluation was incorrectly focused.
“Unfortunately, the success of [the UTI] pilot has been based on how much patients liked being able to access antibiotics for a possible UTI without seeing a doctor,” she wrote recently on change.org, “rather than on appropriate clinical outcome measures like assessing whether any of the treated women actually had a UTI and how many in fact had non-UTI urogenital infections (e.g. genital chlamydia), interstitial cystitis or other serious pelvic pathology.”
Queensland Health was approached for comment.