Downscheduled trimethoprim and pharmacists’ practice: study

pharmacist talking with customer

New research has shown strong acceptance of the unique model used in many recent New Zealand drug reclassifications

University of Otago researchers have highlighted New Zealand pharmacists’ experiences around trimethoprim.

The drug was reclassified in the country by Green Cross Health and Dr Natalie Gauld in 2012 in a world-first move.

Only pharmacists who have completed specific training can supply the medicine to women meeting strict criteria for supply. A screening tool and written information for the patient are used to ensure appropriate supply.

In the qualitative research project, pharmacists from throughout New Zealand were interviewed to learn their opinions and experiences of the trimethoprim reclassification.

Interviews focused on training, screening tool use, supply experiences, and feedback pharmacists had had from consumers and doctors on the service.

The research found that the availability of trimethoprim had changed pharmacists’ practice, with women provided with trimethoprim where criteria were met, rather than urinary alkalinisers previously used.

The screening tool received strong support, with pharmacists reporting it to be helpful, easy to follow and an efficient way to ensure all the necessary information had been covered.

This is in contrast with some findings from the UK of pharmacist concerns regarding some protocols used for prescription only to pharmacist medicines. Pharmacists expressed high levels of satisfaction with the training provided by the Pharmaceutical Society of New Zealand and found it convenient and informative.

Associate Professor Rhiannon Braund says this research has been important to conduct, as New Zealand has developed an unusual model of supply with reclassifications in which training is mandated and screening tools provided for use.

Pharmacists have embraced this model, enabling new services.

While pharmacists reported that a small number of women were frustrated if they were not eligible for trimethoprim, expected a short consultation, or sometimes found questions too personal (for example, questions about sexually transmitted infections), most pharmacists reported that women viewed the service positively.

Dr Natalie Gauld, reclassification specialist and researcher, notes that “as health consumers start to use services like trimethoprim, sildenafil, CPAMs, and vaccinations they will increasingly appreciate the knowledge and skills of pharmacists, and expect extended consultations.”

She adds, “it is rewarding to see pharmacists taking the reclassifications so seriously, as their responsible attitude to supply has enabled widened access to trimethoprim and opened other reclassification opportunities to help their patients.”

The research also found increasing collaboration with general practice. Pharmacists reported referring many women to the doctor because they were outside of the criteria for supply, and there were reports of referrals in return from general practice or Family Planning for pharmacists to manage women with symptoms of urinary tract infections.

Two of the researchers who conducted the interviews, Emily Wallace and Erica McNab, note, “We found that most pharmacists were very pleased to use their clinical skills in such a practical service with trimethoprim.

“As practising pharmacists ourselves now, we see great value in what services, such as trimethoprim for uncomplicated UTIs, add both to our patients and our profession.”

This model of limiting supply to pharmacists who have undergone additional specified training and with a screening tool for supply provided has enabled various reclassifications in New Zealand.

These include the emergency contraceptive pill, vaccines (influenza, pertussis, meningococcal and shingles), trimethoprim and sildenafil, and possibly the oral contraceptive pill, which has recently been considered with the outcome to be release in December.

There have been calls for a similar model of supply in Australia, for example from Dr Natalie Gauld.

Fourth-year pharmacy students, Emily Henderson, Erica McNab, Rachel Sarten and Emily Wallace, conducted the research with supervision by Associate Professor Rhiannon Braund and Dr Natalie Gauld.

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  1. Debbie Rigby

    “Only pharmacists who have completed specific training can supply the medicine to women meeting strict criteria for supply. A screening tool and written information for the patient are used to ensure appropriate supply.”

    I think this is the key to widespread acceptance and positive outcomes of expanded responsibility for pharmacists. Training, assessment tools, and credentialing builds confidence and competence.

    • Jarrod McMaugh

      Agreed to a point.

      I think training should encompass accreditation as well, ie a demonstration of competence with existing knowledge and expertise (as we have with HMR) may preclude a requirement for further training….. and any training should be followed by the same process to ensure that the training has achieved the desired outcome.

      In addition, over time it would be expected that this knowledge is built in to the existing degrees (is it now?) so that graduating pharmacists would have this as part of their basic competence in the future.

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