Facing the consequences

Pharmacists are much more likely than doctors to receive a regulatory penalty if they are subject to a notification for unsafe practice, new study reveals

An analysis of all notifications lodged with the Australian Health Practitioner Regulation Agency over a 24-month period has revealed a range of differences in resultant restrictive action depending on the source of the notification, the type of issue involved, and the profession of the practitioner.

In particular, it found that pharmacists had odds of regulatory action that were nearly three times that of doctors suggesting that, compared with doctors, pharmacists who were the subject of a notification were more likely to receive cautions, reprimands, or fines.

The study, conducted by researchers from the University of Melbourne, examined 8307 notifications.

The notification rate was highest among doctors (a notification rate of 14.5 per 1000 practitioners per year) and dentists (20.7 per 1000) and lowest among nurses and midwives (2.0 per 1000).

There were 409 notifications involving pharmacists, a rate of 6.8 per 1000 practitioners per year.

Across all the professions fewer than one in 300 notifications resulted in suspension or cancellation of registration.

Pharmacists faced a lower risk of restrictive action than the other professions studied, but had a 3.1 times greater risk of regulatory action than GPs, the highest of all the professions.

“The variation we observed between professions, both in the rate at which notifications were made, and the rate at which notifications ended in restrictive actions, is striking,” the authors said.

“Doctors, for example, had one of the highest rates of notifications, but those notifications were less likely to result in restrictive actions than in other professions”.

They suggested several possible explanations for such variation – they may be due to inter-professional differences, such as whether substandard care may directly cause harm (including pain), in the underlying rate of unprofessional behaviors, in the likelihood that any given episode of unprofessional behavior will be notified, in “case mix” (i.e., the nature and legitimacy of notifications), and in how strictly boards respond.

“We cannot disentangle these competing explanations because we did not observe unprofessional behaviour directly, other than through the decisions of boards in cases that reach them”.

In total 38% of notifications involved concerns about performance, 31.5% involved concerns about conduct, and 5.6% involved concerns about the health of practitioners.

Among notifications about performance, the most common issues arising were concerns about the quality of clinical care (30.7%) and communication (4.4%).

Among notifications about conduct, allegations of disruptive behaviour were the most common (8.1%), followed by concerns about improper use or management of health information (7.6%) and non-compliance with regulatory or administrative requirements (4.6%).

Alleged breaches of sexual boundaries accounted for 2.7% of notifications.

The study was published in the journal BMC Medicine

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  1. Jarrod McMaugh

    I could do with a little bit more investigation of ” non-compliance with regulatory or administrative requirements”

    For instance, in Victoria it is not legal to supply multiple repeats of an item just because a patient doesn’t want to come back next month (this is poor QUM anyway). So many patients say “other pharmacies do it for me” that this saying has become a cliche.

    Others include non-recording of S3R and similar requirements that aren’t policed adequately…

    • Dr Phil 42

      In most countries, most medications are dispensed as three month quantities (statins, PPIs, antihypertensives etc)

      • Jarrod McMaugh

        and yet it is illegal to supply more than the prescribed quantity in Victoria.

        Doesn’t mean a doctor can’t prescribe it thusly…. but a pharmacist in Victoria cannot provide more than the individual script quantity (ie not multiple repeats) just because a patients asks.

        • Dr Phil 42

          Maybe Victoria is different – but – as long as it is not PBS – the legislation is grey at best…. Have a read – the legislation is at best vague, at worst uninterpretable

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