Hazzard rejects UTI pharmacist prescribing proposal

pharmacist doctor medicines pills cartoon vector illustration

The NSW Opposition and PSA have called on the recently re-elected Berejiklian Government to trial limited pharmacist prescribing in the state… but the Health Minister has rejected the proposal

Earlier this month, NSW Shadow Health Minister Walt Secord and Shadow Minister for Women Sophie Cotsis wrote a joint letter to Health Minister Brad Hazzard urging him to implement a PSA plan which would see the state’s pharmacists able to provide short-term treatment with trimethoprim for acute uncomplicated urinary tract infections.

Any such plan would see pharmacists offer access to trimethoprim only under an agreed protocol.

Eventually, the same process could be applied to the oral contraceptive pill under some circumstances.

In mid-April, the Queensland Government responded to last year’s inquiry into community pharmacy, accepting the recommendation that it establish a state-wide trial whereby pharmacists would provide low-risk emergency and repeat scripts for the Pill and antibiotics for UTIs.

Such a trial in NSW is a “common sense plan” and “not new,” Mr Secord said.

“It has been put forward by pharmacists. It already occurs in New Zealand, the United Kingdom and in some Canadian provinces.” Mr Secord said.

“It would be an interim measure and could also reduce the number of young women presenting at emergency departments as they cannot get access to a GP outside normal business hours.”

The two Shadow Ministers noted that if such a plan were to be trialled in NSW, it would involve a change to State regulation to allow pharmacists to initiate treatment – a three-day course of trimethoprim (300mg daily) – for eligible patients aged 16 to 65 years.

They pointed out that this access may be particularly important for those living in rural and regional areas, as well as within culturally and linguistically diverse communities and Indigenous communities; they also highlighted the success of pharmacist vaccination in NSW.

“There is an opportunity to follow a similar model based on a treatment protocol to supply specific prescription medicines for acute conditions,” the statement says.

However, on Tuesday Health Minister Brad Hazzard told the Sydney Morning Herald’s Lisa Visentin that he would not act on the proposal.

“I can see the benefit in some regional areas where patients may not be able to get to a GP,” Mr Hazzard said.

“But I’m also being strongly warned by the Ministry of Health [that] there needs to be appropriate protocols in place such that patients are getting the full checks and balances around risks and benefits that exist when they see a GP.

“There are some quite difficult and challenging clinical issues that need to be considered. My view is it would be preferable to make these decision on an Australia-wide basis, not an individual state basis.”

The RACGP’s national president Dr Harry Nespolon again rejected the concept of pharmacist access to treatment for UTIs, again saying it could lead to over-prescription of the drugs.

Professor Peter Carroll, president of the PSA’s NSW Branch, told the AJP that the PSA would continue to raise the suggestion.

“We will continue to try and talk to people with a view to hopefully still get this introduced,” he said. “We would like to continue discussions with the NSW Department of Health and Mr Hazzard regarding this, to understand why they have chosen not to support it, and we’d like to have ongoing discussions with them, as we can see great benefits from this proposal.

“Acute urinary tract infections are very, very much more prevalent in females, so it’s a women’s health issue.

“When an acute UTI comes on, it comes on suddenly, with burning, frequency of urination and painful urination, and it’s can be quite distressing.

“The lady might not be able to get an appointment with the GP that day or even the next day, particularly in rural areas where it’s difficult to get in and see the GP – or on weekends, when the pharmacy is open but the GP perhaps is not.”

Professor Carroll highlighted that UTIs are in the top three preventable presentations in hospital emergency departments, so the PSA’s plan could help alleviate congestion at these services.

He stressed that pharmacists would be held to agreed professional protocols when offering such access to trimethoprim for acute UTIs.

He also said that the proposed model was a patient-centric public health issue.

“It’s not a contest between the GP and the pharmacist,” he told the AJP. “It’s both, working collaboratively for the health of the community.

“It’s about the appropriate short-term use of trimethoprim, a drug specifically recommended for the treatment of acute UTIs, and allowing the lady to have relief from her symptoms. It doesn’t stop her going to the GP the next day or in two days’ time.

“It’s just a logical step.”

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