Pharmacists ‘not currently qualified’ for UTI trial


woman on toilet

A pharmacist and several doctors have again called for the Queensland UTI trial to be halted, citing concerns about antimicrobial resistance

Senior Infectious Diseases Pharmacist, Aryan Shahabi-Sirjani, Chair of the NSW Antimicrobial Stewardship Pharmacist Network (NASPN), said in a statement this week that proposals for a similar trial in the UK had been withdrawn because of concerns about increasing resistance to antibiotics.

He said that a similar trial in New Zealand led to the region having the country’s highest use of trimethoprim and a corresponding increase in rates of resistance to the drug by the common bacteria that cause UTIs.

NASPN made a submission to the TGA last year opposing what it calls the “downscheduling” of trimethoprim to enable pharmacists to prescribe it.

“Pharmacists in Australia are not currently qualified to diagnose UTIs (which requires) utilising the appropriate history, physical examination and investigations of the patient,” the group submitted to the TGA.

“There is an inherent risk of pharmacists missing a differential diagnosis or complications of a UTI. The most important complication that bears significant mortality is sepsis.”

In the submission, Mr Shahabi-Sirjani wrote patient care needed to be delivered in a holistic manner, using all available diagnostic tools and skills, rather than what he calls a “fragmented” fashion enabled by the pharmacy trial.

In the same statement, AMA Queensland President Dr Chris Perry said doctors have grave concerns about the risk of misdiagnosis of symptoms and the threat of patients’ conditions worsening.

“This is a really dangerous initiative and one that doctors have vehemently opposed,” Dr Perry said. “Unfortunately, our concerns have fallen on deaf ears.

“It takes unnecessary and unwanted risks with patients’ health,” he said.

“AMA Queensland calls on the State Government to put an end to the trial and work with doctors and pharmacists on ways to deliver collaborative, efficient and safe patient care.”

Reporting on the statement, RACGP’s newsGP spoke to RACGP Queensland chair Dr Bruce Willett, who said that antimicrobial resistance was one of two top health risks faced by international health stakeholders, the other being pandemics such as COVID-19.

“Antimicrobial resistance is in a sense very similar to this pandemic, both have the potential to kill millions,” he said.
 
“Antimicrobial resistance is the slow-motion version of COVID-19. We have seen the importance in Australia of being able to plan for the pandemic.
 
“But, unfortunately, in Queensland there is a tendency to ignore the growing tsunami of antimicrobial resistance and to go the other way, rather than to improve it.”

He said that “retail pharmacies” were not a suitable setting for patients to receive this treatment, and that the commentary by NASPN illustrates a difference between “retail pharmacies and hospital pharmacists”.

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12 Comments

  1. Anonymous
    02/08/2020

    I completely agree with doctor Berry. Retail pharmacists are not equipped to diagnose UTI. Pharmacists are qualified but not enabled or utilised. Greedy pharmacy owners do not deserve this extra quality to milk of their employee pharmacists.

    • TALL POPPY
      03/08/2020

      Agree 100%. Pharmacists are sick of having to play doctor without extra remuneration. A stronger union is needed. This is one of the main reasons pharmacists are leaving the profession. They have simply had enough of all the extra work without proper reward. Employee Pharmacists that accept this are foolish and/or blind. It’s not right.

      Look at Bunnings. They have given their staff a $2000 bonus in appreciation for being ‘essential workers’ during this critical time.
      Pharmacists appreciation is only fake lip service. Again, another reason why good pharmacists are leaving. Not good. Good luck.

  2. Hey all “UTI Pharmacist Prescribing advocates”, how about putting much needed time and effort into proposals that actually unite the health professions rather than those that create a greater divide?

    • Jarrod McMaugh
      03/08/2020

      you make it sound like no one’s putting in a lot of hard work and effort to do just that Alexander.

      Do you have any suggestions for new initiatives for which no stakeholder will have an objection? I’d be very happy to look at implementing anything you come up with that meets that criteria

      • Sure there are – I’ve mentioned it multiple times in the past. Definitely more moderate and tolerable.

        • Jarrod McMaugh
          03/08/2020

          I don’t recall any suggestions you have made that all stakeholders would support.

          Perhaps you can refresh my memory

          • United we stand
            03/08/2020

            Here’s what we should be fighting for:

            1. Medicare subsidised Consultation fee for checking Drug-Drug and Drug-herb interactions

            2. Medicare subsidised consultation fee for diagnosing minor ailments

            3. Expanding Drug Tariff list of extemporaneous preparations to make compounded medications more affordable for Australian population

            4. Allowing compounded medicines substituting medicines listed on TGA Drug Shortage list to be subsidised under PBS.

            5. Medicare subsidy for administration of vaccine by a trained pharmacist

            6. Medicare subsidy for phone consultations that can go for half an hour to ensure medications are used correctly.

            7. Medicare subsidy for ensuring antimicrobial stewardship protocols are upheld.

            Instead we want to play doctor just to put more dollars in our rich daddy’s pockets (aka shop owners)

          • Jarrod McMaugh
            09/08/2020

            Good list

            Although I was asking Alexander for initiatives he’s raised in the past where all stakeholders will be on board…..

        • actnowpharmacists
          14/08/2020

          I like to chip in a few more to the good list given by United we stand

          Put a stop to how “SCAM” like NDSS is being run by the Govt. You can subsidize Diabetes products by hundreds of dollars for each registrant but you can’t adequately fund the pharmacist who provide the service and education. You give him 1 dollars, yes 1 dollar for each unit distributed. I guess we pharmacists should all be grateful that we are not getting paid in food stamps. It makes absolutely Zero economic sense but that’s how it is.

          Remove the cap on how many Medscheck can be claimed by a pharmacy. You can have a limit of Once a year per customer but you must pay for the Medscheck done by a pharmacist if warranted by the circumstances. Pulling out a number from the hat i.e 20 and saying yep that’s how many people we are going to pay for and you worry about the rest is not a good egalitarian health policy. What crime the 21st person has committed to not have a Medscheck done if there is a clear need for it.

          Cognitive pharmacist services i.e medscheck, clinical interventions, vaccinations done by the employed pharmacists be remunerated directly to that pharmacist or at least a portion of it.

          Put some guidelines in place as to how many scripts/activities a pharmacist can be expected to do.

          • Paul Sapardanis
            15/08/2020

            Don’t blame Diabetes Australia for pharmacy owners being so stupid in offering this service for$1. I wonder if pharmacy was run by corporates would this continue?

          • actnowpharmacists
            16/08/2020

            100%. It’s not Diabetes Australia’s fault for they are a consumer advocate group and to their credits, They have got an excellent deal for people living with Diabetes. It is the Govt,Guild, PSA, and Pharmacy Owners who thinks its perfectly fair to get just 1 dollar for unit distributed and not care about the time spent on care, education and advice. A better or fairer model in my opinion would be if NDSS stations a diabetes educator at every NDSS access point. Its an area of the pharmacy which consistently loses money and Pharmacy owners just have to put up with it.

          • Paul Sapardanis
            16/08/2020

            They don’t have to put up with it. I do not have NDSS in my store and when I hear my employed colleagues bemoan the pay within our profession i ask how can they pay you more when you spend your time on NDSS earning $1 per transaction?

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