Pharmacy accused of ‘cookbook or recipe medicine’


A GP and pharmacist has accused pharmacy of using the Queensland UTI trial and vaccinations as “new ways to get traffic into their retail outlets”

The Australian Medical Association’s Queensland branch says that the Urinary Tract Infection Pharmacy Pilot – Queensland (UTIPP-Q) trial will cost Queenslanders more than a bulk-billed GP consultation.

Wide Bay GP Dr Nick Yim, who worked as a pharmacist for four years before practising medicine, has said in a statement for the AMA that this “role substitution” allows health practitioners to work beyond their scope of training and is dangerous to patient care.

“The pharmacist will not have access to the patient’s medical history to correlate symptoms, will not send urine samples for testing and cannot examine the patient for symptoms of pelvic and bladder cancer which may be similar to infection,” Dr Yim said.

“I’m not exactly sure what the patient is paying for but it’s a prescription for disaster for patient care.”

Dr Yim said that while pharmacists play a vital and valuable role in the health care system, they are not trained to be doctors.

“As a pharmacist, I probably felt I could diagnose a UTI easily due to the simplicity of the condition, but I realise now—having worked as a GP—that I didn’t have the knowledge or training to ensure the symptoms were not masking something more serious which, left untreated, could become a major health issue,” he said.

“Pharmacists are the experts when it comes to the safe use of medicines, but diagnosing patients is not something they get trained to do and that’s why doctors are opposed to the trial.

“You do not want cookbook or recipe medicine. Each patient is different.”

The pharmacy trial went live in June with the release of the Drug Therapy Protocol for participating pharmacists.

Dr Yim’s comments were only the latest in a series of criticism of the trial by GP stakeholders; last month AMA Queensland president Dr Chris Perry said that “Queenslanders are being sold this new style of patient care under the guise of choice and convenience, but it’s simply a bargain basement version of health care,” and called on GPs to fill out a survey on the future of medicine.

At the time, Pharmacy Guild Queensland president Trent Twomey said that such statements were “unfounded” and “anti-patient”.

He said that rather than risking patient health, the UTIPP-Q “is yet another example of safe and effective innovation in the primary healthcare model”.

He pointed out that internationally pharmacists have had the ability to prescribe antibiotics for UTIs for a number of years.

The trial launched at around the same time as the State Government expanded the number of vaccinations that Queensland pharmacists can provide from three to nine—the same number offered by GPs.

Dr Yim also criticised this expansion of vaccination services.

“GPs are able to provide many of these vaccinations free of charge for patients that meet certain criteria, and provide complete care for the patient without conflict of interest,” Dr Yim said.

“I know from first-hand experience that pharmacists are always needing to look for new ways to get traffic into their retail outlets and expanding their scope of training through the UTI trial and vaccinations helps them achieve this.

“Pharmacists are also trained in companion selling—recommending customers purchase other products from the shelves apart from their prescriptions.

“There are shelves of perfumes, cosmetics and non-evidenced products.”

Dr Yim said the UTI trial constituted poor patient care and that “allowing more antibiotics to circulate in the community flew in the face of national and global efforts to combat antimicrobial resistance”.

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11 Comments

  1. michael ortiz
    08/07/2020

    What is about the Queensland AMA and RACGP leadership? I have run out of patience with “chicken little” and “chicken littler” telling everyone how bad this will be for their patients.

    There hasn’t been the dire consequences that they predicted from Pharmacists vaccinations. In relation to UTI, this is only a pilot study to assess safety and efficacy of a new Pharmacist treatment approach to managing uncomplicated UTI. Why not wait for the results of the trial to have an informed discussion?

    The Australian public deserves better from the Medical profession and Pharmacy profession leaders. Lets work together to help all Australians in the time of the COVID pandemic. Lets make our healthcare system work for the Australian Public through improved collaboration, rather than protecting doctors’ and pharmacists income.

    • Dr Evan Ackermann
      08/07/2020

      Who said this –
      Pharmacists in Australia are not currently qualified to diagnose UTIs utilising the appropriate history, physical examination and investigations of the patient.There is an inherent risk of pharmacists missing a differential diagnosis (e.g. vaginitis, interstitial cystitis or chlamydia urethritis) or complications of a UTI (e.g. prostatitis, pyelonephritis or peri-renal abscess).

      1. AMA
      2. RACGP
      3. Pharmacist group

      • Jarrod McMaugh
        08/07/2020

        NASPN said this Evan

        Note that people are allowed to have a difference of opinion. Just because a group made up of pharmacists has this concern, this does not invalidate the position of other pharmacists or pharmacy groups.

        Of note, NASPN were opposed to schedule change.

        That hasn’t occurred.

        Crisis averted.

        • Dr Evan Ackermann
          08/07/2020

          Correct = an independent pharmacy group – The New South Wales Antimicrobial Stewardship Pharmacist Network in their 2019 submission into schedule M – down-scheduling of trimethoprim

          They were against increased access and use of antibiotics through pharmacists as – increasing rates of trimethoprim resistance in the community and lead to potential patient harm through misdiagnosis of severe and resistant urinary tract
          infections.

          So NO – crisis not averted; and it does undermine Michaels chicken little argument.

          • Jarrod McMaugh
            08/07/2020

            While I don’t want to speak for Michael, I believe his point is that every time Queensland AMA and RACGP have a comment about pharmacy, it’s “the end of the world”

            Having a pharmacy group of any kind presenting a point of view on one of the QLD pilots doesn’t support or undermine that point that Michael made.

            Michael does raise another good point – this is a pilot study, designed to gather evidence to support pharmacist interventions in UTI. There are plenty of instances of you personally calling for evidence; why now are you against evidence and relying on opinion to make your case?

          • michael ortiz
            09/07/2020

            Hello Evan, I think it is important to look in one’s own back yard when it comes to antibiotic resistance. If you check the PBS schedule you would find that Dental Practitioners, Medical Practitioners and Nurse Practitioners can currently prescribe trimethoprim on the PBS. You can add vets and even optometrists who can also prescribe antibiotics (but not trimethoprim).

            How did we create a crisis with a simple pilot study in Queensland of all places? or is “Chicken littler” still alive and clucking!! Lets not count your chickens before they hatch as treating UTI is not what I would call a get rich scheme, but the AMA can always flap their wings a “little” harder and make it look like one.

          • Dr Evan Ackermann
            09/07/2020

            Hi Michael. Yes the issue of antimicrobial resistance is quite complex, and you can add A&E and OPD departments to your list. No-one is saying Pharmacists contributed to an AMR crisis.

            2 issues
            The evidence with pharmacy and antimicrobials – The sales of vaginal anti-fungals, and topical Chloromycetin skyrocketed when they were down-scheduled to pharmacist only. It is totally reasonable to expect that the same thing will happen with antibiotics – and the trial is not limited to trimethoprim. Patients will became knowledgeable in how to get what they want and pharmacists will have difficulty policing it.(same as codeine) Hence the overuse concern.

            The trial – well is it a simple pilot study? Haven’t seen the methodology published anywhere. Haven’t seen the “success measures” . Have you seen the results of the 6th CPA trials yet (Diabetes screening, chronic pain)? or the chronic disease monitoring trial in Victoria? Seems the concerns around pharmacy and “clinical trials” has validity as well.

            If Community Pharmacists really fulfilled their “medication expert” mantra – we would hear a lot more pharmacy concerns about the trial beyond those raised by the New South Wales Antimicrobial Stewardship Pharmacist Network.

  2. Pene
    08/07/2020

    I don’t agree… doctors start with empirical treatment for UTIs which is what a pharmacist will be doing including asking questions for red flag symptoms and then if symptoms return or don’t improve they will refer off for further investigation just the same way they manage constipation, diarrhoea, GORD etc etc

  3. Jarrod McMaugh
    08/07/2020

    “As a pharmacist, I probably felt I could diagnose a UTI easily due to the simplicity of the condition, but I realise now—having worked as a GP—that I didn’t have the knowledge or training to ensure the symptoms were not masking something more serious which, left untreated, could become a major health issue,” he said.”

    This is what is commonly referred to as an anecdote – it isn’t evidence, and isn’t representative of anything.

    I think it’s a shame that Dr Yim didn’t feel capable as a pharmacist, and that the AMA is choosing to exploit him in such a manner, but i hope he feels a lot more confident in his new role

  4. TALL POPPY
    08/07/2020

    I agree with Dr Yim – he’s says it like how it is. I respect that. This will be exploited by pharmacy for profits but of course zero extra remuneration for the diagnosing and treating employee pharmacist. Just more workload and responsibility. Just like vaccinations! Gee pharmacists can be so gullible. There will be no end to this turf war whilst profits are held as a priority. He is correct.

  5. actnowpharmacists
    21/07/2020

    Dr Yim is saying this because now he is a GP and not a pharmacist anymore. This is exactly the same mindset which an Employee Pharmacist develops once he/she becomes the “OWNER “of the pharmacy and a guild member. Suddenly he will have no objection to selling as many “health supplements” as possible or loading up their employee pharmacists with unfathomable amount of workload while figuring out how to buy another pharmacy. Dr Yim probably became GP because he got smarten up by working for four years in a pharmacy that Man!!! being a pharmacist means getting peanut money compared to the workload. Dr Yim did something about it. He moved up the food chain.
    It is nothing but a turf war. Lobbying groups (AMA / RACGP) trying to protect their own interest. Views can quickly change depending on which side of the fence you are. Ask them to provide vaccinations/medical advice free of cost for the good of the community and see them raise hell.

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