GPs are worried about their safety as real time prescription monitoring is introduced – but this misses the point about harm minimisation, say pharmacists
The Australian Medical Association Queensland has issued a statement saying that, “GPs fear they will bear the brunt of opioid dependent patients seeking prescriptions” when the state’s QScript Real Time Prescription Monitoring system is introduced.
QScript is expected to be operational by mid-2021 and, according to the AMAQ’s statement, “has been designed to curb opioid misuse by stopping the current practice of doctor shopping that allows patients to visit multiple GPs for prescriptions”.
AMAQ Councillor and GP Dr Nick Yim said that under the new system, doctors would have to “stare down opioid dependent patients or face fines of more than $2300”.
“It can be very scary to be alone in a room with a patient who is under the influence on opioids or going through withdrawal and is seeking some more,” Dr Yim said.
“Many GPs as well as their staff have been verbally and physically assaulted in the course of simply doing their jobs.
“Whilst we strongly support the implementation of QScript to reduce opioid misuse, we are calling on the next State Government to provide GPs with protection under the law in the same way the Palaszczuk Government is considering it for paramedics, police and other emergency workers.”
Anthony Tassone, president of the Victorian branch of the Pharmacy Guild, told the AJP that while anything new in practice “can seem daunting at first,” RTPM “should be seen as a harm minimisation tool to keep patients stay on the safe side and avoid preventable harm from prescription medicines”.
“It should not be seen as a compliance tool, and practitioners should not feel they need to be ‘medicine cops’ in providing care for their patients,” Mr Tassone said.
“RTPM is about having more of an understanding of a patient’s treatment should they be visiting multiple prescribers or pharmacies.
“RTPM is a tool to assist clinical decision making and not a system that directs a practitioner what they must or must not do. “
He said that the Victorian SafeScript program had to date been a useful tool in helping both pharmacists and GPs in making more informed decisions when prescribing and dispensing medicines that can carry risks of dependency for some patients.
Mr Tassone said that it was essential that properly resourced support services for pain management and drug dependency treatment, should a patient be identified to be at risk of potential harm from their medicines.
“Patients need and deserve a comprehensive treatment approach, and sometimes simply saying ‘no’ to supply in itself is not in the best interests of the patient,” he noted.
Amin Javanmard, a Gold Coast pharmacist and state Greens candidate who has spoken out in the past and this year about the increased frequency of robberies and other poor behaviour pharmacists are facing, told the AJP that as it stands, patients who are attending multiple prescribers and who are at risk of harm from prescribed medicines do not have anywhere near enough support.
He said that real-time monitoring is “about much more than issues of opioid dependence” and that the entire issue “needs to be considered in the light of better funding for primary health services in the community”.
All the stakeholders told the AJP that there needs to be better support in place for pharmacists as well.
“Everybody deserves a safe workplace, including health professionals,” said Mr Javanmard. “At the same time, patients rightfully have an expectation that the services they need to assist them should be available to them at a minimum.”
This includes the means to access their mediciines: Mr Javanmard told the AJP that since JobSeeker was introduced, replacing the NewStart payment at a higher rate, as well as JobKeeper, he has had “quite a nice situation where we haven’t had to counsel patients on which medications they can skip’.
“Now that JobKeeper and JobSeeker are being reduced, we are starting to face that situation again.”
“Health professionals and their teams must and deserve whatever legal protections are possible to ensure their safety,” said Anthony Tassone.
“What we have seen during the COVID pandemic unfortunately is that unacceptable behaviour can be directed towards frontline workers from members of the public at potentially any time in different circumstances.
“Health professionals are here to help and care for patients.”
Dr Yim said that the state government needs to invest more in drug recovery support services and programs.
“When QScript flags a patient, GPs need to be able to offer timely treatment options.”
Meanwhile, Mr Tassone pointed out that health professionals need to change their language when referring to their patients.
“’Doctor shoppers’ is a term we must abandon,” he told the AJP.
“Patients who are visiting multiple prescribers or pharmacies to obtain medicines that carry risks of addiction and dependency need our help. They are patients. That’s how they should be referred to.”