Qld trial ‘redundant before it starts,’ says GP


man holding 'no' sign

Queensland’s pharmacy trial would mean a conflict of interest similar to that found by the banking Royal Commission, says a leading doctor

GPs continue to criticise moves towards pharmacist prescribing, with RACGP Queensland Chair Dr Bruce Willett telling newsGP that the prescribing trial – which is to see a statewide pilot of pharmacist prescribing of low-risk emergency and repeat prescriptions for the contraceptive pill and antibiotics for UTIs – would cause a similar conflict.

The Royal Commission into the Banking and Financial Services Sector highlighted numerous instances where trustees believed they could “manage” conflicts of interest.

Commissioner Kenneth M Hayne said that in regard to the banking commission findings, conflicts should not be “managed” but “eliminated”.

Dr Willett told newsGP that the Queensland trial would constitute “creating exactly that situation in the pharmacy sector”.
 
“We’re looking at an area where this situation has been disastrous, and now it seems we’re replicating the disaster.”

He said that a recent study, by researchers from QUT’s Business School and Faculty of Health School of Clinical Sciences made the pharmacy trial “redundant before it starts”.

The study involved mystery shopper patients performing two patient scenarios – one requesting emergency hormonal contraception, and the other bacterial or viral conjunctivitis.

The researchers found that of the 205 Brisbane-area pharmacies mystery shopped, 57.6% of pharmacies followed dispensing behaviour compliant with the protocol, while 31.3% involved some form of overtreatment or overselling of medication.

At the time, PSA CEO Dr Shane Jackson said that the study actually suggests that “consumers receive focussed and cautious care from pharmacists in response to the simulated case studies”.

“While the sample size is relatively small, the results suggest consumers would benefit from a remuneration structure which supported longer patient-pharmacist interactions, particularly in more complex cases,” he said.

“This would allow pharmacists more time with patients and provide more targeted treatments tailored to each consumer’s specific health needs.”

Dr Willett, however, told newsGP that the QUT study’s results were “really worrying”.

He said that the likelihood of encouraging antibiotic resistance and “future ‘super-bugs’” is raised by the dispensing of oral antibiotics.

“We really expect to see the same behaviour as displayed in the study,” he said.

The comments are only the latest in a series of attacks on the Queensland pharmacy trial by leading doctors representing the RACGP or AMA.

Doctors from both groups have repeatedly claimed that pharmacist prescribing of antibiotics will encourage antibacterial resistance.

The comments also follow criticism this week of moves towards pharmacist prescribing in Western Australia by AMA WA president Dr Andrew Miller, who made several claims on ABC Radio which were refuted by the Pharmacy Guild’s Matthew Tweedie.

Dr Miller is critical of the recommendations arising out of a WA Government review into the pharmacy sector, which included carefully watching initiatives like the Queensland trial to determine whether a similar program could be instituted in WA.

Dr Miller continues to speak out on social media on the subject.

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5 Comments

  1. Glen Bayer
    25/07/2019

    Luckily we never have inappropriate antimicrobial prescribing by GPs to encourage resistance…

  2. Jarrod McMaugh
    25/07/2019

    Ironically, the issue with the banking sector is the “sale” of cognitive services rather than physical product.

    The greatest risk when it comes to conflict of interest is failing to recognise when a CoI situati on exists.

    For instance, when a professional earns a reputation-based income but believes this is not subject to a conflict of interest.

    It is dangerous to operate as a professional- earning income based on your reputation – without understanding or acknowledging this risk

  3. Tim Hewitt
    25/07/2019

    Isn’t it just a matter of scheduling?
    I remember when Ibuprofen and ranitidine where both ‘prescription only’ . at the time no doubt it was thought these drugs needed to be prescribed by Doctors for safety reasons.. and the notion of pharmacists ‘prescribing’ them would have been met with the response we see in this debate.. but here we are now and you can buy ibuprofen in a petrol station.. go figure.. is the oil company conflicted?
    Pharmacists ‘prescribe’ all day (AKA ‘recommending’).. and the AMA etc don’t seem bothered by that..
    I think its the work ‘prescribe’ they don’t like.. just go back to ‘down scheduling’ and no one will bat an eyelid…

    • John Black
      26/07/2019

      Yes Tim you are 100% correct, the conflict is largely in the terminology, Doctors prescribe prescription only drugs and Pharmacists recommend products in pharmacist only and pharmacy only schedules. The conflict is resolved by using the term “down scheduling”, many prescription
      drugs have been down scheduled over the years by pack size or strength or safety profile or public benefit.

  4. Free pharmacist
    25/07/2019

    Why in the hell they talk about a conflict of interest as the main problem, more than 80% of pharmacists workforce doesn’t own a pharmacy business, as a pharmacist, like many, we have the right to utilise our extensive knowledge in medicines to recommend the right treatment for patients, we never claimed that we are capable of diagnosis, but after diagnosis by a physician wer’e the most trained healthcare professionals who can choose the right treatment for each individual, it’s unfair to judge the whole profession based on an issue “conflict of interest “ that doesn’t apply to the majority of us who never benefit of selling medications. It feels like a fight between two big businesses “pharmacy owners and doctors “ with no interest at all in pharmacists themselves who have the rights to work independently. There’re heaps of role models that can help fixing that conflict like not allowing prescribing pharmacists to dispense their prescriptions ‘I.e. non dispensing pharmacists “
    Believe me we are trapped by our own people, as an example, pharmacy guild was stepping up against “general practice pharmacists “ as it affect their own business interests because it might cause pharmacists rates to goes up due to the effect of it to lower the number of pharmacists who currently work in community pharmacies

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