The AMA says pharmacists working in retail pharmacies should never prescribe
Two weeks after the Queensland Government announced that it would run a statewide trial of these services – following recommendations made by the recent Pharmacy Inquiry – AMA president Dr Tony Bartone said Queensland has set a “dangerous precedent”.
The move undermines the importance of continuity of care and threatens the health of patients, he said.
“No other State or Territory in Australia allows these medicines to be prescribed by pharmacists,” Dr Bartone said.
This week NSW Health Minister Brad Hazzard rejected a similar proposal made by the PSA in that state.
“Medicines are poisons,” Dr Bartone said on Thursday. “They are highly regulated by Australian governments under ‘poisons’ legislation because they are fundamentally dangerous.
“Until now, all State and Territory governments have complied with the recommendations of the independent Therapeutic Goods Administration about whether a doctor or a pharmacist or other health practitioner has the expertise to safely prescribe a specific medicine.
“The TGA has categorised the oral contraceptive pill and antibiotics for urinary tract infections as ‘schedule 4 medicines’, which means they can only be safely prescribed with the advice of a doctor.
“Pharmacists do not have the medical training required to determine the various complex factors involved in ensuring patient safety when it comes to prescribing a schedule 4 medicine. Simply prescribing the medicine, without holistic care and continuity of care, is dangerous.”
The AMA statement says that the Queensland move followed “determined lobbying by the Pharmacy Guild of Australia, representing pharmacy business owners”.
Dr Bartone said that even if a woman has previously been prescribed an oral contraceptive, it may not continue to be the most appropriate contraceptive.
“There may be other factors relating to a woman’s health that have changed from her last prescription that can impact on which type of oral contraceptive is prescribed, or even whether an oral contraceptive is the most appropriate form of contraceptive. Seeing the doctor provides the opportunity for holistic, preventive patient care,” Dr Bartone said.
“And unfettered prescribing of antibiotics by pharmacists to treat a urinary tract infection, without any clinical diagnosis, flies in the face of responsible antibiotic stewardship.
“With this trial, the Queensland government is encouraging potentially unnecessary use of antibiotics and the increase of antimicrobial resistance in our community. This is a global crisis with the emergence of ‘superbug’ epidemics.
“This is occurring while the Federal Government is trying to address antimicrobial resistance with a new committee working with GPs to reduce antibiotic prescribing.
“All governments should be working together to fight the threat of antibiotic resistance, rather than increase it.”
His words echo those of Dr Harry Nespolon, national president of the RACGP who said two weeks ago that pharmacist prescribing of these antibiotics could lead to the rise of “super bugs”.
“Pharmacists are expert in medication management and education, and in dispensing low risk, non-prescription medicines,” Dr Bartone said.
“The AMA supports non-medical health practitioners, including pharmacists, prescribing in a medically-led and delegated team environment.
“But pharmacists working within a retail pharmacy environment should never prescribe.
“Pharmacists deriving an income from medicines they prescribe represents a fundamental conflict of interest.
“Doctors derive no income or any other benefit from prescribing medicines. The separation of prescribing and dispensing is critical for patient safety.
“The Queensland model is a fundamental corruption of a safety check that has stood the test of time. There must be a separation between prescribing by a doctor, who prescribes with no financial or other benefit, and the dispensing of that medication by a pharmacist, who is solely responsible for checking the dosage and frequency.
“The Queensland approach means that retail pharmacists, receiving a financial benefit from every prescription, will now have a licence to do both, which potentially puts patients at risk.
“It is extremely worrying that the Queensland approach will see pharmacists prescribing independently, with no consultation with the patient’s doctor.
“Multiple prescribers caring for a patient, independent of each other, is just bad health care.”
PSA NSW Branch president Professor Peter Carroll told the AJP yesterday, referring to Mr Hazzard’s rejection of the proposal in that state, that such measures were a public health issue and that pharmacists would be held to agreed professional protocols if providing three-day courses of trimethoprim (30mg daily) to women with acute UTIs without a script.