Simple UTIs aren’t simple, says doc


doctor makes "stop" gesture with hand - ama

Doctors continue to oppose Queensland’s trial of pharmacist provision of UTI treatment, with one GP warning of “landmines”

Following the Queensland Government’s announcement last month that pharmacists would be able to provide short-term treatment for simple UTIs under the state-wide trial, doctor groups lashed out at the concept.

The RACGP and national AMA both warned that such a move could lead to “superbugs” via over-provision of antibiotics for such infections, while Dilip Dhupelia, president of the Queensland branch of the AMA, called the move “irresponsible and reckless”.

Now Dr Rob Park, a GP on Queensland’s Sunshine Coast, has weighed in, writing in a doctor publication that “this decision in the wrong hands can lead to people getting hurt”.

He gives three examples of patients presenting with a potential UTI: a young woman with stinging on urination who may have chlamydia; an older woman with her “regular UTI” who may have lichen schlerosis; and a middle-aged man with dysuria whose true condition could be revealed with an “appropriate rectal examination”.

Many more such “landmines” exist, he warns.

“GP learners have years of training specifically in clinical reasoning and the diagnostic method, but even they find this diagnosis difficult to do safely without years of experience and pattern recognition,” he writes.

“Now, imagine if we removed their ability to ask sensitive questions, tied their hands behind their back to stop them from examining the patient, disabled their access to order and follow up test results, gave them no practical hospital experience caring for the complications of UTIs, and dramatically reduced their clinical reasoning training.

“Essentially this is what we are doing by allowing pharmacists to write antibiotic scripts for UTIs.”

In discussing the suggestion that pharmacists contact the 13-health telephone service or access My Health Record, or refer patients to their GP, Dr Park says this could just be “adding a dangerous middle step that again leads patients back into the GP’s office?”

“UTIs are easy? No, they are not.”

Last week, after NSW Health Minister Brad Hazzard rejected a PSA proposal that that state implement a similar trial, PSA state president Professor Peter Carroll told the AJP that the Queensland trial model, and that being proposed in NSW, was patient-centric.

“It’s not a contest between the GP and the pharmacist,” he told the AJP. “It’s both, working collaboratively for the health of the community.

“It’s about the appropriate short-term use of trimethoprim, a drug specifically recommended for the treatment of acute UTIs, and allowing the lady to have relief from her symptoms. It doesn’t stop her going to the GP the next day or in two days’ time.”

Meanwhile AMA Media continues to criticise pharmacist provision of antibiotics for simple UTIs on social media.

 

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