Doctors have again lashed out at suggestions that pharmacists could provide more health services, such as a minor ailments service
NewsGP reported on a recent study conducted by the University of Technology and the Western Sydney PHN, which looked at how pharmacists could help in common conditions such as colds, coughs, heartburn/reflux, headache (tension and migraine), menstrual pain or primary dysmenorrhea, and acute low back pain.
“The guiding principles were integration of community pharmacy practice into the health care system, collaboration with general medical practitioners and patients, high quality and safe use of nonprescription medicines and appropriate treatment of minor ailments,” the report says.
The researchers, led by chief investigator Sarah Dineen-Griffin, say that such a service is “ready to be rolled out,” and they hope to have it included in the Seventh Community Pharmacy Agreement.
The results included that pharmacists were 2.6 times more likely to change the customer selection of a medicine for self-treatment to a safer, more appropriate alternative; and patients were 1.5 times more likely to receive an appropriate referral by their pharmacist.
They were also five times more likely to adhere to that referral advice and seek medical practitioner care within an appropriate timeframe (20% of all patients were referred).
Pharmacists identified that 2% of all patients presenting to pharmacy had red flag clinical features requiring immediate referral to the GP or emergency department including shortness of breath, severe or disabling pain, fever and neck stiffness.
Pharmacists also provided self-care advice in almost all consultations (98%), compared to 62% of patients receiving usual pharmacist care. For example, patients presenting with heartburn were recommended to quit smoking by their pharmacist.
The report suggested a potential saving of up to $1.3 billion a year, thanks to alleviation of pressure on the health system.
But Associate Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care (REC–QC) has now told newsGP that pharmacies have an “inherent conflict of interest” because in order to remain economically viable, they must sell products.
“Who pays in the end? The patient does,” he said.
“In the study the most common presentation was respiratory and 84% of patients were supplied at least one non-prescription medicine, mostly cough mixture or cold remedies.
“Pharmacy shelves are stocked with substances that are very low value. Supplements, homeopathy, children’s cough mixtures are generally unnecessary – but they are sold to unsuspecting customers.”
He said that interpreting the study “requires care” – and that consideration should be given to where this $1.3 billion could come from.
The study selected 15 pharmacies [24 patients each] to provide the minor ailments scheme and 15 pharmacies to provide usual care. It was not a study to compare pharmacy care to GP care,’ he said.
“What are the consequences?” he asked. “Will services to patients actually be reduced as a consequence of practices closing in marginal areas?
“Overseas experiences demonstrate that minor ailments schemes struggle even in countries where there is greatly reduced access to general practice; such as the UK, where there are far more patients per GP.
“The repeated history of schemes attempting to substitute general practice is that they look cheaper on first glance but end up being false economies.”
Former AMA president Dr Kerryn Phelps has spoken to The Australian, also criticising an expanded role for pharmacists.
“Pharmacies are not set up with appropriate privacy for consultations; there is also a perverse incentive for pharmacists to diagnose and prescribe because they will benefit from it,” she said.
“GPs might make it look easy, but it’s not,” Dr Phelps said.
The Australian also quoted Ross Tsuyuki, a pharmacology professor at the University of Alberta, who said that it was a “common misnomer” that pharmacists would prescribe more medicines.
Meanwhile in Queensland, Pharmacy Guild state branch president Trent Twomey reacted to an Australian Institute of Health and Welfare report which showed that more than 179,000 Queensland hospitalisations were potentially preventable in 2017/18.
Allowing pharmacists to work to full scope could help prevent these, he said.
“Alarmingly, over 20,000 potentially preventable hospitalisations due to urinary tract infections were recorded during this reporting period.
“The quickest way to take pressure off patients and hospitals, is to allow pharmacists to work to their full potential. For example, instead of having to wait for hours at an emergency department for antibiotics, that they may have had before, to treat a urinary tract infection– a patient could be prescribed medication by a pharmacist immediately.
“Excessive wait times and high costs of local GPs have long been a barrier when it comes to Queenslanders accessing health services.
“The report makes it clear there is the potential for pharmacists to make the most of their training, reduce costs on the public health system and play a larger role in making sure Queenslanders have the best possible health system,” he said.