UTI study shows pharmacist prescribing value


woman on toilet

Pharmacists can provide effective and fast treatment – including prescribing – for patients with uncomplicated urinary tract infections, new data shows

The first comprehensive evaluation of community pharmacist assessment and management, including prescribing, for uncomplicated UTIs has just been released at the Canadian Pharmacists Conference and published in the Canadian Pharmacists Journal.

“This research told us clearly that pharmacist management of uncomplicated urinary tract infections is very effective and in high demand by patients,” says Dr Ross Tsuyuki, Professor of Medicine in the Faculty of Medicine and Dentistry at the University of Alberta and one of the peer-reviewed study’s authors.

“Patients were also highly satisfied with the care their pharmacists provided.”

UTIs are among the top ten reasons for ambulatory clinic visits, and the top five reasons for emergency department visits in Canada.

New Brunswick pharmacists have been able to prescribe for uncomplicated UTIs since 2014, but the service is not funded by Canada’s Medicare public funding system when it is provided by a pharmacist.

Instead, in New Brunswick patients must pay out of pocket to access pharmacist care for UTIs, though this fee was waived for study participants in order to remove the cost barrier and encourage enrolment in the study. The participating pharmacies were reimbursed for this from the study budget.

Between June 2017 and April 2018, the study enrolled 750 patients in New Brunswick, who presented to pharmacies looking for help with symptoms of an uncomplicated UTI, or with a new script from a physician for a UTI treatment.

Pharmacists at 39 New Brunswick pharmacies performed patient assessments for symptoms of a urinary tract infection and either prescribed antibacterial therapy, modified antibacterial therapy, provided education only, or referred to physician, as appropriate.

Pharmacists screened all patients for signs of complication and referred them to a physician if those signs were present.

At the two-week follow-up, 88.9% of patients reported their symptoms had resolved.

The study also found that patients could access a pharmacist an average of one day faster compared to a physician.  

“Pharmacists are accessible health care professionals who are very capable of taking on a larger role in the management of urinary tract infections,” says co-author Dr Nathan Beahm, Clinical Assistant Professor of Pharmacy at the University of Alberta.

“Although an economic analysis will be forthcoming, it is not difficult to see that pharmacist management of this ailment will be a cost-effective measure, especially when comparing to the cost of an emergency department visit or a walk-in clinic visit.”

Meanwhile co-author Dr Daniel Smyth, an Infectious Diseases specialist physician at The Moncton Hospital, says the study “has demonstrated that uncomplicated urinary tract infection can be safely managed in the community by pharmacists with improved access and high levels of patient satisfaction”.

“It justifies an expanded scope of practice for our pharmacist colleagues in New Brunswick, especially for common clinical problems such as UTI that lead to high use of acute care facilities in our province.”

Dr Tsuyuki highlighted that the fee for this service is a barrier to many who seek help from their pharmacists for urinary tract infections.

“Public funding of this important service would likely improve access,” says Dr Tsuyuki.

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