‘Who is going to train these pharmacists?’

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The president of the AMA in Queensland has written to the state health minister urging him to reconsider the pharmacy contraceptive pill and UTI trial

In April, the Queensland Government responded to the report into the establishment of a Pharmacy Council and transfer of ownership in Queensland, which also looked into pharmacist scope of practice.

It announced that it would “develop, implement and evaluate a state-wide trial to provide low-risk emergency and repeat prescriptions for the contraceptive pill and antibiotics for urinary tract infections”.

The announcement has received considerable pushback from doctor groups, who have called it a risk for the development of “super-bugs” and a threat to patient health.

Now, Queensland AMA president Dr Dilip Dhupelia – who previously described the trial as “reckless and dangerous,” has written to Health Minister Steven Miles asking him not to go ahead with the trial, but instead to wait for national regulations to be decided by the Council of Australian Governments.

Dr Dhupelia said GPs had genuine concerns about patient safety and were worried that allowing pharmacists to dispense medications could lead to further overuse of antibiotics, rendering them ineffective.

“The Queensland Health Minister’s decision has gazumped the national considerations now underway by the Australian Health Protection Principal Committee,” Dr Dhupelia said.

“AMA Queensland believes there should be national uniformity in such decisions and Queensland shouldn’t be going it alone.”

Dr Dhupelia pointed out that in NSW, Health Minister Brad Hazzard had rejected PSA calls for such a trial.

“When the New South Wales Health Minister dismissed calls for a similar trial, he agreed it should be dealt with at a national level so as not to lead to different prescribing practices in different states,” he wrote.

Dr Dhupelia said Mr Miles’ decision to allow a trial also went against the recommendation of the Therapeutic Goods Administrations Independent Advisory Committee on Scheduling, which warned in 2015 against pharmacists dispensing of oral contraceptives.

He said that only doctors could determine what medication was suitable for a patient after reviewing their full medical history.

“Who is going to train these pharmacists? Who is going to decide what they need to know to allow them to safely dispense Schedule 4 medications?” he said.

He also complained that the Queensland Government had not consulted with AMA Queensland before green-lighting the trial.

The Minister had indicated he would work with AMA Queensland on these issues but we learned that the trial was going ahead through the media,” he said.

“GPs are rightly concerned that, once we open the floodgates, the pressure will be on to allow pharmacists to dispense an expanded list of medications, then where does it stop?

“This would only lead to further fragmentation of care and put at risk the health and well-being of patients.

“This is a blatant push by the pharmacy sector and the State Government has condoned the move. We mustn’t put convenience ahead of our health.”

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  1. Rosemary Peacey

    Dentists prescribe, nurses prescribe, podiatrists prescribe, optometrists prescribe. Is there always to be discrimination against pharmacists?
    The statement that ‘only doctors could determine which medication was suited to a patient after reviewing their full medical history’ seems to be at odds not only with pharmacists training but also at odds with the above professions right to prescribe.
    If more pharmacists were involved in the prescribing process perhaps there would be less medication misadventure and better patient outcomes with less overall cost.
    The recent ‘Antibiotic Stewardship’ workshops conducted by the PSA highlight the need for a collaborative approach to reducing antibiotic resistance. To suggest that pharmacist prescribing would lead to an increase in antibiotic resistance is insulting. Effective prescribing requires comprehensive training, ongoing CPD, willing collaboration and good communication. Many GPs could well do with updating their prescribing habits (particularly around antibiotic use) by engaging in CPD that follows current practice guidelines.
    Many countries around the world allow pharmacists to prescribe for various conditions (UTIs included). This does not come without consequences but it would not be fair to say that obtaining an antibiotic for a UTI from a pharmacist would lead to any more antibiotic resistance than obtaining it from a doctor or hospital. What needs to be on the discussion table is how do all prescribing professionals manage antibiotic resistance from an overall public health point of view.
    There are many health issues where a pharmacist’s early intervention could lead to better health outcomes. The waiting times to see a GP who knows a patient and their medical history is constantly growing along with widening Gap Payments. The public certainly deserve better.

    • John Wilks

      One of the issues with pharmacists prescribing abx in UTI without path results for susceptability is the possibility of increased bacterial resistance. Our hospital has recently had a case of multidrug resistant E coli.
      Caution and prudence is mandatory.

    • Pharmacists can prescribe but pharmacists cannot diagnose. That’s the paradox.

      Collaborative prescribing is perhaps the answer.

  2. Tony Lee

    Alexander’s comment spot on plus the opposite of a paradox is a paradox.
    Reasonably all pharmacists have the necessary skill to offer a short term UTI (say 3 days trimethoprim) and 1 month OC where they consider the matter imperative (eg. after hours, GP not accessible, patient panic). The commonly used UTI algorithm in general practice is available to ensure pharmacists consider and refer as needed.

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