Pharmacy trial puts profits ahead of patients

“People need access to doctors, not short-term, short-sighted experiments that place them at risk,” AMA Queensland President Dr Maria Boulton said.

“This experiment will not reduce the pressure on our hospitals, ambulance ramping or bed access block. Patients who need hospital beds are patients who are unwell enough to need hospital care. I have visited many Queensland hospitals and witnessed these issues first hand.

“What the government is proposing goes against the independent, unbiased, evidence-based advice from the federal Therapeutic Goods Administration (TGA) about who can prescribe and access medication, and research into patient safety.

“GPs train for 12 to 15 years to be able to diagnose these conditions, yet the Health Minister thinks pharmacists can deliver the same level of care after 120 hours of learning in practice.

“The pilot proposes that pharmacists will perform a lung exam, spirometry, otoscopy without the appropriate training. This goes against a holistic approach to patient care.

“For example, nausea may seem straightforward, but it can be a symptom of diabetes, gastroenteritis, brain cancer, appendicitis, sepsis, meningitis and more. Treating just the symptom and not the underlying cause places the patient at risk and leads to more expensive hospital stays.

“This pilot is an approach to medicine that has no input or support from doctors or pharmacists on the ground - doctors and pharmacists who work together collaboratively every day to ensure the best and safest health outcomes for patients.

“The Minister says this was an election commitment to pharmacy bodies. But bad election promises should be dumped. Promises to political donors should not trump patient safety, particularly when pharmacists are in short supply in these regions.

“This is not the answer to overcrowded emergency departments and over-capacity hospitals around Queensland. We need more staff, with proper qualifications, and better resourcing.”

This dangerous experiment is based on the failed urinary tract infection (UTI) prescribing pilot that the government’s own evaluation showed led to hundreds of women needing further care. AMA Queensland’s survey of doctors found missed cancer cases, serious sexually transmitted infection misdiagnoses, antibiotic resistance and an ectopic pregnancy among patients needing further care.

AMA Queensland Vice President Dr Nick Yim, a pharmacist who retrained as a GP, said pharmacists were already overworked and underpaid.

“This not the answer to workforce shortages,” Dr Yim said.

“An Australian Journal of Pharmacy survey found ‘increasing professional services workload eg vaccination’ is the third highest ranked reason for pharmacists to consider leaving the profession.

“It is simply not true to claim that similar schemes operate in New Zealand, Canada and the United Kingdom. In New Zealand, pharmacist prescribers train in a specific clinical area – paediatrics for example – and then they work within a hospital ward, not in a retail pharmacy.

“Getting a diagnosis and prescription from a chemist while doing the weekly grocery shopping may seem more convenient than seeing a GP, but it’s like fast food – it’s not good for you in the long-term.”

Cairns GP and AMA Queensland Councillor Dr Lee Jones said North Queenslanders – particularly Aboriginal and Torres Strait Islander communities – were tired of being treated as expendable.

“If we are going to be experimented on, we want it to be a proper clinical trial, so doctors and patients know how to report adverse effects from this ‘pilot’,” Dr Jones said.

“Our communities need to know when this is going to begin, which pharmacists are taking part, what training they have had, and exactly how this experiment’s effects on patient safety and health are going to be measured.

“The UTI trial was promoted as filling healthcare shortages in regional areas and after hours, but the government’s own evaluation shows that the majority of services were provided in cities and major regional towns during normal business hours – not in country towns at night or on weekends.”

Background

• The proposed North Queensland Pharmacy Scope of Practice Pilot was scheduled to start in June 2022 in 37 local government areas to the north and west of Mackay.
• The Queensland Government commissioned QUT to manage and evaluate the UTI pharmacy prescribing pilot.
• 65 per cent of women who took part in the UTI pilot were not contacted for follow-up, meaning their safety or adverse events are not known.
• Of those who were followed up, at least 270 needed further treatment, either because they were misdiagnosed, suffered complications, or did not respond to treatment, possibly due to antibiotic resistance.
• 97 per cent of women who took part were sold antibiotics, whether they needed them or not.
• One in two pharmacists said they would have found it difficult to charge the $19.95 consultation fee without also supplying antibiotics.
• Claims that the UTI trial prevented almost 1,000 ED presentations are extrapolated from 12 participants agreeing that ‘one’ of the alternative options they would have considered was ‘Hospital/Emergency Department’.
• QUT is investigating whether failings identified in its evaluation report constitute a breach of its code for responsible conduct of research.

International experience:

New Zealand

• Pharmacists must have a postgraduate clinical diploma or equivalent and have several years of clinical experience in a specialised area before applying for the 12-month postgraduate course.
• The course involves a 250-hour practical along with an academic component.
• Qualified pharmacy prescribers work within their specific clinical area of practice in a hospital ward.

United Kingdom

• Minimum standard learning time of 26 days’ worth of structured learning and a 90-hour practical.
• Most work in general practices.

Canada

• Limited emergency prescribing and prescription extension powers in 10 of 13 provinces.
• One province (Alberta) allows pharmacists to apply for additional prescribing authorisation. All information must be relayed back to the patient’s doctor. If it is a new condition, the pharmacist must refer the patient to a doctor for formal diagnosis and treatment.