UTI trial : GPs advised to report poor care |
Geir O ’ Rourke GPs who think their patients have received substandard care in Queensland ’ s pharmacy antibiotic prescribing trial should report the pharmacist to AHPRA , the state ’ s health department says .
The message follows calls for an inquiry into the rate of misdiagnoses and adverse events in the pilot , which involves around 1100 pharmacists diagnosing and treating women with uncomplicated UTIs .
Last month , Dr Aileen Traves said one of her patients was misdiagnosed as having a UTI when she had chlamydia .
The pharmacist did not realise she was pregnant and prescribed trimethoprim , which is not recommended during the first trimester , Dr Traves said .
The Cairns doctor said another of her patients had been given antibiotics after being incorrectly diagnosed with a UTI when she actually had a 15cm pelvic mass .
“ I shudder to think how many others like her have been misdiagnosed ,” Dr Traves said .
Queensland Health said it had contacted Dr Traves to discuss the cases .
But it added that any GP concerned about the management of their patient under the trial should contact the pharmacist or make a formal complaint so it could be “ appropriately addressed ”.
Doctors could also contact Queensland Health directly with details of adverse events so the department could alert the co-ordinators of the trial , it said .
Since the trial ’ s launch in June 2020 , more than 7000 women have been prescribed antibiotics — either trimethoprim , nitrofurantoin or cefalexin .
But concerns remain over the adequacy of the scheme ’ s evaluation , which was completed by Queensland University of Technology ( QUT ).
Virtually no details on the methodology have been made public , and it is not clear how rates of misdiagnosis will be assessed given no urine tests are being performed to confirm the pharmacist ’ s diagnosis .
Nor is it clear if patients ’ GPs have been contacted and interviewed as part of the evaluation .
The official evaluation report , which was handed to Queensland Health in January , has yet to be released .
In its statement to Australian Doctor , Queensland Health defended the trial , which is expected to run until June .
It said 87 % of patients surveyed after their pharmacist consult reported their symptoms had resolved within 48 hours .
Doctors and patients could still share any concerns with the trial co-ordinator or with the research ethics advisory team at QUT , it added .
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Dr Aileen Traves . |
NEWSPIX |
MSAC eyes new screen in pregnancy Rachel Worsley ALL pregnant women would be eligible for screening with a trio of tests for pre-eclampsia risk under a new MBS item number proposed by a group of obstetricians .
The Medical Services Advisory Committee ( MSAC ) is considering the application to screen women in the first trimester — around the time of the nuchal translucency scan — to determine if they need prophylactic aspirin .
But the RACGP has queried whether “ the entire pregnant population ” or only those at higher risk need to be screened . In a submission to MSAC last month , the college called for careful consideration of the potential harms from aspirin , such as pregnancy loss .
The proposed screen comprises clinical measurement of maternal mean arterial pressure , a blood test for maternal serum concentration of placental growth factor and ultrasound assessment of uterine artery pulsatility index .
Based on the result , the referring GP or obstetrician would consult an algorithm to determine if the patient should be offered aspirin 150mg nocte or not . The prophylactic treatment is a cost-effective strategy shown to prevent 62 % of deliveries for preterm pre-eclampsia , according to research cited in the application .
Melbourne obstetrician Professor Shaun Brennecke , who supports the bid , says although clinical and epidemiological factors can point to increased pre-eclampsia risk , many women will not have obvious predisposing factors .
“ For women in their first pregnancy , when there aren ’ t otherwise
good predictors of who would develop pre-eclampsia and who won ’ t , that ’ s the group who will find this test … valuable ,” he said .
Professor Brennecke , the Dunbar Hooper professor of obstetrics and gynaecology at the Royal Women ’ s Hospital , stressed that universal low-dose aspirin was not being advocated .
In women prescribed the antiplatelet , the regimen would be stopped at 36 weeks of pregnancy , “ so by the time the woman is in labour there would be no potential problems as the … aspirin would not be present in her system ”.
‘ For women in their first pregnancy … that ’ s the group who will find this test … valuable .’
The MSAC application made in January noted that an estimated 2 % of pregnant women were on prophylactic aspirin and this would rise to about 10 % if the screening was implemented .
The move follows the landmark 2017 ASPRE study and research for the US Preventive Services Task Force that showed early prophylaxis afforded a “ net benefit ” in reducing the risk of pre-eclampsia , preterm birth and perinatal mortality .
A spokesperson for RANZCOG was not available to comment .
MSAC application : bit . ly / 3wwz69M ASPRE : N Engl J Med 2017 ; 377 : 613-22 .
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Call to scrap GP referrals for Better Access Siobhan Calafiore CLINICAL psychologists say patients should not need a GP referral and a mental health care plan to receive Medicare rebates to fund their consults , at least for their first three sessions .
The Australian Psychological Society says the Better Access funding mechanism is creating bottlenecks . “ Additional red tape is potentially stopping [ a lot of people ] from getting treatment or stopping them
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from getting treatment as early as they would otherwise ,” its president , Tamara Cavenett , said .
The society , which represents clinical psychologists , also wants to allow patients to claim up to 20 MBS-funded psychology sessions each year . Two years ago , the cap was raised from 10 to 20 as a temporary pandemic measure .
Its demands were made last month in response to the launch of a federal
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Department of Health review of the Better Access scheme , which has been a major funding stream for GP mental health care since it was launched more than 15 years ago .
The department said the findings would be considered together with recommendations from the Productivity Commission , which controversially claimed three years ago there was “ no evidence ” that treatment plans had
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“ improved either GP referral practices or [ patient ] mental health outcomes ”.
However , a second group called the Australian Association of Psychologists — that represents registered psychologists — has taken the call a step further , demanding the need for GP referrals under Better Access be scrapped altogether . It also wants the maximum number of subsidised sessions per year raised to 40 .
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NOW PBS LISTED |