NEWS 9
Black hole swallows pharmacist prescribing trial
Local GPs fear there is no clear evidence for the safety of the UTI trial .
ANALYSIS Geir O ’ Rourke , Paul Smith
ONE of the more curious aspects of the Queensland pharmacy prescribing and dispensing saga — and there have been many — is the justification we heard from the state ’ s Minister for Health , Yvette D ’ Ath .
She was asked by reporters back in February why she was going ahead with a trial , which is set to batter and break some of the fundamentals of safe healthcare .
“ We have already been running a trial on [ pharmacists prescribing antibiotics ] for UTIs ,” she replied . “ And I believe that this has been very successfully applied .” So what was this belief based on ? This is important because if you were ever to suggest these days , that it is acceptable to adopt medical interventions without a robust evidence base , people would assume you had lost the plot . But the fact is there is no detailed evidence in the public domain on the results of the trial ( see box for the scheme ’ s details ).
All we know is that 7000 women were prescribed and dispensed antibiotics for uncomplicated UTIs and that Queensland Health has declared its evaluation found “ no reported adverse events or safety concerns ”.
And that 87 % of women treated “ reported their symptoms had resolved ” — so what happened to the other 13 %?
Dr David Mildenhall , a GP in Bundaberg , 375km north of Brisbane , has reason to be concerned .
“ I recently had a patient who was a 25-year-old female . She had stinging and burning on urination , with a vulval itch , going on for two weeks .”
“ When I spoke to her , she said she went to two
Queensland Minister for Health Yvette D ’ Ath .
different pharmacies who were participating in this trial . Each time , she was given prescribed and dispensed medication . But she came to me because the symptoms were getting worse .
“ We did an examination , and it was clear she
had lichen sclerosus , which of course is a condition that is precancerous and needs to be monitored by a gynaecologist .”
Dr Mildenhall said he was disturbed by the incident even though the patient was treated successfully with a steroid ointment .
“ There were no side effects from the overthe-counter antibiotics , but it was still a delayed diagnosis , and I have been in touch with colleagues with similar experiences ,” he said .
‘ She was prescribed medication … But she came to me because the symptoms were getting worse .’
“ The other side to it is they are calling the trial a success . But were these errors picked up ? It ’ s unclear ,” he added .
Maybe his patient ’ s experience was an outlier case . Maybe the other 7000-plus women , who
NEWSPIX
How the Queensland Government ‘ s script scheme works
Pharmacists can prescribe trimethoprim , nitrofurantoin or cefalexin for uncomplicated cystitis to women without a current script from their GP .
Patients must not be pregnant and aged between 18 and 65 to be eligible for the trial .
They are charged a fixed amount of $ 19.95 for the consult : an amount based on what was judged the typical out-of-pocket cost for a GP consultation .
The fee for any treatment prescribed is left with the pharmacist / pharmacy .
Under the protocols , women must be referred on if assessed by a pharmacist as having symptoms that are not associated with a UTI .
Pharmacists must refer patients to a doctor if UTI symptoms have not resolved within 48 hours of starting the prescribed antibiotic ; recur within two weeks of completing the antibiotic course ; or are assessed as not being symptoms associated with UTIs .
each paid $ 20 for their pharmacy consult , were all eventually assessed , diagnosed and treated safely and effectively , including the 13 % cohort .
But could the evaluation methodology used for the trial capture Dr Mildenhall ’ s experience ? Or would it be missed ?
He said he was never asked to fill out any survey to document what had happened or to give his views of what , to many , would constitute an adverse outcome .
As Australian Doctor reported when the trial was first launched two years ago , there are no public documents outlining its evaluation methodology , so no-one knows if it is any good .
For many doctors , the scheme is seen as part of a political fix to ensure nothing PAGE 10