Prescribing trials expand as health pressure bites

Greater prescribing powers for pharmacists has widened the rift between doctors who fear for patient safety and pharmacists who say it will ease pressure on Australia’s overburdened health system.

Both Victorian Premier Daniel Andrews and, as of Sunday, NSW Premier Dominic Perrottet have spruiked similar trials during their respective election campaigns, allowing pharmacists to prescribe antibiotics to women for urinary tract infections and refill contraceptive pill prescriptions.

South Australia is considering it after a similar trial in north Queensland, but Cairns general practitioner Aileen Travers is deeply concerned.

She says pharmacists in the trial misdiagnosed her patients, including a woman with chlamydia after a sexual assault, another who had a pelvis mass and a third who developed sepsis.

All three needed urgent pain relief after hours but told Dr Travers they weren’t comfortable describing symptoms in a shop to an unknown pharmacist within earshot of other customers.

“(A patient) said, ‘Well, what did they expect, that I was going to climb onto the pharmacy counter so they could have a look at my pelvis right there in the middle of the pharmacy?'” Dr Travers says.

“I just didn’t know what to say to her because that is what she needed.”

She says she has no way to check who prescribes what medication to her patients.

An AMA Queensland survey found sexually transmitted infections, cancers, antibiotic resistance and an ectopic pregnancy were missed during the initial trial, hundreds needed further care and some men were given antibiotics despite the trial being only for females.

However, a 2022 report by Queensland University of Technology Professor Lisa Nissen found the pilot in Queensland was “of significant value” to both patients and pharmacists.

The Pharmacy Guild has told AAP all consultations will always be carried out in private.

Chelsea Felkai, NSW president of the Pharmaceutical Society of Australia, stresses any issues uncovered in the Brisbane trial will be taken into account before it is rolled out in her state.

She says anyone with red flags will be referred to GPs and dismisses concerns it could create more antibiotic resistance.

“We’ll still receive payment for that (consultation) so we’re not leaning towards providing antibiotics unnecessarily in any way,” Ms Felkai tells AAP.

She says pharmacists are the most accessible healthcare professionals and likens the trial to prescribing antibiotic eyedrops or the morning-after pill, which pharmacists are able to do.

Monash University Senior lecturer Dr Zareh Ghazarian says taking the policy to an election offers several benefits.

As well as targeting female voters, he says it signals parties want to talk about health issues other than COVID.

“It is ultimately reducing barriers to healthcare and medical care and I think that is a very good news story any government or potential government can take to an election,” he says.

Everyone agrees GPs and the broader health system system is struggling but disagree on the solution.

Ms Felkai says too many women with painful urinary infections go to emergency rooms while waiting for GP appointments and patients should be able to get treatment in the meantime.

Urological surgeon Ashani Couchman disagrees, blasting the trials as a “knee-jerk reaction” that put patient safety at risk.

She’s worried pharmacists can’t do in-depth urine culture tests showing what drugs a person responds best to and would have no way to access previous cultures taken by GPs.

“I wonder about trying to get something to someone quickly, but doing it so that in the long term they might actually be worse off,” Dr Couchman says.

“The risk is actually quite considerable that the diagnosis might be wrong in the first place.”

Dr Couchman favours other options including greater prescribing powers for other clinical workers like nurse practitioners.

That will be trialled in Western Australia and examined along with pharmacy trials in NSW and Victoria, according to Federal Assistant Health Minister and former nurse Ged Kearney.

Ms Kearney has also left open the door for other health workers to be part of prescribing trials.

“We need to utilise our workforce to the absolute maximum capacity that we possibly can,” she told reporters on Tuesday.

“If we do that more people will access primary health care and we’ll be a healthier country for it.”


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