Resulting misdiagnosis may lead to inappropriate patient referral or delayed treatment, which doesn't quash community concerns about pharmacy prescribing.
An error in the NSW Pharmacy Trial for skin conditions guidelines for shingles risks inappropriate patient referral and delayed treatment, say ophthalmologists.
In July, NSW started the NSW Pharmacy Trial for skin conditions, allowing participating pharmacists to prescribe treatment for eczema, shingle, impetigo and mild plaque psoriasis.
The plan attracted the apprehension of the Australian College of Dermatologists, who told The Medical Republic at the time that it was critical that models of care were underpinned by appropriate clinical governance and protocols.
“Some serious and malignant conditions can masquerade as common diseases of the skin,” they said.
“Misdiagnosis can lead to incorrect treatment, dangerous delays to appropriate treatment, and result in patients experiencing significant financial burden due to ineffective treatments.”
This week, the Medical Journal of Australia published a letter to the editor by a group of ophthalmologists outlining an error in the trial’s NSW Pharmacy Trial’s clinical practice guidelines.
According to the authors, while the guidelines on diagnosis of shingles (herpes zoster) correctly noted that “vesicles on the nose have been found to be predictive of eye involvement”, they incorrectly attributed this to herpes zoster oticus (Ramsay Hunt syndrome), rather than herpes zoster ophthalmicus.
While the impact of this may be limited by the fact that both diagnoses require referral to a GP or ED, it may still impact patient care.
“Although protocolised health care can prevent deviations from evidence‐based care, robust clinical standards are required,” said the authors.
“The current clinical practice guidelines risk misdiagnosis between two anatomically distinct entities, with potential consequences, including inappropriate patient referral and delayed treatment initiation, which would not serve to allay community concerns regarding pharmacist prescribing in NSW.”
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The authors said that this concern was communicated to trial investigators for further review on 25 September 2024.
In September, at the Pharmacy Guild conference, NSW Health Minister Ryan Park announced plans to expand the list of treatable conditions, attracting the ire of the RACGP and AMA.
The NSW Pharmacy Trial for skin conditions is due to close in February.
