Western Australia and the Australasian College of Pharmacy’s protocols were among the worst, an international study has found. But NSW’s offering made it to the top four.
Pharmacy prescribing is in the crosshairs again, as new international research shows a “deficiency in the quality” of most pharmacy-led UTI prescribing trial protocols.
Interestingly, one Australian protocol was among the best-ranked in terms of quality: NSW’s PATH-UTI.
But two other Australian trials were in the low-quality pool: the WA branch of the Guild and the Australasian College of Pharmacy’s protocols.
The review, published in the International Journal of Clinical Pharmacy last week, assessed 40 protocols allowing community pharmacists to manage acute, uncomplicated UTIs in 16 to 65-year-old women across Australia, the UK, Canada the US and New Zealand.
Almost a quarter of the examined protocols, nine to be exact, were Australian, from across all states and territories bar the Northern Territory and the ACT.
Over a third of the protocols, 15 in total, scored less than 50% on the study’s metric – the Appraisal Guidelines for Research and Evaluation version II – and were categorised as low-quality.
The metric assessed the protocol content on symptoms, differential diagnoses, red flags, choice of treatment, eligibility and follow-up, among other criteria.
Only 10% of the studies were regarded as high-quality, one of which was NSW’s PATH-UTI.
Similarly, only four studies provided recommendations on how to circumvent antimicrobial resistance.
“The findings highlight a deficiency in the quality of most clinical management protocols governing pharmacist-led urinary tract infection management,” the researchers said.
Last year, controversy erupted over pharmacy-led prescribing of UTI treatment in Australia after patients presenting to emergency departments in Queensland increased, rather than dropped, following the permanent implementation of pharmacy prescribing in the state in October 2022.
NSW, also somewhat controversially, permanently adopted the treatment of uncomplicated UTIs by pharmacists at the beginning of June this year, after the “successful completion” of the 12-month trial, as announced by the state’s Health Minister Ryan Park.
The decision on permanency was made prior to the completion of a comprehensive evaluation of the trial outcomes, which is not expected until early next year.
While sold as a move to take pressure off primary care, autonomous pharmacist prescribing has long attracted the ire of GPs.
RACGP NSW chair Dr Rebekah Hoffman previously refuted claims permanent pharmacy prescribing was a win for GPs in NSW, as it traded safety and quality for “an easy headline” and didn’t target the root cause of primary care workforce shortages.
“This risks misdiagnosis, worse health outcomes, and flies in the face of antimicrobial stewardship,” she told The Medical Republic.
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The international analysis recommended that pharmacy-led UTI treatment trials incorporated clinical protocols offering step-by-step guides for pharmacists.
“To reduce fragmentation of primary care and enhance patient health outcomes, consistency between protocols must be prioritised,” said the researchers.
“The delineation between medical and pharmacy practice presents a challenge for community pharmacists managing UTIs, raising concerns about patient safety and pharmacist competency in expanding their scope of practice.
“Establishing collaborative, high-quality clinical protocols may help clarify this debate by defining the boundaries between professions and guiding their respective roles and responsibilities.”
They also praised the use of IT platforms in Australia to integrate protocols.
Beyond Queensland and NSW, all other states and territories have now adopted their own versions of pharmacy-led UTI prescribing.
