Qld UTI emergency presentations spike by 50%

Meanwhile, pharmacists in NSW have been given the go-ahead to prescribe the oral contraceptive pill.

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A year after making pharmacist-led UTI prescribing permanent, Queensland has seen a dramatic increase in women presenting to emergency departments with the condition.

According to the latest data from Health Minister Shannon Fentiman, there were around 37,000 presentations to Queensland emergency departments between 2022 and April 2023 (the exact date range wasn’t made clear).

Between 2018 and 2020, the number of emergency UTI presentations dependably sat at around 25,000.

2021 was a notable exception, with just 20,540 UTI presentations recorded in the state.

Queensland’s UTI prescribing pilot program began in June 2020 and allowed community pharmacists who took a short, online course to diagnose and prescribe for uncomplicated cystitis in women aged between 18 and 65.

The first-line treatment was a three-day 300mg course of trimethoprim and second-line treatment was a five-day course of 100mg nitrofurantoin.

In July of 2022, the program was made permanent across Queensland.

In the absence of another clear explanation for the sudden and substantial rise in emergency UTI presentations at that time, AMA Queensland joined the dots with pharmacy prescribing.

AMAQ president Dr Maria Boulton said the rise was a sign that pharmacist-led prescribing was “flawed”.

“This is not a criticism of our hardworking pharmacist colleagues, who we work with every day to get the best outcomes for our patients,” she said.

“It is a criticism of short-term, shortsighted political Band-Aids that will not resolve our health workforce shortage.”

Queensland was the first state to experiment with pharmacist-led prescribing, but it certainly was not the last.

Pharmacists south of the border in NSW were the next to pick up extra roles, kicking off a UTI prescribing trial at the end of July this year.

From today, the NSW trial has been expanded to allow pharmacists to supply the oral contraceptive pill to women aged between 18 and 35, so long as they have been prescribed the pill for contraceptive purposes by a doctor or nurse practitioner some time in the previous two years.

While the OCP component has been on the table for some time, it has not always been clear as to when it would kick off; it was always slated to begin after the UTI prescribing trial, but that was delayed by several months earlier in the year.

Media releases marking the beginning of the OCP trial have referred to it as being the second phase of the ethics-approved UTI trial led by the University of Newcastle.

“I am excited by today’s launch of the trial’s second phase, as early evidence from the first phase of the trial suggests we are seeing a very real benefit to patients through increasing the avenues available for treatment,” said lead investigator Dr Sarah Dineen-Griffin.

The OCP component is not mentioned in the listing of the UTI trial on the Australian New Zealand Clinical Trials Registry, nor could The Medical Republic identify it as a separate listing on the site.

It’s understood that the trial arms are being run separately; TMR notes that there was a gap between the first patients getting treated under the UTI program in May and the trial protocol being published on ANZCTR in late August.

Mr Park said the government would ensure that the “necessary evaluations” took place.

“This initiative is not only making it easier for people to access medicines, it is also alleviating pressure on our GPs and primary care services,” he said.

It comes two years after the TGA rejected an application from two hormonal contraceptive pill manufacturers to down-schedule the medicine, making them available over the counter.

“The adverse effects of oral contraceptive substances, and the potential for evolving risks over time, are significant and require management by a medical practitioner,” the regulator wrote in its interim decision, which it ultimately stood by.

Ultimately, the TGA cannot enforce the Poisons Standard and it is powerless to intervene when individual states and territories depart from it.

While NSW will be the first state to allow pharmacist-led OCP prescribing, both Queensland and Victoria have indicated that they will follow suit.

The statewide Victorian pilot will begin in October and incorporate prescribing powers for the OCP, mild skin conditions and UTIs.

Queensland’s upcoming version of an expanded pharmacy prescribing trial was initially set to occur in a limited, northern area of the state but was unexpectedly extended to the entire jurisdiction on Tuesday.

The AMAQ’s Dr Boulton said the process had been “secretive, not based in evidence, rushed and dangerous”.

While the decision to expand the trial was purportedly based on the success of the state’s UTI trial, Dr Boulton pointed out that the Office of the Health Ombudsman is still considering an open complaint about the conduct and outcomes of the pilot.

At this stage, the expanded version of the Queensland program will go live in March 2024.