An evaluation of Queensland’s controversial pharmacy scheme lacks scientific rigour, says the AMA.
Queensland Health has released its report on the outcomes of the state’s UTI pharmacy pilot, following numerous requests from doctors’ groups and media outlets, including Freedom of Information applications.
The report claimed the pilot “has successfully demonstrated the implementation and evaluation of a service that has reinforced the value provided to the health care system and patients by the accessibility of community pharmacy; and demonstrated that pharmacists have delivered safe and appropriate care that align to clinical protocols”.
While not questioning pharmacists’ professionalism in general, doctors’ groups have argued the pilot created roles outside their training, experience and scope of practice.
The report, by contrast, concluded “pharmacists have the appropriate skills, competencies and training to manage the empiric treatment of uncomplicated UTIs in the community pharmacy”.
It made only two recommendations.
“Pharmacists should have access to decision support tools within their pharmacy to reinforce patient and protocol choices,” it said, “and pharmacists should have an ongoing requirement to record clinical information about patient interactions in either a written or electronic form.”
The AMA’s Queensland branch president, Dr Maria Boulton, said she was very disappointed with the report.
“When you look at the report, it doesn’t actually read like a scientific study,” Dr Boulton told TMR. “There’s a lack of scientific rigour in it and it doesn’t really address the concerns we have about patient safety. There was a distinct lack of follow-up.”
The report was prepared by Professor Lisa Nissen who was seconded from QUT to Queensland Health.
However, it was also QUT that led the “consortium” of pharmacy groups, university teams and overseas partners that developed the pilot’s model of care and training requirements, supported by an advisory group mainly comprising pharmacy groups.
Three doctors’ groups were also approached when the advisory group began meeting in December 2019 but did not subsequently contribute to the design of the program.
“After the initial communication, the AMA (QLD) and ACRRM (QLD) declined to participate in the [advisory group], expressing their views about pharmacists and non-medical prescribing broadly,” the report said.
“Following their initial attendance at the first meeting, the RACGP (QLD) declined to continue their participation in the group, citing a number of items including their views on non-medical/pharmacists prescribing.
“The consortium, in consultation with the Department of Health, obtained other medical input into the advisory group. The terms of reference were amended to include ‘medical representative’.”
“I would have liked to have seen more independence,” said Dr Boulton. “This study was run by QUT and the report was written by QUT. Similarly, [patients] were followed up by the pharmacy where they received the services so there was really no independence in the report.
“I’d also would have liked to see the PSA [Pharmaceutical Society of Australia] more involved – they’re the ones that come up with all the practice guidelines and they have come out and said they believe a more collaborative approach is the way to go.”
Dr Boulton said the AMA fully supported greater collaboration with the pharmacy profession, rather than “independent prescribing by some”.
“Once again, I think it’s the government trying to keep up with an election promise,” she said, “but it raises a lot of questions, including the question of whether it’s worth putting patients’ safety at risk.”
Queensland Health was asked about the delay in releasing the report but declined to comment. QUT was also contacted for comment.
