Push for pharmacist prescribing trial in NSW

The Pharmacy Board of Australia has announced new work on pharmacist prescribing as another state moves to initiate a urinary tract infection (UTI) pharmacy prescribing pilot.

Last week (6 October), the Board announced accreditation standards for pharmacist prescribing education programs would be developed, equipping pharmacists to prescribe autonomously with any emerging authorisations through state and territory medicines and poisons legislation.

With models of pharmacist prescribing such as the Urinary Tract Infection Pharmacy Pilot – Queensland (UTIPP-Q) potentially expanding into other jurisdictions, the Board said the accreditation standards will ‘facilitate these discussions in the public interest’.

The Australian Pharmacy Council has been tasked with developing the standards, which will involve extensive consultation with stakeholders including the public, pharmacists, governments and other health professions. 

The aim of the accreditation standards is to ensure high quality pharmacist prescribing courses by developing:

• standards for education programs on autonomous pharmacist prescribing 
• a performance outcomes framework for pharmacist prescribing program graduates
• a guide for supporting education providers to develop evidence of compliance with the accreditation standards.

The standards will be informed by the NPS Prescribing Competencies Framework, which sets prescribing expectations for all prescribers across health professions.

The Board announcement came as NSW Health Minister Brad Hazzard last week requested his department pursue a similar trial to UTIPP–Q to ease pressure on the state’s health system, as GP appointments, particularly in regional and remote areas, are increasingly hard to access.

‘There’s a very clear message from COVID-19 that pharmacists have been able to step up where needed to fill gaps,’ Mr Hazzard said.

‘There are parts of the state where it is extremely tough to get in to see a GP and there are some conditions, like UTIs, that I think lend themselves to the possibility of pharmacists having an expanded scope of practice.’

PSA backs expansion of UTI pharmacy pilot

Mr Hazzard’s comments echo PSA’s, which has long advocated for pharmacists to practise to the top of scope, including through prescribing.

PSA National President Dr Fei Sim told Australian Pharmacist: ‘The UTI pharmacy pilot in Queensland has shown the role that community pharmacists can play in managing uncomplicated UTIs’.

‘The involvement of pharmacists ensures access to care and treatments, at the same time triaging and appropriate referrals of cases requiring further medical assessment to GPs.’

The success of UTIPP-Q provides evidence to support the safety, effectiveness and impact of pharmacist prescribing to strengthen the primary healthcare system and patient outcomes, said Dr Sim, refuting criticism of the trial from medical organisations. 

‘Unfounded criticism is not only unhelpful to our profession, but also to patients and the sustainability of our health system,’ she said. 

‘We have had no reports to Queensland Health, and we’ve had no reports to the Ombudsman.’

DR Lisa Nissen FPS 

‘It is time that healthcare professionals across the sector put aside the turf wars and ensure all Australians have access to timely, equitable, high-quality care.’

Dr Sim said PSA unreservedly backs pharmacists to support patients suffering from uncomplicated UTIs by prescribing appropriate therapy, and in complex cases facilitating a timely referral to a GP.

We are ‘one country’, she said, so there is no reason for access to vary between locations.

‘Findings from [UTIPP-Q] provide sufficient evidence to support a national rollout of the program as a permanent service by community pharmacists.’

UTIPP-Q report data debunks criticism

During the conception of UTIPP-Q, medical organisations were invited to join the steering committee, said University of Queensland Professor Dr Lisa Nissen FPS, who led the pilot. 

But the offers were either declined or the organisations dropped out early in the process.

‘We know it’s political. [But] we thought it was very important to continue to have medical input [so] we sought an independent medical representative to be on the committee,’ Dr Nissen told a session at PSA22 about the program.

‘We’ve had a general physician, an internal medicine specialist, as part of our advisory group since that time.’

At the conclusion of the pilot, certain media reports claimed, ‘patients were suffering during the trial’ and pharmacists treated men and pregnant people, with nine patients ending up in hospital due to sepsis or kidney issues. 

But the Queensland University of Technology’s Outcomes Report found the pilot prevented almost 1,000 emergency department presentations. In fact, patients indicated they would have sought hospital treatment if the service had not been available.

The report also found that only four patients presented to emergency departments throughout the pilot, including two with unresolved symptoms, one with an allergy and one patient with appendicitis.

Alongside the Outcomes Report, an independent survey, released in May 2022, indicated that 239 patients had complications after seeing a pharmacist involved in the pilot, which Dr Nissen said the UTIPP-Q team took seriously.

‘It was important for us to go back and look at the safety [aspects],’ she said. ‘As researchers, a key part of this was to see if it was safe.’ 

The survey claimed 184 doctors disclosed post-trial complications, with 157 respondents providing details of their experiences.

Dr Nissen told a full auditorium at PSA22 that no reports or complaints were made through QUT’s reporting system. 

‘We have had no reports to Queensland Health, and we’ve had no reports to the Ombudsman,’ she added.

It is impossible to investigate these claims with no official complaints recorded, Dr Nissen said.

‘From the research point of view, we’ve done what we can to look at the safety,’ she said. ‘We’ve asked our medical colleagues to come forward with the clinical information … for us to look into, and we’ve not had any brought forward to investigate.’

To ensure appropriate clinical governance measures in the trial to support safe and effective patient care, PSA worked closely with Queensland Health during the pilot. 

‘The outcomes described in the evaluation report show these [measures] worked and serve as a model for broader rollout in the future,’ Dr Sim said.