On August 4, WA joined QLD and NSW in the UTI pharmacy prescribing ‘trial’ though there is no sense of a temporary nature on WA Health website, where it lays down the legal and clinical requirements for local pharmacies taking part, as well as patient elimination criteria.
The RACGP (WA faculty) and AMA (WA) have jointly raised concerns about the trial, which will see pharmacists who have completed training requirements set by the Pharmaceutical Society of Australia and the Australasian College of Pharmacy, consult, prescribe, and dispense medication to women presenting with ‘uncomplicated” UTI symptoms.
The RACGP and the AMA both in WA and nationally have raised their ongoing concerns about the program. Here in WA, they have lobbied and participated in the trial working group in an attempt to mitigate some of the potential harms associated with pharmacy prescribing.
Of great concern was the effect of already worrying trends of antibiotic resistance, as was patient safety.
“While we cannot endorse this trial due to the potential harms, we want to make sure it’s as safe as possible for all the patients involved,” RACGP WA president Dr Ramya Raman said.
“Not all the risks can be mitigated. This is largely because there is no such thing as a simple diagnosis – GPs train for over 10 years before they diagnose patients and do ongoing training for their entire working life. Pharmacists aren’t trained to diagnose or prescribe.
“The best practice for UTI diagnosis involves urine dipstick testing as a minimum to determine if it actually is a UTI. This is one of the recommendations the RACGP and AMA WA put forward for this trial and any future trials.”
AMA (WA) President Dr Michael Page said there were still questions that remain unanswered about the trial, and rigorous evaluation of patient health outcomes was essential, which has been an enduring criticism of the QLD trial.
“There are still questions yet to be answered about the trial, one of the critical ones being how will it be evaluated? A rigorous evaluation of patient health outcomes is essential to ensure patient safety and the best health outcomes possible, and Western Australians shouldn’t settle for anything else,” he said.
However, the input of the two groups has shaped the WA trial. They presented local data that showed what antibiotics were efficacious and those that weren’t in various populations around the state.
It has led to the WA Health Department to limit the choice of antibiotics and in the supplementary information sheet for participating pharmacists, it says:
“In WA, E. coli urine culture susceptibility surveillance results show nitrofurantoin should remain effective >90% of the time. Trimethoprim is likely to be <80% effective.
“Nitrofurantoin should be considered as the first line antibiotic in this UTI program and…trimethoprim the second line choice. Please note that cefalexin is excluded from this program due to local resistance patterns.”
Dr Page said he was glad that the expert advice from the RACGP and AMA WA was accepted and the first-line antibiotic for the trial was changed to one that was likely to actually work in the West Australian setting.
However, the department fell short of mandating the use of urinalysis by dipstick but adds “the use of urinalysis is strongly advocated for by infectious diseases physicians, clinical microbiologists, and other doctors. It is routinely performed by many health practitioners as a bedside test.”
There will be a consultation fee, which appears to be $19.95 if WA follows the QLD model, plus the cost of the medication. However, sharing the outcome of the consultation with a person’s GP has been reduced to “pharmacists are encouraged to urge.”