An Australian evaluation of international pharmacy-led UTI prescribing guidelines has found that only four protocols were high-quality.
The analysis included the Urinary tract infection treatment summary 2023 — published by the WA Branch of the Pharmacy Guild – which was among those found to be of lower quality, scoring below 50%.
Pharmacist-led management of urinary tract infections has been introduced as a service in the United Kingdom, Canada, United States of America, New Zealand and Australia.
However, the decision was controversial for the AMA and RACGP, which raised concerns that pharmacists would be working outside their scope of practice, resulting in unintended consequences for patients.
Lead author, Dr Mitchell Budden, from the School of Biomedical Sciences and Pharmacy at the University of Newcastle, echoed those concerns, noting that UTIs accounted for 1.2% of all GP consultations in 2015–16, 109,612 ED presentations in 2019–20, and 76,854 hospitalisations for kidney infections and UTIs in 2017–18.
“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,” Dr Budden said.
A grey literature search was undertaken for protocols intended for use by community pharmacists for the management of acute uncomplicated urinary tract infections in women aged 16–65 years – resulting in 246 documents.
However, after a comprehensive review of the full texts, only 40 CMPs met the criteria for inclusion in the review: nine of the protocols were published in Australia, 19 in the UK, five in Canada, four in the USA, and three in New Zealand.
“Professional organisations in the UK, NZ and Canada were also contacted directly for additional protocols that may have been excluded from the search due to them being hidden behind the front website pages of professional organisations,” Dr Budden said.
Their quality was appraised using the Appraisal Guidelines for Research and Evaluation version II instrument.
Content analysis identified ten key components: common signs/symptoms, differential diagnosis, red flags/referral, choice of empirical antibiotic therapy, nonprescription medications, nonpharmacological/self-care advice, patient eligibility criteria, patient follow-up, dipstick testing recommendations, and recommendations on antimicrobial resistance.
The lowest scoring domains in the quality assessment were ‘editorial independence’ and ‘rigour of development’.
“While the review demonstrated that clinical management protocols for pharmacist-led management of urinary tract infections consist of similar recommendations, despite variation in international practice, the findings also highlight a deficiency in the quality of most clinical management protocols governing pharmacist-led UTI management,” Dr Budden concluded.
“Establishing collaborative, high-quality clinical protocols may help clarify this debate by defining the boundaries between professions and guiding their respective roles and responsibilities.”
The study is available here.