Medical societies speak out against Queensland pharmacy pilot

Ciaran O’Mahony

Two medical societies have warned Queensland Health that its Urinary Tract Infection (UTI) Pharmacy Pilot will have serious health implications.

The pilot, which was recently extended until June 30 2022, allows pharmacists to prescribe antibiotics to women for UTIs, without any medical review or investigations.

The Urological Society of Australia and New Zealand (USANZ) and the Royal Australian College of GPs (RACGP) have cautioned that this approach poses numerous health risks, including delayed diagnosis of cancer.

President of USANZ, Associate Professor Prem Rashid, says UTIs are very common, but must be diagnosed through microbiological confirmation on urine testing.

“The importance of the mid-stream urine test in recurrent and chronic UTIs cannot be underestimated,” according to Rashid.

“This defines whether the patient has a bacterial UTI as opposed to other potential causes of similar symptoms and is also fundamental to ensure optimal and accurate treatment with the appropriate antibiotic,” he says.

USANZ President, Associate Professor Prem Rashid. Photo: Twitter.

Vice President of USANZ, Professor Helen O’Connell AO, shares Rashid’s concerns.

“Tracking of urinary white cells and epithelial cells is critical to assessment of patient progress and exclusion of a chronic state,” O’Connell says.

“It does not represent best practice for women to simply attend a pharmacist with symptoms which may or may not be due to bacteria and receive antibiotics which may not treat the bacteria present due to resistance,” she says.

UTI symptoms are similar to those experienced in a wide range of health issues, including bladder cancer.

It is therefore imperative that UTIs are correctly diagnosed to rule out other life-threatening conditions.

Photo: Science Photo Library via Getty Images.

“The symptoms of a UTI are common to a number of serious health issues, including bladder cancer, which is why a correct diagnosis of an UTI is necessary to rule out other potential health serious issues,” says Professor O’Connell.

“Blood in the urine and a burning feeling while passing urine are just two of the symptoms common to both bladder cancer and UTIs. More than 3000 people are diagnosed with bladder cancer each year, a significant number of these are women. This cancer is treatable if detected early but delayed diagnosis and treatment can compromise outcomes, and at worst may mean someone cannot be cured,” she says.

“Why should a common condition in women be redirected from medical care without long term proof of its safety?”

The RACGP says it welcomes an overhaul of the management of UTIs, but argues that the pilot is not supported by evidence and risks doing more harm than good.

RACGP President Dr Karen Price has “deep concerns about moves by the retail pharmacy sector to push through policy changes that put financial gains ahead of patient care and safety.”

“The trial in Queensland of pharmacists prescribing antibiotics for urinary tract infections is concerning,” says Price.

“One of the main problems here is that this trial is effectively an implementation trial. It’s not research on best practice and the results of the trial should be made publicly available.”

RACGP President Dr Karen Price. Photo: Twitter.

The pilot has been extended despite growing concerns around antimicrobial resistance resulting from the misuse or overuse of antibiotics.

While GPs have begun reducing unnecessary prescriptions of antibiotics, this Queensland Health initiative is seen as a threat to their efforts to tackle the problem.

Over 6,300 women have accessed this service to date.

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