Evaluation? Evaluation? We don't need no stinking evaluation.
The fact that a trial evaluation hasn’t been completed yet has not stopped the NSW government from making the pharmacist-led prescribing program for urinary tract infections permanent.
State Health Minister Ryan Park made the announcement today, following what he termed the “successful completion” of a 12-month trial.
It’s unclear how Mr Park concluded that the trial was successful, given that – according to his own press release – the comprehensive evaluation is still underway.
This means there are no final figures on the number of women who required medical treatment after the pharmacist prescription, how often women were referred to other services or even how often antibiotics were supplied.
According to University of Newcastle evaluation team lead Dr Sarah Dineen-Griffin, the final report will not be provided to the Ministry of Health until early 2025.
All that is publicly known at this point is that the 1000 participating pharmacies treated around 16,000 women for UTI over the past 12 months.
While the trial being made permanent is not necessarily unexpected, it is quite telling that the decision has been made prior to the evaluation being released.
NSW was keen to market the trial as being more scientifically robust, and it was the only pharmacist-led prescribing trial to be registered on the Australian New Zealand Clinical Trial Registry.
The fact that it was running as a registered clinical trial was enough to keep the NSW AMA from outright condemning it.
AMA NSW president Dr Michael Bonning told The Medical Republic that the association would be keeping an open mind, but was disappointed that the government had pre-empted the trial evaluation.
“While the government wants to push on with this as a version of retail politics and wanting to be seen to address problems in healthcare … there hasn’t been a real outcome from a clinical trial yet,” he said.
“[There is nothing] to show that there is any genuine benefit at a statistical scientific level, as opposed to what is essentially anecdotal evidence that people can use a pharmacy as opposed to seeing a GP.”
Pharmacist-led prescribing for uncomplicated urinary tract infections will be made a permanent feature of the NSW health system from June.
Both Queensland and SA have already introduced their own versions.
Mr Park touted the permanency of the program as a win for primary care and said the NSW government was “committed to taking pressure off GPs”.
RACGP NSW chair Dr Rebekah Hoffman begged to disagree.
“The New South Wales Government knows it has workforce challenges, including of pharmacists, and it should tackle the root causes rather than trade safety and quality for an easy headline,” she told TMR.
“This risks misdiagnosis, worse health outcomes, and flies in the face of antimicrobial stewardship.”
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Pharmacy Guild NSW branch president David Heffernan also claimed the program would take pressure off GPs and hospitals.
“This UTI trial has been a success in providing affordable, accessible everyday healthcare with over 16,000 women treated across the state,” he said.
Whether it will remain affordable is also questionable.
During the trial phase, the state government was paying participating pharmacies $20 per patient consult and patients only paid out-of-pocket costs for the medicines they were prescribed.
From June, the government support will end and pharmacies will be able to set their own prices.
The concurrent trial of pharmacists prescribing the contraceptive pill will be evaluated separately.
