What we’re seeing is not a UTI treatment trial but a dysuria detection trial, one GP said.
The long-awaited final reports from the NSW pharmacist-led prescribing trials for urinary tract infections have finally landed – and while patients were satisfied, there’s still no way to tell who was actually sick.
When pharmacist UTI prescribing kicked off in NSW, hot off the back of the North Queensland pharmacy scope of practice trial, it was pitched to GPs as having a “robust co-design process” and enhanced patient safety due to its status as a registered clinical trial.
The University of Newcastle was selected to run the trial.
Despite the final report from the trial not being publicly released until now, pharmacist prescribing for uncomplicated cystitis was made permanent in 2024.
The report looked at the outcomes of around 17,400 women treated at pharmacies across NSW and the ACT for symptoms of urinary tract infections.
Because pharmacists cannot order pathology through Medicare, urine testing was not performed at pharmacies.
“It’s not a UTI trial, it’s a dysuria trial – we don’t know who has got an infection,” AMA NSW general practice chair Dr Kenneth McCroary told The Medical Republic.
Instead, the trial’s success was measured by whether patients self-reported a total absence of symptoms one week after presenting to pharmacy.
By this measure, it was indeed a success; 79.4% of patients had no symptoms at seven days post-presentation and a further 17.9% reported partial resolution of symptoms.
Just 7.3% of patients who presented to a pharmacy with symptoms left without an antibiotic prescription.
This number is closer to 10% for patients who visit GPs; one of the key differences, though, is that GPs can request pathology.
The rate of self-reported adverse events was low, at 5.1%.
According to the report, it was also “highly unlikely” that the antibiotics prescribed as part of this trial would have any significant impact on antimicrobial resistance rates.
Dr McCroary said the threat of fragmentation still posed a large risk to patient safety.
“When a woman turns up here for her dysuria, then we do a urinary specimen and we send it away, so if … she’s just got blood and no infection, then [we can investigate] why she’s getting blood coming out of her bladder – does she have a cancer? Does she have an STI? We can do those screenings,” he said.
“They also get the opportunity to talk, and we can do other physical care like check her blood pressure and see when she last had her mammogram or breast check or cervical screening test.
“We look at their other health determinants – has she had weight loss? Is she eating and exercising? Is she high risk of diabetes? Is she risk of other poor outcomes?
“We miss all that when someone rocks up to a pharmacist, says ‘I’ve got dysuria’ and gets a script.”
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One thing the report did disprove, however, was the argument that pharmacist-led prescribing would help women who wouldn’t otherwise be able to access care.
The study population did not include any patients from MM7 areas, and there were just three patients from MM6 areas. Around 70% of patients were in MM1 locations.
Close to 40% of patients were from the most advantaged socio-economic quintile, and just 8.8% were from the most disadvantaged quintile.
“It’s more highly educated women in more affluent areas are accessing this sort of care,” Dr McCroary said.
“Which is interesting too, because it means they’re neglecting their holistic care with their GP, and that’s probably going to contribute to poor outcomes in those that group of women as well.
“But yeah – [the idea that] the richest, most educated women are the ones that can’t get access to GPs? How does that work, seriously?”
Nonetheless, the Pharmacy Guild of Australia has already seized on the report as evidence for wider scope of practice expansion.
“For many women, particularly those juggling work, family, and other responsibilities, going to a pharmacy is faster, easier, and more accessible than other options,” NSW branch president Mario Barone said.
“This is about putting patients first, removing barriers and ensuring they can get the care they need, when they need it.
“This is exactly the kind of reform our health system needs. It’s evidence-based, patient-centred, and cost-effective.”
