WA kicks off pharmacist prescribing

5 minute read

Meanwhile, Mark Butler has called out the Pharmacy Guild's latest ‘cynical scare campaign’ over 60-day dispensing.

Despite entreaties from both the RACGP and AMA, WA has gone ahead with a trial allowing community pharmacists to prescribe antibiotics for women presenting with what they believe is uncomplicated cystitis. 

It is the third state to do so behind Queensland and NSW. Since the beginning of this July, pharmacists in NSW have also been able to prescribe repeat scripts of the oral contraceptive pill, while Victoria also has a statewide pilot that will allow pharmacists to prescribe for UTI, oral contraception and mild skin conditions slated to begin in October.  

The RACGP and AMA said they had lobbied the WA trial working group to try and get urine dipstick tests added to the trial protocol so pharmacists could confirm whether patients had true cystitis before prescribing antibiotics.  

“While we cannot endorse this trial due to the potential harms, we want to make sure it’s as safe as possible for all of the patients involved,” RACGP WA chair 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 … [but] pharmacists aren’t trained to diagnose or prescribe.” 

Much like in the eastern states, pharmacists in WA must do a short course before they may begin prescribing and follow a set of exclusion criteria: all patients must be women between 18 and 65 years of age, have had no more than two episodes of acute cystitis in the previous six months and no diabetes or history of renal disease, among other things.  

The WA government selected the antibiotic nitrofurantoin as the first line treatment and trimethoprim as second line, citing recent urine E. coli antibiograms that point to nitrofurantoin as being the most effective antibiotic for empirical therapy in community acquired UTIs. 

“We’re glad that they accepted our expert advice and changed the first-line antibiotic for the trial to one that is likely to actually work in the West Australian setting,” AMA WA president Dr Michael Page said, adding that the association was still waiting to hear how the program would be evaluated. 

“A rigorous evaluation of patient health outcomes is essential to ensure patient safety and the best health outcomes possible, and West Australians shouldn’t settle for anything else,” he said.  

The lack of a rigorous, transparent evaluation was one of the criticisms levelled at the Queensland trial, which was evaluated and declared successful by a researcher seconded from the very team that developed and ran the pilot.  

The University of Newcastle, which is running the NSW pharmacist-led prescribing pilot, has committed to registering it with the Australian New Zealand Clinical Trials Registry. 

Even though the trial itself has now been up and running since May – and expanded from 100 sites to 1000 at the start of this month – it still cannot be found on the registry. 

The University of Newcastle told The Medical Republic last week that the listing was imminent.  

Any celebrations within the pharmacy sector over new and expanding trials, though, have been overshadowed by the spectre of 60-day dispensing.  

As fears grow that the federal opposition will move to block the extended dispensing legislation, Health Minister Mark Butler has brought forward negotiations for the eighth Community Pharmacy Agreement in order to deliver “business certainty” to pharmacies. 

The CPA is renegotiated by the government, Pharmacy Guild and the Pharmaceutical Society of Australia every five years and tends to contain commitments on the part of the government to fund or invest in community pharmacy programs.  

The guild welcomed the announcement that negotiations for the CPA had been moved forward by almost one year, but also said it was a tacit admission by the government that 60-day dispensing would damage community pharmacy.  

“The government has decided to bring forward negotiations for a new agreement by a one year, acknowledging they have got the implementation of 60-days completely wrong, and we need a new agreement before it is brought in,” guild vice president Anthony Tassone said.  

During the announcement in question Mr Butler acknowledged no such thing, labelling the guild’s recent claim that people in aged care would have to pay an additional $800 per year for their medicines a “cynical scare campaign”. 

“First, they said it would be unsafe and that was debunked,” Mr Butler said.  

“Second, they said it would lead to medicine shortages and all of the medicines experts debunked that scare campaign as well.  

“But I’m really shocked that … the pharmacy lobby and the Liberal Party have tried to scare vulnerable aged care residents that they would have to pay extra because of this measure to save six million patients from having to get their prescription filled every single month.  

“This is a cynical scare campaign from the pharmacy lobby that should be rejected.” 

Elsewhere in politics, Liberal Party Senator Hollie Hughes accused GPs of operating “as a pseudo union” in the face of 60-day dispensing. 

It’s understood that Ms Hughes was referring to the fact that GPs will have discretion over whether they write repeat scripts for 60-day supply or not.  

“They’re not writing the scripts for longer,” she told the Senate on Thursday.  

“So you can have the medicines apparently because your condition is stable for a longer period, but the GPs won’t write the script for longer periods, even though they are saying you are stable, because they want to clip that Medicare ticket but won’t bulk bill those people who are having to still go to the doctor.” 

Sixty-day dispensing is not set to begin until September.  

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