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Bad medicine: Doctors lash government’s pharmacy-led health solution

A report used by Health Minister Yvette D’Ath to establish credibility for a state-wide women’s health program is “seriously flawed’ and hiding potential risks for patients who will encounter the service, according to doctors.

Jul 20, 2022, updated Jul 20, 2022
Health Minister Yvette D'Ath. (Photo: AAP Image/Jono Searle)

Health Minister Yvette D'Ath. (Photo: AAP Image/Jono Searle)

D’Ath has confirmed that soon all Queensland women aged between 18 and 65 will be able to receive advice and treatment for “uncomplicated” urinary tract infections (UTIs) through their local participating pharmacy.

The state-wide expansion follows a trial Queensland Health conducted which was dogged by controversy and claims from local doctors that pharmacists were misdiagnosing patients, missing life-threatening diseases such as cancer and dispensing unnecessary medications.

Despite the widely-held concerns from medical practitioners, D’Ath has described the trial launched in June 2020 as “incredibly successful”.

She has cited a QUT report as evidence “pharmacists and consumers were generally pleased and supportive of the scheme”.

AMAQ president Dr Maria Boulton told InQueensland the report lacked sufficient detail to confidently make those claims and support large-scale public health policy.

“It reads more like a customer satisfaction survey than an analytical report from a clinical trial,” Boulton said.

“When you’re dealing with people’s health and safety you really need that level of scientific rigour to inform your decision making.”

The national AMA president Dr Omar Khorshid, will be in Cairns on Wednesday with GPs from north Queensland, where he is expected to detail further problems with the scheme during a press conference outside Cairns Hospital.

Khorshid’s visit comes after AMAQ found 240 cases of complications from the state-wide UTI trial and nine hospitalisations.

The organisation says nearly every woman under the scheme was sold antibiotics, whether they were needed or not.

AMAQ is also concerned the State Government has proposed adding more complex conditions for pharmacists to diagnose and treat, such as hypertension, chronic obstructive pulmonary disease, obesity and type 2 diabetes.

The additional health conditions will be the subject of a north Queensland pilot, which could then follow the UTI model and progress to state-wide implementation without appropriate clinical investigation, doctors warn.

According to AMAQ, training for pharmacists prior to the UTI trial consisted of a two-hour online training module.

The model is also outside the guidelines of the Pharmaceutical Society of Australia, the Commonwealth’s Professional Services Review which oversees the Pharmaceutical Benefits Scheme, and federal legislation that seeks to keep the process of prescribing and dispensing separate to avoid financial conflicts of interest.

“There are good reasons why doctors prescribe and pharmacists dispense. It ensures that antibiotics and other medications are only given when absolutely necessary, without any financial incentive,” Boulton said.

The latest intervention by the AMA and its Queensland branch comes more than six months after peak medical bodies, such as RACGP, RDAQ, ACRRM and the QAIHC, exited the Health Minister’s steering committee in charge of the trial, leaving the Pharmacy Guild as one of scheme’s lead advocates.

The Pharmacy Guild, which represents large corporate pharmacy owners and is listed as one of Australia’s biggest political donors, has come under scrutiny for its apparent closeness to key decision-making out of D’Ath’s office amid pressure on the State Government to provide transparency in its dealings with lobbyists in the wake of the Coaldrake report.

Boulton said the ongoing tensions may be causing pharmacists to vote with their feet, with 817 pharmacies enrolled in the Queensland UTI trial, but more than one-third reporting that they offered no services at all during the 18-month trial, and only five provided more than 100 services.

“Our argument is not with pharmacists or pharmacy owners. It is with the Health Minister who withheld the evaluation report for months despite our repeated right to information applications, and has now decided not just to make the UTI pilot permanent, but to expand this to at least 23 more serious medical conditions across north Queensland,” she said.

Pharmacy Guild Queensland president Chris Owen has drawn attention to doctor shortages, particularly in rural and regional areas, and Covid’s relentless pressure on medical resources, as reasons why pharmacists were helping to advance primary healthcare.

“The nearly 9000 women who have accessed the UTI service since its inception are evidence that this service is in demand and provides positive health outcomes,” he said.

“Those women who don’t have access to a GP clinic or cannot book an immediate appointment due to the sudden onset of symptoms, will be able to access safe, effective and convenient care at their local community pharmacy for uncomplicated UTIs.

“In Queensland, 97 per cent of metropolitan and 66 per cent of regional patients are less than 2.5km from a community pharmacy. 

“The quicker a case of UTI is diagnosed and treated, the less likely the patient is to experience further complications that may result in hospitalisation. In 2018 alone, there were more than 20,000 potentially preventable hospitalisations in Queensland due to urinary tract and kidney infections.“

Brisbane GP Dr Stephanie Dawson-Smith, who has examined the QUT report’s methodology, said only 68 women completed the survey out of 7500 women who participated in the trial, leaving massive gaps in understanding how well the trial performed.

Of the 68 women who responded, she said, telephone screening was conducted by pharmacists first before they were sent a link to complete an online survey.

“So based on the opinion of 68 women, whose input may have been influenced by bias from pharmacists who stand to financially benefit from the scheme, all Queensland women will now be given the option of accessing this program, without any security that a full and proper risk assessment has been conducted and that the health minister has been straight with them,” Dawson-Smith said.

The Brisbane medico is also questioning why QUT would adopt a strategy open to selection bias that would potentially distort its findings.

“The evaluation follow-up questions didn’t ask women about important complications such as whether they had been given the wrong diagnosis or incorrect treatment or had to visit an emergency department or be hospitalised,” she said.

“A survey of over 1300 Queensland doctors (conducted by AMAQ) reported hundreds of adverse events related to the pilot, including missed diagnosis of cancerous conditions, pregnancy and severe STIs (sexually transmitted infections) as well as ineffective or inappropriate treatment resulting in preventable hospitalisations.

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“The pilot evaluation was not designed to adequately assess safety and efficacy. The evaluation appears to have been designed to provide positive conclusions rather than accurate conclusions.”

Dawson-Smith said 64 per cent of women in the pilot were not followed up, which may be hiding a significant number of poor results.

“We know that reasons participants can be lost to follow-up include having a serious complication or bad outcome, and so it is not acceptable to assume (as the authors did) that those 64 per cent of women had similar outcomes to the women who were followed up,” she said.

A spokesperson for QUT said the report was an evaluation, not a clinical trial. The spokesperson asked for further questions to be referred to Queensland Health.

A staffer from D’Ath’s office also referred InQueensland’s questions to Queensland Health’s corporate media team, which had not responded before deadline.

Boulton said the 18-month pilot was a missed opportunity to collect high-quality data about patient safety.

“This report has no scientific rigour and gives us no confidence that the UTI scheme is safe for patients,” she said.

“This has been touted as a way to make healthcare more accessible after hours and in rural and regional areas, yet the report shows that 85 per cent of services were delivered in major cities and large regional towns, and most were accessed Monday to Friday between 9am and 5pm.”

 

 

 

 

 

 

 

 

 

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