According to pharmacist and Senior Lecturer in UNE's School of Rural Medicine and Pharmacy, Anna Barwick, it's a significant breakthrough for women and an important antidote to the growing doctor shortage that has blown out GP waiting times and overwhelmed hospital emergency departments.
"This trial will predominantly assist women, giving them more control over routine health matters and more timely access to healthcare," Anna said. "Particularly in rural and remote areas, women can be left behind and experience poorer health than their city counterparts.
"I had a telehealth consult a few weeks ago with a woman who had a UTI for a week and couldn't get in to see a GP for another week. This is exactly where greater prescribing powers for pharmacists can save women a great deal of pain and more adverse health impacts."
Women, who number 2.4 million state-wide in the UTI trial's age range (18-65 years), are 30 times more likely than men to develop UTIs. In 2017-18 there were 76,854 hospitalisations for kidney infections and UTIs, and the hospitalisation rate among Aboriginal and Torres Strait Islander people was around double that of other Australians.
Anna is one of 18 chief investigators for the $3 million trial being co-ordinated by the University of Newcastle, which also includes partners from Macquarie University, the University of Technology Sydney and Charles Sturt University. Starting on 1 April, she and her UNE team will help implement the trial across rural and regional NSW, where more limited GP surgery and pharmacy opening hours present unique challenges.
"We will be visiting community pharmacies, supporting pharmacists to adhere to the trial protocols in their private consulting rooms, ensuring they undergo any additional training required and checking they are completing the required data collection," Anna said.
Data on patients, and when medications were prescribed or denied, will inform any future changes to the role of pharmacists in the healthcare system.
"In the case of UTIs, patients will have to meet strict criteria before they are considered for antibiotic treatment," Anna said. "If a UTI case is complicated, pharmacists will refer the patient to a GP for an urgent appointment, just as they have always done."
The involvement of patient advocates, Aboriginal and Torres Strait Islander representatives, antimicrobial stewardship physicians, health economists and medical research experts has informed the trial.
Still, it has not been without controversy. Members of the RACGP have called for its scrapping, raising concerns about patient safety and the risk of fuelling antimicrobial resistance. Royal Australian College of General Practitioners (RACGP) president Adjunct Professor Karen Price was quoted in The Guardian: "Healthcare is about more than just writing prescriptions and sending people out the door on their way. This alarming NSW scheme promises to be little more than a dangerous script writing service that puts patient safety in jeopardy".
However, Anna is confident that the risks are minimal.
"We have always prescribed pharmacist-only medication, and been able to differentially diagnose and start somebody on treatment," she said. "Pharmacists are highly skilled healthcare professionals and medication experts and need to be treated as such.
"Patients should always be at the centre of care. Pharmacists are not trying to replace other health professionals. It's about timely access to medications and hopefully relieving GP surgeries and emergency departments to concentrate on more complex patients and issues."
Many pharmacists already help women in need of emergency contraception. From 1 July, the NSW Government also intends to commence a trial allowing pharmacists to extend an original oral contraceptive pill prescription issued by a GP or nurse practitioner within the past two years.
"The UTI and oral contraceptives trials do not represent a massive expansion to our prescribing," Anna said. "COVID vaccinations illustrated the important role pharmacists can play when we work to our full scope of practice and I think we will continue to see that expand in certain areas."
