Once again, a review of pharmacist prescribing has measured how many services were delivered rather than providing robust evidence that patients received safe, effective care, the Royal Australian College of GPs says.
The recently released evaluation of Tasmania's community pharmacy urinary tract infection (UTI) pilot recorded 6,534 episodes of care and found around nine in 10 patients were supplied antibiotics. But it did not adequately track the most important measure – whether patients got better and received safe care.
RACGP President Dr Michael Wright said the evaluation was not robust enough to determine whether the model delivered safe and effective care.
"Counting consultations and prescriptions tells us how much care was delivered. It doesn't tell us whether patients got better or whether the care was safe," he said.
"UTI symptoms can overlap with other conditions. If the diagnosis is wrong, patients risk receiving antibiotics they don't need while the real cause of their symptoms is missed or treatment is delayed.
"Every unnecessary antibiotic prescription contributes to the growing threat of drug-resistant superbugs. If we don't use antibiotics carefully, we risk returning to a time when a simple cut or infection could become life-threatening."
Dr Wright said the evaluation's methodology also limited the conclusions that could be drawn.
Just 120 patients responded to the survey, equivalent to 1.8% of all episodes of care delivered through the pilot. Of those who responded, one in five said they needed further medical care after treatment, with most follow-up care provided by a GP and one patient requiring hospital care.
"When fewer than two in every 100 episodes of care are represented in the patient survey, that is not a strong enough evidence base to assess safety and patient outcomes or guide major changes to healthcare," Dr Wright said.
"Before governments expand prescribing models, evaluations need to measure what matters most – whether patients get safe, effective care."
RACGP Tasmania Chair Dr Toby Gardner said the evaluation also highlighted problems with continuity of care.
More than one-third of pharmacists surveyed reported being unable to communicate with a patient's GP following treatment.
"Good healthcare depends on clinicians having the information they need to care for their patients," Dr Gardner said.
"When a patient's usual GP doesn't know what treatment or antibiotics they have received, care can become fragmented and important information can be missed.
"The evaluation also found some pharmacies had to close temporarily to provide private consultations, while pharmacists reported workforce pressures and difficulty providing other services at the same time.
"These findings raise important questions about whether this model can work at scale, particularly in rural communities already dealing with workforce shortages."
Only 82 of 397 endorsed pharmacists participated in the evaluation survey.
Dr Gardner said governments should expect stronger evidence before making decisions about expanding prescribing powers.
"Government-funded pilots should be evaluated to a standard that allows us to properly assess their benefits and risks," he said.
"Convenience and the number of services delivered are part of the picture. The most important test is whether patients receive safe, effective and connected care."
