‘Substantial uncertainties and limited evidence’ for pharmacy prescribing

A SAX Institute report commissioned by the RACGP reviewed international and Australian evaluations of pharmacy prescribing models, finding weak and limited evidence to support and expansion of prescribing powers.

In WA, where hundreds of pharmacists are currently undergoing training to prescribe for a range of different conditions, there was no evaluation of the Enhanced Access Community Pharmacy Pilot (EACPP) program available.

Of the eight states and territories, only Queensland and Victoria had reports available on the evidence for pharmacy prescribing of some conditions. The ACT and NSW had an evaluation underway.

While the report found there was some merit in allowing pharmacists to prescribe more medications, including an opportunity to improve access, there was limited evidence to inform the development of robust policy.

“Substantial uncertainties exist both in international research and Australian grey literature in terms of clinical effectiveness, safety and health service implications,” the report stated.

“Broader evidence about pharmacy-delivered services, including independent prescribing, suggests well-designed interventions can achieve positive clinical outcomes under controlled conditions.

“However, concerns remain regarding patient safety, appropriateness of prescribing and continuity of care, particularly when communication with the patient’s usual general practitioner is limited.”

The report noted other concerns linked to clinical governance, overprescribing of medication, conflicts of interest and the potential to fragment the primary care system.

The RACGP said the report raised series questions about the lack of evidence underpinning the ongoing roll out of pharmacist prescribing across the country.

President Dr Michael Wright said expanded access to healthcare should never be at the expense of patient safety.

“GPs across Australia are seeing patients with adverse health outcomes or diagnoses missed after forgoing a GP appointment in favour of a pharmacy prescription. 

“This can look like a patient getting prescribed treatment for a urinary tract infection and then presenting to a GP down the track with chlamydia, gonorrhoea, pelvic inflammatory disease or even an ectopic pregnancy. We cannot take these risks lightly.”

Several states and territories have begun pharmacy prescribing for a range of conditions, but the report showed the bulk of these conditions had not been formally evaluated.

“We looked for high-quality clinical evidence that might support safe autonomous pharmacist prescribing but couldn’t find it. Then we asked state governments to give it to us, but they declined,” Dr Wright said.

“So, our last resort was to commission this independent report in case we were missing something. As it turns out, the evidence doesn’t exist and what does exist is limited or of very low quality.”

‘Report confirms our position’ – pharmacists

Despite the concerns raised in the report, the Pharmacy Guild of Australia said in confirms its position that pharmacy prescribing improves access to care.

National Vice President Simon Blacker said improved access means patients receiving treatment sooner, avoiding unnecessary delays and preventing minor conditions from becoming more serious health problems.

He said it backs up a recent Pharmacy Guild-commissioned report which suggested pharmacist autonomous prescribing could free up more than 10 million GP appointments and prevent more than 30,000 hospitalisations each year.

"What the report doesn't fully reflect is the extensive recent evidence demonstrating pharmacist prescribing is safe, effective and highly valued by patients,” he said.

“For example, the University of Newcastle's PATH‑Urinary Tract Infection study found that more than 17,000 women accessed pharmacist-led urinary tract infection care, with nine in 10 patients satisfied or very satisfied, 79.4% reporting complete symptom resolution within seven days, and pharmacists adhering to clinical protocols in 99% of consultations, demonstrating that community pharmacists can deliver safe, effective and accessible care for uncomplicated UTI.”

The Guild referenced 11 studies to back up it’s claim that pharmacy prescribing in Australia is safe. Three were undertaken in Australia, the rest were based on overseas models.