I’m a doctor who’ll trust pharmacists to diagnose

The pharmacy trial in NSW is a mirror image of the successful trial in Far North Queensland which allowed pharmacists to prescribe a range of antibiotics to young women with urinary tract infection. The antibiotics used, trimethoprim and cephalexin, are among the safest and widely prescribed.

Claims that “patients will die” from such a trial are implausible. Wearing my infectious diseases hat, the prescription of an antibiotic such as trimethoprim has an excellent safety profile. Empowering health-literate young women to access rapid and effective treatment for a ubiquitous condition is a desirable health outcome.

The main risk is the misrecognition of serious pathology requiring urgent admission to hospital and intravenous antibiotics, or missing a different diagnosis such as sexually transmitted infection. However, the argument can be made that inability to access care is more likely to result in bad outcomes than misrecognition by a pharmacist.

Claims that pharmacist-prescribed antibiotics will drive antibiotic resistance ring a little hollow given the prescribing practice of many doctors. The most recent National Antibiotic Prescribing survey in residential aged care, which is firmly the bailiwick of general practice, showed that one in five antibiotic prescriptions were for prophylaxis (the prevention of infection), which is outside recommended guidelines and a known driver of resistance. By contrast, pharmacists have been the backbone of successful hospital-based antibiotic prescribing improvements over the past decade.

Neither position on safety and efficacy should be left to assertion by either profession in this debate. What is required is thorough investigation and safety analysis of these trials. While it is true that the Far North Queensland trial underwent evaluation and the results were positive, there is room for improvement in the design and rigour of the NSW pilot evaluation.

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But the response cannot be to swim against the tide of autonomous pharmacist prescribing. There are stark realities from a patient’s (and therefore a politician’s) perspective. Access to general practice is increasingly difficult in outer metropolitan and regional areas. Reform to improve access to GPs is likely to take years if not decades. And Australia lags comparable nations in allowing pharmacists to prescribe independently.

Politically these drivers are too strong for the AMA or RACGP to be successful in pushing back. Much better to have a seat at the table and argue passionately and constructively for a model that leverages our complementary skills as health practitioners and is safe for our patients.

Clinical Associate Professor Nick Coatsworth is a respiratory and infectious diseases physician at the Australian National University Medical School.

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