Patients say it is convenient, but is it actually helping those who need it most?

Eight out of 10 women who saw a pharmacist to assess and treat their urinary tract infection symptoms reported positive experiences — with many emphasising the high level of convenience, an evaluation of the NSW government sponsored clinical trial into the management of uncomplicated UTIs by community pharmacist has found.

The evaluation by the University of Newcastle was released this week – long after pharmacist prescribing for uncomplicated cystitis became permanent in NSW in 2024.

But while the report is overwhelmingly positive, not everyone is so sure.

RACGP President Dr Michael Wright said the evaluation had failed to provide the necessary clinical outcomes and should not be relied on to develop policy.

“It involved an unrepresentative patient cohort, lacked a clinical control group, and was more focused on measuring the dispensing of medicines rather than whether patients received the healthcare they needed,” Dr Wright said.

“These limitations make the evaluation findings too premature to base policy decisions on.”

Is it really improving access?

Pharmacist prescribing has been promoted as a way to improve access – but despite high levels of satisfaction among participants, uptake has been highest in women with higher socioeconomic status, as well as in urban areas.

“The service was disproportionately used by women with higher levels of education and for those residing in wealthier areas,” the report stated.

Specifically, 38% of participants were in the most advantaged quintile (based on their postcodes), while 9% were from the most disadvantaged quintile.

“The data shows that most patients accessed the service in metropolitan areas (72%), while being employed (80%),” the report also noted.

Participation generally reflected the proportion of pharmacies in a given geographic area. For example, the evaluators note that 14% of pharmacist consultations were in larger rural towns, which house 11% of pharmacies in NSW. But there was limited participation in more remote areas. Only three pharmacies in remote areas provided consultations – and none in very remote areas – although there are 17 pharmacies in remote and very remote areas in NSW.

How effective were the consultations?

The primary outcome of the 10-month trial was self-reported total absence of symptoms within seven days of accessing the service, which was achieved by 79% of nearly 15,000 patients who completed the follow up survey. Partial symptom resolution was reported by another 18%.

According to the report, symptom resolution rates in studies looking at physician-led care range from 67-95%.

In the trial, 93% of patients were prescribed antibiotics.

The rate of adverse events was 5%, with most being gastrointestinal symptoms related to the antibiotics.

The study did not have a comparison group to assess outcomes against usual care.

A significant proportion of patients went on to see their GP

Almost one quarter (23%) of patients who saw a pharmacist regarding a UTI saw their GP within seven days– a significantly higher proportion than the 7% who were referred to either their GP or the emergency department by the pharmacist.

In the 28 days after the pharmacy consultation, 43% of patients had seen their GP, according to MBS data analysed as part of the evaluation.

GP consultation rates also increased significantly in the six months following the trial compared to the 12 months prior (15.9 per 100 vs 11.6 per 100).

The reasons for the GP consultation weren’t available, but urine tests were ordered in 49% of GP consults that occurred within 0 to 2 days of the pharmacist consultation, 40% of those within 3 to 6 days, and 19% of those that took place with 7 to 28 days.

“Community pharmacists found the service feasible but emphasised the need for better integration with health systems, including information from pathology services and general practitioners,” the report stated.

Dr Wright said the trial helps us understand “how these models operate under tightly governed trial conditions,” but it “does not establish whether these services deliver better outcomes than GP-led care, reduce overall demand for the health system, or do so without compromising patient safety.”

Healthed survey results suggest unsatisfactory experiences are common

Meanwhile, three out of 10 GPs in a March Healthed poll also said they’d encountered unsatisfactory experiences with pharmacists prescribing for UTIs.

GPs recounted instances of misdiagnosis, including missed bladder cancer, leukaemia and other malignancies, renal calculus, thrush, herpes, chlamydia and other unspecified STIs. Many GPs were concerned that prescribing without urine testing was leading to antibiotic overuse and resistance.

Several had patients whose symptoms went unresolved after being given the incorrect antibiotic – leading to negative outcomes such as progression to pyelonephritis, prolonged antibiotics and discomfort, and even requiring hospitalisation.

There were also patients who had been prescribed multiple antibiotics when vaginal oestrogen would have been more appropriate, and several instances where the wrong antibiotic had been prescribed.

Some doctors described patients inappropriately prescribed trimethoprim without the pharmacist taking an adequate medical history or asking about pregnancy.

For more information

Read the final evaluation report here.