The Victorian government is making its pharmacist prescribing pilot program permanent, citing high patient satisfaction due to no out-of-pocket fees and shorter wait times, while just 18% of over 1300 GP respondents in a Healthed survey last week support this decision.
Days after announcing that the program would both continue and expand, the government released a glowing evaluation report that emphasised convenience and affordability over long-term, comprehensive care.
The pilot allowed pharmacists with additional training to prescribe certain Schedule 4 medications to treat shingles, uncomplicated urinary tract infections and flare-ups of mild plaque psoriasis, as well as to resupply select oral contraceptive pills without a prescription. They could also provide vaccinations for travel, as well as for hepatitis A, hepatitis B, poliomyelitis and typhoid.
Over the next two years, the program will be expanded to include type 2 diabetes, COPD, asthma, allergies and minor wound care, bringing the total number of conditions and services to 22.
Consultations are free for patients, as the pharmacies get a $20 payment per consultation, courtesy of the Victorian government.
(In the pilot, medication costs were also offset so that patients would pay the same amount as if they had a prescription from a doctor – but this medication subsidy ends from 1 July.)
The evaluation states that 97% of patients were satisfied with the care they received, with shorter waiting times, greater convenience and no out-of-pocket costs for the consultation named as key benefits.
The program incentivises patients and pharmacists to prioritise convenience and cost over continuity of care.
“It was amazing. Saved a $90 GP fee. Had medication within 10 minutes and killed off symptoms quickly, rather than waiting to get a doctor’s appointment,” one patient is quoted as saying.
The evaluation report notes that 87% of 3172 patients who were surveyed would have used a GP service if the pilot was not available; 5% would have gone to a hospital ED and 4% would not have sought any treatment or care.
Convenience was a major driving factor, with 41% of patients who completed the survey saying shorter waiting time was a key reason they chose to get care from a pharmacy.
GPs frequently cite fragmented care as a major concern with pharmacist prescribing, and the evaluation suggests this is not without merit.
Information sharing with GPs is listed as “an opportunity for improvement,” alongside increasing advertising and promotion of the program, expanding patient eligibility and available treatments, and addressing the shortage of pharmacists.
The report explains that although information sharing was encouraged, “the pilot did not mandate that pharmacists share details of patient visits with the patient’s usual GP, and privacy laws prevented them from doing so without patient consent.”
Likewise, no automated system was set up to share patient data securely.
According to the evaluation, pharmacists could generate a summary letter for patients to give to their GP, and 68% of pharmacists reported creating these. There is no mention of whether patients actually gave the letter to their GP.
Lack of comprehensive records could also create problems.
“If the patient does not have a My Health Record, and we do not have any patient history at our pharmacy, it can be hard to verify that they have been taking the same oral contraceptive pill for 2+ years,” one pharmacist who participated in the evaluation said.
Another prominent concern among GPs is that patient safety will be compromised.
The report claims safety is paramount and states that none of the reported adverse patient safety events resulted in serious harm (defined as needing life-saving intervention, shortened life expectancy, or permanent or long-term physical harm or loss of function).
There were 49 complaints out of more than 23,000 services provided during the 12-month pilot, and “issues of non-compliance were minor,” it says.
Regarding care for uncomplicated UTIs, 14% of patients went to seek further care for the same issues, which the report says is consistent with findings from international studies.
Patients, pharmacists and consumer advisory groups recommended expanding service eligibility, with the evaluation highlighting their complaints about the exclusion criteria that exist to reduce risks and ensure safety.
“UTI has such strict criteria that many patients don’t qualify which is frustrating,” one pharmacy owner said.
Source: Page 42 of The Victorian Community Pharmacist Statewide Pilot: Summary report on the evaluation findings and the first 12 months of operation
GPs in Healthed’s survey cited many concerns, including over-prescribing due to conflict of interest, misdiagnosis, less comprehensive and preventative care and more fragmented care.
The RACGP criticised the timing of the evaluation report and the lack of consultation, with Victoria chair Dr Anita Muñoz noting it “appeared to have been conducted with a foregone conclusion and ready-made plan in mind – expanding pharmacy prescribing.”
“If the Government was so confident that the evaluation report proved the worth and effectiveness of expanding pharmacy prescribing powers, they would have released it publicly months ago and given health experts and groups such as the RACGP the opportunity to properly review it.”
The Victorian Community Pharmacist Program will be expanded over two years to include the following conditions and services:
Source: Pharmacy Guild of Australia
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