WA, Qld expand pharmacists' scope

Western Australia has expanded the role of community pharmacists following the success of uncomplicated urinary tract infection (UTI) treatment program that is said to have helped 7000 patients across the state.

The decision is a practical and logical next step towards a new network of pharmacists, who are appropriately trained and authorised to deliver care to more Western Australians for a broad range of acute specific conditions such as mild to moderate shingles, acne, dermatitis, musculoskeletal pain and inflammation, nausea and vomiting, and wound management, said a statement issued by the Western Australian Health Minister Amber-Jade Sanderson.

“Design, development and implementation will take place over the next two years, with the aim for pharmacists to deliver advanced care by 2027,” the statement said.

The announcement follows the commencement of the Queensland Community Pharmacy Hormonal Contraception Pilot aimed at improving access to hormonal contraception in order to reduce barriers to reproductive health care.

The Pharmaceutical Society of Australia (PSA) welcomed the pilot reminding participating pharmacists that they can now enrol in PSA’s Sexual and Reproductive Health Contraceptive Service – Queensland training program. Once completed, they can immediately begin offering the service to Queensland women.

PSA’s CEO Adjunct Associate Professor Steve Morris said, “PSA has worked closely with Queensland Health to certify our training program which uses case-based learning powered by artificial intelligence — a world first in pharmacist education. The simulated clinical environment uses the most life-like patient simulations possible to hone pharmacist communication and clinical skills in providing more timely and safe access to hormonal contraception.”

The Royal Australian College of GPs (RACGP) criticised the pilot saying that the move “may be good retail politics, but is unsafe health practice”.

RACGP Queensland Chair Dr Cathryn Hester said, “Prescriptions exist primarily to keep patients safe. The Therapeutic Goods Administration, or TGA, determines the rules for medicines to protect the health of Australians. Prescription medicines have potential side effects that are well beyond the scope of pharmacists’ training, and a six-hour course and minor pharmacy renovation doesn’t change that. This is a political decision, not an evidence-based health decision.

“Hormonal contraception is safe and appropriate for most patients, but it has many potential side effects. The TGA was asked to consider down-scheduling oral contraceptives and didn’t due to the potential for adverse events. To quote that decision, ‘Consumers can identify when they require (oral) contraception, but consultation with a pharmacist is not sufficient to ensure safety, particularly over extended periods of time.’

“A patient could be taking the same contraceptive pill for years, but that doesn’t mean it’s always right for them. The potential for risks changes over time, like if a family has a history of early age breast cancer, and new side effects can occur after many years. There could also be a better contraceptive option.

“A consult to review and issue a new prescription is not just about getting a script, it’s an opportunity to discuss safe sex, ensure a patient’s cervical screening is up to date and consider STI screening. Governments need to consider the second order effects of their decisions. You could have fewer unplanned pregnancies, but more people with STIs, which are already on the rise. All that is lost with this reckless approach.

“GPs do over 10 years of training to be able to diagnose patients, as well as ongoing training for the rest of our working lives. There’s no substitute for the care a patient receives from a GP who knows them, and you certainly can’t replicate that with a short training course and a rushed discussion in a pharmacy.”

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