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NZRGPN responds to the UTI prescribing protocol for pharmacy

December 3, 2012

NZRGPN responds to the UTI prescribing protocol for pharmacy

The New Zealand Rural General Practice Network supports the exploration of new models of primary health care, but changes should be integrated within the existing system and not in isolation, says Network chairman Dr Jo Scott-Jones.

“This is a basic principle that must be applied whenever introducing changes to the health care system if we are to provide patients with ongoing safe, acceptable, affordable health care,” he says.

His comments follow the recent announcement that specially trained pharmacists can now sell a three-day course of trimethoprim to women aged 16-65 with uncomplicated UTIs who meet certain criteria. Earlier this year (May) Medsafe reclassified trimethoprim. Pharmacists at Amcal, Care Chemist, Life, Radius and Unichem community pharmacies this month began offering the service.

Dr Scott-Jones says pharmacists have a huge amount to offer the patient in the community and there is no doubt that they are underutilised at present, however this initiative is not the best way to make the best use of all they can do.

“The Network has been a long-term advocate for system changes that improve access to patients for care, best illustrated in the PRIME and rural ACC services, both of which demonstrate the expanded use of skilled nurses within primary healthcare teams.

“Utilising members of the primary health care team to the peak of their confidence and competence is a key response the system will need to make in order to address the growth demand for increasingly poorly resourced health care services in the future.

“There is a significant difference between this and the approach taken in development and implementation of the expanded use of pharmacy skills in both the administration of treatment for UTIs and the management of Warfarin in the community.

“The Network does not believe that these initiatives have taken any account of the need for care to be applied in a way that is integrated into the primary health care team with which the patient identifies.

“It is within the context of a primary health care team that patient safety, acceptability of care, and improved health outcomes and better value for money have been shown to be consistently improved.

“Fragmenting care by increasing the number of prescribers working independently of each other leads to increased health system costs, poorer long term outcomes, and compromises patient safety.

The safety of the pharmacist has to be considered too, says Dr Scott-Jones.

“For example, while cystitis is often a fairly straightforward issue, we still frequently find that urine results do not reflect the symptoms and bring up other issues.”

"This change is intended as a ‘Trojan Horse’ that will lead on to bigger changes in the future. The potential downstream implications of increasing access to prescription medicines outside of the current system has not been thought through well enough.”


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