Pharmacist prescribing backed by ‘limited’ and ‘weak evidence’, report warns

A new report is casting fresh doubt over the evidence underpinning the nationwide rollout of pharmacist prescribing, identifying “substantial uncertainties” at the centre of the reforms.

Prepared by the SAX Institute and commissioned by the Royal Australian College of GPs (RACGP), the report was prompted by escalating concerns over patient safety as pharmacist prescribing expands to encompass more than 20 health conditions.

RACGP President Dr Michael Wright said the findings were deeply concerning, particularly in light of repeated claims that pharmacist prescribing initiatives were evidence-based.

“The RACGP supports increasing access to healthcare; however, this should never be at the expense of patient safety,” he said. “Coordinated care is vital, but GPs across Australia are seeing patients with adverse health outcomes or diagnoses missed after forgoing a GP appointment in favour of a pharmacy prescription.”

“This can look like a patient getting prescribed treatment for a urinary tract infection and then presenting to a GP down the track with chlamydia, gonorrhoea, pelvic inflammatory disease or even an ectopic pregnancy. We cannot take these risks lightly,” he added.

While every state and territory has now announced or commenced pharmacist prescribing for around 20 common and minor conditions, the independent review found that the overwhelming majority of these conditions have never been formally evaluated through robust clinical trials internationally, let alone in Australia.

Yet, recent modelling commissioned by the Pharmacy Guild of Australia has put a dollar figure on this contentious reforms, arguing that permanent pharmacist prescribing could deliver more than $1 billion in annual health system savings while helping to offset the shortage of general practitioners (GPs). To support that transition, it recommends remuneration for pharmacist prescribing consultations through the Medicare Benefits Schedule (MBS), PBS funding for medicines prescribed by pharmacists to prevent out-of-pocket costs, and integrated digital health systems that enable real-time communication between pharmacists, GPs and other healthcare providers.

The SAX Institute report makes clear that there is only “limited” and “weak evidence” to support the development of robust policy governing independent pharmacist prescribing in community pharmacy settings.

States and territories have pressed ahead with implementing pharmacist prescribing in community pharmacy settings before evaluation findings have been made publicly available. Only Queensland and Victoria have publicly released evaluations covering a limited number of conditions.

Dr Wright challenged State Governments and the Pharmacy Guild to publicly release full details of any robust clinical evidence or peer-reviewed trials and evaluations demonstrating that autonomous pharmacist prescribing is safe.

“This new report identified some evidence that pharmacist prescribing may improve access to medicines, but the evidence largely measured service uptake and prescribing activity rather than patient or health system safety outcomes,” stated Dr Wright. “Rolling out major changes to our health system without evidence that they are safe and effective is reckless.”

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