(Lee: Have you ever had a situation of a UTI, I know it might be an uncomfortable discussion but it’s one that many people are having at the moment, particularly a Parliamentary Committee that has been looking into whether or not UTI medication should be able to be prescribed or distributed by a pharmacist instead of a GP and it’s not just UTI medication, also contraceptive pills as well. Jayne Stinson is the Chair of the Select Committee that’s been looking into this… Good morning Jayne… So if this is rolled out in South Australia how will it work?) What the committee has recommended is that the scheme is available for women who are aged 18 to 65 and what it will mean is that right at the moment you have to go to your GP, you have to line up for an appointment, obviously pay for that before you can get a script and then head to your pharmacist. What we’re proposing is that you can go straight into your pharmacist, the pharmacist will screen you, have a consultation, a chat with you about your circumstances and if they think you’ve probably got a simple, uncomplicated UTI, then they’ll be able to prescribe you one of a range of antibiotics, but if they think that… things are a bit muddy here, maybe you’ve got some health complications or maybe you’re a bloke and you’re not eligible for the scheme, then they’ll send you back to your GP, so we think this is a way that will be much more affordable for women but also importantly, it will mean that they get medication faster and we know that this is a really painful condition, I experience it myself so I can tell you it’s quite excruciating and you really want that medication straight away, and if it’s untreated you can end up in hospital. (Beilharz: And so are they the key reasons behind why there has been recommended change? What’s the driver for change, access to medication?) Certainly the committee heard this is what women want, they want fast, affordable and convenience access to basic healthcare. The conditions really painful as I said, so they want to be able to cure their pain as quickly as possible, to be able go to work and look after their kids. We heard that a lot of women are taking days off work or can’t work if their self-employed so they’re losing money and that’s a situation we don’t want to see. We want to see women healthy… but also almost 9,000 people end up in our emergency departments each year with a UTI or a kidney infection, that’s a lot and we’re hoping that this measure might help alleviate that. Someone people who are queuing up in the ED in the middle of the night are there because they just need a table and hopefully, they’ll be able to get one from their pharmacy if they’re eligible under this scheme. (Lee: You mentioned only women, why wouldn’t men be eligible?) That’s a really important question. So the committee heard that for men, for children and for people aged over 65, there’s an increased likelihood of them having health complications or what’s called a complicated UTI, so not a straightforward infection that can be treated easily with the range of medications that we’ve put forward, so for that reason we think it’s best that those people still go and see a GP, that’s a sensible thing to do for their health to make sure it’s safe for them.
Dr John Williams, State President, Australian Medication Association (ABC RADIO ADELAIDE 7.17-7.19) Women's access to UTI medication from their pharmacist
(Lee: Let’s bring in Dr John Williams, he’s the State President of the Australian Medical Association, good morning Dr Williams … What’s the AMA’s response to this?) There is no way we can support this in any way. The science does not support this in any way. In fact, I’m extremely concerned because this is a negative impact on women’s health. This is second-rate care for women’s health. UTIs are not easy, UTIs are not simple, and prescribing antibiotics safely is a complicated process. (Beilharz: If pharmacists were provided with additional training though, if they were given more resources to be able to identify as you say if … someone has a simple UTI or if it becomes more complex, they can then refer back to a GP, does that alleviate some of those concerns?) No. … there’s lots of other things behind this that we’re deeply concerned about. One of those things is antibiotic resistance. This is a looming disaster for health for us all. So, antibiotic resistance needs to be managed very, very carefully. In fact, the guidelines for GPs around due ties [phonetic] have become stricter, testing things sure that we’ve got exactly the right antibiotic and it is an infection so that we give the person the right treatment and also don’t encourage antibiotic resistance. So, this is absolutely crucial. Antibiotic resistance is as looming disaster. I feel like I’m talking about climate 20 years ago, everyone saying, ‘where’s the science’ and ‘this is not happening’. We know now it’s happening and the same is going to happen with antibiotic resistance and so we are extremely concerned about this. Also, the argument around Emergency Departments, the latest figures from Queensland show that UTI presentations in Emergency Departments have gone up by 50% since the start of pharmacy prescribing. (Beilharz: So, in Queensland this is allowed where pharmacists can prescribe …)
Back to Jayne Stinson
(Beilharz: Jayne… as Chair of this Select Committee, did you look at antibiotic resistance because Dr John Williams says it’s a looming disaster.) We took on board their concerns that doctors had, we took them really seriously and we took about 7 months to investigate those claims and we just found that it just wasn’t borne out in evidence, so our committee’s not here to referee a turf war between pharmacists and doctors, our interest is in patient needs and we’ve obviously looked at the safety concerns that were raised. In relation to pharmacists, we found that they do already have adequate training and their accreditation bodies told us that, but nevertheless, we’ve gone the extra step and recommended additional training in things like anti-microbill resistance, cultural awareness and also the importance of referring to a GP where there isn’t clarity about a person’s symptoms and our anti-micro bill resistance we heard from experts in that field, the peak body in South Australia, SAGAR and they provided some expert evidence to us and certainly, we’re not wildly opposed to this measure going ahead. So, we have put in quite a few safeguards among the 29 recommendations that we’ve made, trying to address some of those concerns that doctors had but at the end of the day, this scheme has been working successfully for many years in Queensland and is now being rolled out across Australia and the evidence just doesn’t back up those concerns that John is raising. (Lee: So, you and the other 4 pollies on the committee listened to the AMA and said, actually we’re not buying your figures, we know more than you?) Well this was a bipartisan committee, so members from Labor and Liberal party and we unanimously reached the view that this was a measure that could be safely implemented in South Australia. We obviously took evidence from a range of different doctors organisations and individual doctors as well, but also other experts in the field and of course our job is to weigh that up and to present a report to the Parliament and we’re obviously recommending that this is something that can be done safely, with a number of safeguards and of course as I mentioned, limiting it to women who are aged 18 to 65.
Caller Darryl (ABC RADIO ADELAIDE 7.21-7.22) Women's access to UTI medication from their pharmacist
(Lee: Darryl from Largs Bay is on the phone, good morning …) Good morning … this is a very important issue and I think of people like myself with a disability that have experienced lots of UTIs because of the nature of paraplegia and similar disabilities. This is a silly thing because there’s a rampant amount of antibiotic resistance amongst the community of disabled people, the thing which would actually help most would be to be able to go straight to a pathologist if I feel the early symptoms coming on to get a specific result to see what drug would be the drug to use in that circumstance because you just create the resistance problems by doing it at as prophylactic and a general one fits all because often it’s just one specific drug for one specific bug that’s causing the UTI. So that would be the thing to do so I can go along to a pathologist, still go to my doctor and they’ll be able to tell me that it is a UTI and what drug will be the most effective. (Lee: Alright Darryl, thank you for the call.)
Caller Selma, Pharmacist (ABC RADIO ADELAIDE 7.22-7.23) Women's access to UTI medication from their pharmacist
(Lee: Good morning Selma, you’re a pharmacist?) I’m a pharmacist, yes, community pharmacist and a UTI sufferer myself who once ended up in hospital because I could not get hold of a doctor who had prescribed me antibiotics which is ironic when I’ve got the antibiotics sitting on my shelf at work… I think it’s great news for sufferers and female sufferers, especially in South Australia who now can get access to UTI treatments. Like Jayne’s mentioned, it is just protocols, guidelines that we’ll follow, as a pharmacist we see these patients presenting at our pharmacy every single day, we chat to them, we know exactly what they have, most times patients even know… and we’re having to turn them away with no help other than symptom relief… but that’s not fixing the issue and not fixing the infection. (Lee: Selma, thank you for the call.)
Back to Jayne Stinson
(Lee: Might just go back to Jayne Stinson very briefly … was there a suggestion at some point … that the contraceptive pill was going to be included in this as well? Where did that land?) Yeah well obviously our inquiry was focused on UTI, but we did have quite a lot of submissions of people saying they’d like to see the contraceptive pill more readily available from the pharmacist as well. So, we’ve recommended that, the Minister takes a look at that, particularly about resupplying the pill. So, not giving the initial script, that would still be done by a doctor, but there might be some, say, three year renewal period in which a script could be renewed, and women wouldn’t have to constantly go back to the doctor, paying a lot of money and waiting in a long queue to be able to get a medication refilled that they’ve been on sometimes for decades. (Beilharz: Ok, have you spoken to the Health Minister when you’ve been giving these recommendations? Do you know when you’ll get a response and a decision?) Well certainly the committee is independent of the Minister, but I tabled the report late yesterday and certainly have had discussions with the Minister. So, he’s going to take on board the recommendations and I’m hoping and urging him to implement this scheme as soon as possible. (Lee: Ok, Jayne Stinson, thank you for your time.)