Newcastle-led trials back pharmacist care for UTIs and contraceptive resupply

newy.com.au – University of Newcastle-led trials have found pharmacist-managed services for uncomplicated urinary tract infections and oral contraceptive resupply were safe, effective and valued by women, after more than 19,000 consultations were delivered through more than 1000 pharmacies across NSW and the ACT.

The final reports from the statewide trials, Management of Urinary Tract Infections by Community Pharmacists, known as PATH-UTI, and Resupply of Oral Contraception by Community Pharmacists, known as PATH-OC, provide new evidence on how pharmacist-led women’s health services could be designed, governed and monitored in NSW.

Funded by the NSW Government, the trials examined timely access to care, referral to GPs when clinically needed, patient outcomes, healthcare use and safety. The UTI trial involved more than 17,000 women aged 18 to 65 over 10 months, while the oral contraceptive resupply trial involved 1946 women over 12 months.

Chief investigator Associate Professor Sarah Dineen-Griffin, from the University of Newcastle and the HMRI Population Health Research Group, led a consortium of 13 partner organisations, including peak pharmacy and medical bodies, consumer organisations and universities.

“Our findings show that patients really value having pharmacists manage uncomplicated UTIs and oral contraceptive resupply, reflected in the high satisfaction reported across both studies,” she said.

“Women from cities, regional towns and most rural areas — accessed the services, and pharmacists referred them to their GP when required by the clinical guidelines.”

In the UTI trial, nine out of 10 women reported being satisfied to very satisfied with the pharmacy service, and 79.4 per cent reported complete symptom resolution within seven days. About 7.3 per cent of participants were referred to a GP or emergency department, while 99 per cent of pharmacist consultations followed clinical protocols.

Around 5 per cent of UTI trial participants reported common side effects and 0.3 per cent reported serious adverse events, a rate the report said was consistent with previous research. The data also showed no unexpected rise in antimicrobial resistance after the study.

The UTI service was used across metropolitan and rural communities, with 71 per cent of consultations in metropolitan areas and 26 per cent in rural towns. About 85 per cent of patients said cost would not limit future access to the service. Indigenous community members involved in the qualitative evaluation said they valued the convenience and access, while also highlighting the need for continuity of care, culturally appropriate support and alignment with programs such as Closing the Gap.

Economic modelling in the UTI report found a shift from GPs and emergency departments to pharmacist-led care could save the health system an estimated $2.2 million to $2.3 million a year, although some costs may move to patients outside trial conditions.

The oral contraceptive trial also recorded strong satisfaction, with participants reporting an average experience score of 91.6 out of 100. Women aged 18 to 25 were the most common age group, and 99.7 per cent of pharmacist consultations followed clinical protocols.

At seven-day follow-up, 99 per cent of women in the oral contraceptive trial did not report any side effects. Hospital use was low, with no hospitalisations or emergency department presentations for oral contraceptive-related adverse events. About 6.9 per cent of participants were referred to a GP, and about 7 per cent saw another healthcare professional in the first four weeks after their pharmacy consultation.

The trial found 77.8 per cent of oral contraceptive patients said cost would not limit future access. Indigenous community members valued the service for its convenience and rapid access, but also pointed to the need for continuity of care and tailored support. No participation occurred in remote or very remote areas, which the report said indicated a need for rural-specific solutions.

Both trials emphasised the importance of collaboration between pharmacists and GPs.

“Our interviews made it clear that trust between GPs and community pharmacists is essential,” Associate Professor Dineen-Griffin said.

The research was undertaken by the University of Newcastle, The George Institute for Global Health, HMRI, UNSW, UTS, UNE and CSU across NSW and the ACT. The multidisciplinary team included experts in primary care, collaborative practice, women’s health, Aboriginal and Torres Strait Islander health, regional and rural health, antimicrobial resistance and stewardship, and community pharmacy service implementation.

University of Newcastle Interim Deputy Vice-Chancellor, Research and Innovation, Professor Juanita Todd, said the work was helping shape primary care in Australia and could guide how pharmacist-led services are delivered for women’s health conditions.

Since 1 June 2024, pharmacists in NSW with suitable facilities and the required training have been able to continue providing consultations and prescriptions for the relevant medications after the trials closed.

Both reports are available here.