Medical indemnity firm Avant is calling on the federal government to hit the brakes on pharmacist-led prescribing until it decouples consultation remuneration from medicine supply.
A new analysis of 16,000 closed claims and complaints handled by Avant over the past five years found that one in six involved a medication-related claim.
In 90% of those medication-related claims, prescribing was the primary issue.
Schedule 8 opioid medicines where the most common subject, followed by Schedule 4 psychotropic medicines.
Avant chief medical officer Professor Steve Robson said it had surprised even him to see how commonly prescribing was cited as the cause of complaints against members.
“Prescribing rarely happens out of the blue,” he told The Medical Republic.
“Prescribing happens at the end of making a diagnosis and planning the management for somebody. In fact, many of the issues come from getting the diagnosis right in the first place.
“Our members clearly are experienced. They often have the benefit of investigations; they can examine a patient and so on. And even with those safeguards around making a diagnosis and then deciding how to initiate a treatment, it ends up leading to complaints.”
Doctors also had the benefit of a pharmacist checking their prescription at the point of dispensing.
“We’re really concerned that pharmacists and their indemnifiers don’t understand just what a source of risk [prescribing] is,” Professor Robson said.
“Pharmacists will not have the benefit of all of the investigations. They probably won’t be able to examine a patient. There’s no second check after they write the prescription.
“It puts them at great risk.”
Related
Another insight from the Avant data was that while both refusing/reducing a prescription and over-prescribing were common sources of complaints against doctors, regulatory assessments were much more likely to find that the doctor had met the standard of care in cases of refusing/reducing a prescription.
Just 3% of cases where the complaint was about a doctor refusing, ceasing, or reducing the dose of a medication ended in the prescriber being found to have performed below the standard of care – but this figure was 56% for cases of overprescribing.
This is relevant to pharmacist-led prescribing because in the 2023 evaluation of Queensland’s UTI prescribing pilot, around half of participating pharmacists indicated that they would have found it difficult to charge a consultation fee if they did not supply a medication.
“Any expansion of prescribing must consider whether the model makes the decision not to prescribe more or less difficult,” the Avant report read.
“Where the same business earns the consultation fee and the sale, a pressure exists that no individual professionalism removes.”
The medical indemnifier also noted that, last month, state and federal health ministers agreed to develop for consideration a National Decision-Making Framework to promote national consistency in prescribing scope of practice.
Until the framework was developed, Avant said, the government should put a pause on any further expansion of autonomous prescribing.
It also recommended that the framework decouple consultation remuneration from supply of medicine, arguing: “a framework that pays for the consultation regardless of the outcome protects the decision not to prescribe and protects the prescriber who makes it”.
Other requests from Avant included keeping Schedule 8 drugs outside of pharmacist prescribing programs, requiring real time prescription monitoring records to be operational before expanding scope, and tasking the Australian Commission on Safety and Quality in Health Care to set and test national prescribing criteria.
The post Scope expansion legally risky as well as unsafe: MDO appeared first on Medical Republic.
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