A/Prof Magdalena Simonis AM was invited to talk about the perils of ‘convenience store’ type Telehealth services, following the publication of a patient’s near miss with death, after seeking treatment for a UTI. Read the full RACGP article published 3 November, 2023 by Michelle Wisbey
What is your overall opinion on online prescribing, and do you think it can be done safely?
Online prescribing is not as safe a method of treating medical problems as using Telehealth or face to face with the patient’s regular GP.Despite its convenience and the ease of access, this demonstrates how inefficient and potentially dangerous this approach of managing common conditions such as a UTI can be. Online tick-box prescribing without a real-time patient–doctor consultation, fragments care, is not founded on the basis of an ongoing therapeutic relationship and the flow on from this is that it is not good medical practice.
Are you surprised by this patient’s story?
This patient’s experience is not a surprise and we have already seen the same with pharmacy prescribing in the Northern QLD UTI prescribing pilot. Since ‘convenient’ pharmacy prescribing has been enabled there has been a sudden steep climb in hospital admissions due to misdiagnosed or mismanaged UTIs resulting in sepsis, or STIs which were misdiagnosed as UTIs and inappropriately treated with antibiotics to which the bacteria were unresponsive. It is a warning to policy makers and politicians that fragmentation of care which does not take into account the differential diagnoses, the patient’s response to the treatment and the need for review the patient by an expert in health such as a GP, poses a risk.
Does it go to show the potential dangers if online prescribing is not done in an appropriate way?
The verbal and nonverbal exchange which occurs between a patient and the doctor who is familiar with them, will often provide further items of key information about the presenting complaint. It is not unusual for a person to associate their symptoms with what they already have had in the past, even if there might be a difference. UTIs are a classic example of this where a patient might have dysuria and frequency but in fact have an STI or an undiagnosed pregnancy. The need to come back/ call for review ‘if things don’t improve, or new symptoms develop’, is key to preventing such unfortunate and potentially lethal outcomes. Any such encounter should include the GP in a responsible patient-centred way.
What changes do you think are needed to ensure that online prescribing is done safely?
As a priority, patients should have the ability to access their GP or regular practice either for a face to face appointment or by Telehealth. Telehealth works well with a patient’s usual medical home as there is continuity of care, which means there is the option of scrolling through results of previous infections which can increase best guess therapy. This is usually in conjunction with a discussion around the efficacy of the treatment – such as, ‘you should feel much better within 12 hours and close to 100% within 48 hours. Call me or come in if you don’t’.
Where this is not possible, online prescribing should only occur to access medications by patients for existing medications for an ongoing chronic condition like hypertension and script renewals.
The appetite for online prescribing and diagnosis also comes from patients who are referred to as ‘consumers’ by the companies in the tech industry where these tools are designed. We know that when things go wrong, patients appreciate the importance of having a regular GP and this should be encouraged. However as these industries evolve, the key requirement should be that these encounters come with a recommendation for follow up with the patient’s usual medical home.
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