‘Instant’ prescription providers prompt warnings from GPs and pharmacists
Doctor and pharmacist peak bodies are voicing concerns about online services offering “instant” prescriptions to people who fill out a digital questionnaire, arguing they heighten the risk to patients.
Instant Scripts is one of several online platforms offering immediate prescriptions for medications such as pain management, steroid creams and anti-depressants by having patients fill out a digital questionnaire.
The developers of the Instant Scripts app call it a “safe” temporary solution when you cannot get to your doctor for a prescription.
But the Royal Australian College of General Practitioners (RACGP) and the Pharmacy Guild of Australia are both concerned a growing number of companies are trying to shake up traditional healthcare in the name of convenience.
Instant Scripts clinical director Dr Asher Freilich rejects suggestions their platform reduces the skill of prescribing to an algorithm or is seeking to replace GPs.
He said it served as a stop-gap for people “in a bind” by only providing 30-day prescriptions for Schedule 4 medications, not for drugs “of dependence or abuse”.
The platform works by patients picking medication from categories including antihypertensives, blood thinners and cholesterol on the Instant Scripts app, or via a pharmacy terminal, then answering a short questionnaire.
The results are sent to a GP to review and, if successful, a prescription is emailed to the pharmacy at a cost of $15. An original script is mailed out later.
The ABC had to answer five questions for Meloxicam capsules — an anti-inflammatory drug commonly prescribed for rheumatic diseases and osteoarthritis.
A minute later, a message appeared on the screen: “Your script request is successful. Script has been sent to the pharmacy.”
Asked how scripts could be approved so quickly, Dr Freilich insisted the online results are always checked by a doctor.
“There is no such thing as instant approval — it would be nice if that were available,” he said.
“The word algorithm refers to a series of medication-appropriate questions … but our results always go to a clinician at the other end.”
However, in the ABC’s case before the script arrived an employee at the pharmacy asked if it was a repeat prescription.
When told it was not, the pharmacist said the medication could not be dispensed.
Pharmacy Guild Queensland president Trent Twomey said generating a prescription without having a conversation with the patient first was a “worry”.
“While I have frontline clinical concerns, I’m heartened that there is a pharmacist who is ultimately dispensing that medication and having contact with that patient, even though the GP function is virtually non-existent,” he said.
“One company came to the Pharmacy Guild asking whether we’d endorse it — naturally we did not — and we’ve had multiple and regular conversations with Queensland Health about the legitimacy of this particular service.”
The guild believes pharmacists are better placed than a digital platform to help patients get the medication they need.
“Australians and Queenslanders have known for many years that they cannot [always] get access to a GP … whereas they can get access to their local pharmacist,” Mr Twomey said.
RACGP Queensland chair Dr Bruce Willett said there is a risk of misdiagnosis if people obtain first-time prescriptions after a short digital questionnaire.
“Someone I knew came in and wanted a quick script for antibiotics for [a particular condition], and it wasn’t that at all,” he said.
“It’s a minefield, really. Often people do know what they need, but very often they don’t — they get it wrong.
“We do try to look over the whole of the needs of the patient and, over time, build up a full picture of that patient and their family and social situations that allows us to better understand what’s going on.”
But Dr Freilich said “in 98 or 99 percent” of cases, Instant Scripts was only offering a 30-day repeat, not a first-time prescription.
“The patient goes through a series of questions that gauges suitability and eligibility based on clinical input, National Prescribing Service guideline criteria and Therapeutic Guidelines criteria,” Dr Freilich said.
He said medication was only dispensed via pharmacies, with “several hundred” across Australia involved so far.
“The pharmacies are enjoying the convenience of the platform.
“Even if it’s approved, there’s a time lag for the pharmacist to receive the prescription — it doesn’t go to the patient, it goes to the pharmacist — and the pharmacist then has the opportunity to cross-check it against the ID of the patient.
“At the moment, we have over 20 doctors on our team … but the service is growing very rapidly and we anticipate a very strong hiring drive within the next three to six months.”
‘Pursuing a loophole’
A Queensland Health spokesperson said it was aware of a number of online services such as Instant Scripts.
“These services are largely compliant with current regulations,” the spokesperson said.
“In Queensland, the provision of a prescription currently must be by fax, but by email will be supported in the new Medicines and Poisons regulation framework.”
Dr Willett said regulators have not kept pace with the growth of online health services.
“These services are pursuing a loophole in the legislation and it really does need to be tightened up,” he said.
“There is some room for disruption where the online one can be part of an existing relationship.
“All patients will do better with a regular GP.”
Dr Freilich said it was an evolving space and Instant Scripts was keen to work with regulators “to ensure a totally compliant platform”.
“We’ve been in constant contact with the guild and regulator.
“We’ve had the DHHS (Department of Health and Human Services Victoria) have a look at our processes and we’re in constant dialogue,” he said.
‘We need to improve access to care’
Pharmaceutical Society of Australia president Dr Chris Freeman said accessing medical care can be a challenge for some patients.
“I think we do need to work on ways to improve access to care for patients when and where they need it — and technology does offer opportunities for us,” he said.
“But we do need to be conscious to make sure that, ultimately, the service is both safe and effective for that person.”
Consumers Health Forum of Australia CEO Leanne Wells said digital prescribing might seem convenient, but it disrupted the flow of care.
“Consumer convenience needs to be balanced with care that supports quality use of medicine, particularly for patients with multiple chronic conditions,” she said.