An error in the clinical practice guidelines of the NSW Pharmacy Trial for skin conditions may lead to misdiagnosis and delayed treatment for shingles patients, according to ophthalmologists. The error could result in inappropriate patient referrals and potentially worsen health outcomes.
Launched in July, the NSW Pharmacy Trial allows pharmacists to prescribe treatments for conditions such as eczema, shingles, impetigo, and mild plaque psoriasis. However, the initiative has drawn concerns from medical professionals, including the Australian College of Dermatologists (ACD). The ACD warned that any model of care must be backed by sound clinical protocols to prevent misdiagnosis and inappropriate treatment.
“Some serious and malignant conditions can masquerade as common skin diseases,” the ACD told The Medical Republic at the time. “Misdiagnosis can lead to incorrect treatments, dangerous delays, and significant financial burdens on patients due to ineffective therapies.”
This week, the Medical Journal of Australia published a letter from a group of ophthalmologists highlighting a specific error in the trial’s guidelines related to shingles (herpes zoster). According to the letter, the guidelines correctly note that “vesicles on the nose” are predictive of eye involvement, but they erroneously attribute this to herpes zoster oticus (Ramsay Hunt syndrome) instead of herpes zoster ophthalmicus.
While both conditions require referral to a general practitioner or emergency department, the confusion between these two distinct conditions could still have significant implications for patient care.
“Although protocol-driven healthcare can reduce deviations from evidence-based practice, robust clinical standards are essential,” the ophthalmologists stated. “The current guidelines risk misdiagnosis, leading to inappropriate referrals and delays in treatment initiation. This only intensifies public concerns regarding pharmacist prescribing in New South Wales.”
The authors of the letter informed the trial’s investigators of the issue on September 25, 2024, urging a review of the guidelines.
The trial, which is scheduled to end in February, also faced criticism in September when NSW Health Minister Ryan Park announced plans to expand the list of conditions eligible for pharmacist prescription. This proposal has been met with resistance from both the Royal Australian College of General Practitioners (RACGP) and the Australian Medical Association (AMA).
As the trial nears its conclusion, the potential for misdiagnosis remains a critical issue, raising doubts about the safety and efficacy of expanding pharmacist roles in patient care.
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