Year of Publication



Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. Min-Woong Sohn

Committee Member

Dr. Ty Borders

Committee Member

Dr. Frank Romanelli


Introduction: In November 2013, Scotland piloted a program in Grampian for the treatment of Urinary Tract Infections (UTIs) in community pharmacies, increasing health access for patients and reducing general practitioner workload. This program became known as ‘Pharmacy First’ and was later implemented nationwide in November 2017. This paper seeks to understand utilization of the Pharmacy First program across Scotland by patients and potential barriers to access.

Methods: Using data from the Prescribing Information System collected by the National Health Service of Scotland from July 2013 to April 2019, orders for uncomplicated UTIs were gathered by examining all nitrofurantoin and trimethoprim prescriptions dosed according to the National Institute for Health and Care Excellence (NICE) guidelines (allowing up to a maximum 7 day supply), including women 16-65 years of age (those who would qualify for Pharmacy First). Prescribing rates for UTIs by community pharmacists were compared to all prescribers, and rates were broken down by age, location by regional health board, and socioeconomic quintile based on 2019 data from quarter one.

Results: In Q1 2019, 12,628 UTI prescriptions were prescribed by community pharmacists in Scotland for women 16-65 years of age, comprising 19% of all UTI prescriptions in that group. In two of the first three health boards to have implemented the service, the numbers were even higher at 29%. Community pharmacists prescribed 23% of UTI prescriptions for women in the highest socioeconomic quintile and 16% of UTI prescriptions for women in the lowest socioeconomic quintile. Women 51-65 years of age received 31% fewer prescriptions from community pharmacists than women 16-50 years of age.

Discussion: Data suggests Pharmacy First has seen significant growth, particularly since its implementation nationwide in 2017. As earlier implementers have higher rates of Pharmacy First use, there is still room for growth nationally. Differences between socioeconomic status and age groups suggest that there may be barriers to access or issues in patient acceptability and preference.

Conclusion: These findings could be used to reinforce that the role of the community pharmacist can be enhanced in the diagnosis and treatment of uncomplicated UTIs with the potential for protocol extensions to other common conditions. There may be some differences in patient access and acceptability of such services, and this warrants further study.