The AMA has slammed pharmacies as “retail shops” where it is inappropriate to discuss sexual health, but the Guild says they’re “out of touch”
The Australian Medical Association has issued a statement about its submission to the Therapeutic Goods Administration regarding a potential downschedule of some oral contraceptive pills, saying it “strongly opposes” any move to allow pharmacists to dispense them without a prescription.
The doctors say that they are concerned about risks to patient safety and conflict of interest.
Two proposals to make OCPs available at pharmacies without a prescription will be considered at a meeting of the TGA’s Advisory Committee on Medicines Scheduling in late June 2021.
AMA President Dr Omar Khorshid said that pharmacists are not trained to properly assess patients for key risk factors or provide advice on other, potentially more effective forms of contraception.
“Taking the oral contraceptive is not without risks and it is best for patients to talk to their GP about which contraceptive option is right for them,” he said.
“It can take time and expertise to determine which contraceptive option is right for an individual patient and this is best done under the advice of a doctor because pharmacists may not know a patient’s full medical history and are not qualified to assess whether the benefits of taking an OCP outweighs the risks.
“In fact, an OCP might not be the most suitable form of contraception for a patient. For example, intrauterine devices and implants are more effective forms of contraception.”
He highlighted the issue of increased risk of blood clots, stroke and heart attacks which may arise with taking an OCP.
Dr Khorshid said a pilot study in 2021 had found that 96 per cent of GPs had diagnosed a secondary health issue when an OCP prescription was sought by their patient.
Dr Khorshid said pharmacies operate as retail shops and are not an appropriate setting to discuss intimate details of a patient’s sexual health and their detailed medical history.
“Patients may face additional out-of-pocket costs as Medicare will not cover these services,” he said.
Dr Khorshid said any move to make OCPs available over the counter would further fragment health care by excluding the patient’s GP from involvement in their patient’s sexual, reproductive and overall health.
The submission itself also discusses a potential conflict of interest in not separating prescribing and dispensing.
“Pharmacists would gain a direct financial benefit from prescribing OCPs which may bias their decision to prescribe without fully assessing patient suitability, their needs, and the risks and side effects of the medication,” it says.
The submission also notes that patients use OCPs to manage a number of conditions – such as endometriosis, bleeding disorders, period pain and acne – as well as to prevent pregnancy.
“Pharmacists will not be able to assist patients with prescribing OCPs if the patient has other reasons for needing the medication. This is due to scope of the proposal and because they are not medical practitioners who are suitably trained to diagnose and prescribe for these conditions,” it says.
Anthony Tassone, Victorian Branch President and National Councillor of the Pharacy Guild said that the AMA’s view was “out of touch” and not “patient-centric”.
He noted that the Royal Australian College of General Practitioners had been discussing the issue in the media a couple of weeks ago.
“Ho hum, it looks as though the AMA is ‘late to the party’ and has blared its entirely predictable criticisms of competent health professional colleagues, after the RACGP has had first swing,” he said.
“Unsurprisingly, the AMA have reassumed its believed righteous self-appointed role of deeming what other registered health professionals are or are not competent to undertake without regard to what the responsible registration and professional board believe in view of the practitioner’s scope of practice.
“Patients expect and have a right for their health professional team to collaborate and work together, not squabble and criticise one another over who has exclusive rights to provide safe and appropriate access to care.”
Mr Tassone pointed out that pharmacists are highly educated medicine and health experts and the most accessible healthcare professionals in Australia.
“The Guild supports pharmacists being able to manage the risks and contraindications for oral contraceptive use, as has been demonstrated throughout the COVID-19 pandemic when patients were unable to attend face-to-face appointments with prescribers and would require their pharmacist to complete the risk screening process prior to supply of continuation of oral contraceptive treatment,” he said.
“We know that many patients have greatly appreciated and benefited from continued dispensing and medication continuation provisions put in place during the COVID-19 pandemic for a wide range of prescription medicines including the oral contraceptive pill (OCP).
“It has become the difference between patients continuing therapy and treatment without interruption or not.”
He said that the use of a suitable screening tool, such as the globally recognised Medical Eligibility Criteria for OCP use, would support pharmacists in supplying oral contraceptive pills as Schedule 3 medicines.
“This system provides clear guidance on medical conditions that would warrant refusal of supply and patient referral to a medical professional for further evaluation.
“This system would be easily incorporated into pharmacy practice, and studies have shown that pharmacists can successfully identify patients without contraindications for hormonal contraception using this system, along with the measurement of blood pressure and body mass index (BMI).
“The requirement for patients who are stable on therapy to have a valid prescription for ongoing supply is creating an unnecessary barrier to access and can lead to treatment interruptions resulting in unplanned pregnancy.
“Unplanned pregnancy is a public health issue in Australia; an issue that improved access to oral contraceptives could address.
“The risk of developing venous thromboembolism (VTE) is highest in the first year of use. However, it is important to note that the risk of developing VTE is higher during pregnancy and immediately following giving birth than it is in patients taking the OCP, and therefore unintended pregnancy can pose a greater risk of VTE to a patient than the use of the OCP.”
Mr Tassone said that the Guild acknowledges that there are risks associated with the use of OCPs and supports the risk mitigation strategies outlined in Appendix M in the scheduling framework including supply only for continuation of treatment, only after the first 12 months following initiation of treatment and regular clinical review by a prescriber or pharmacist.
“If used correctly the OCP is highly effective at preventing pregnancy, with a failure rate of 0.3% annually. The effectiveness of the OCP reduces when used inconsistently or incorrectly, with the failure rate increasing to 9% annually.
“Difficulty in accessing the OCP in a timely manner can result in treatment interruptions or ceasing of continuous treatment which leads to inconsistent use and non-compliance.
“One of the identified barriers to individuals being able to access the oral contraceptive pill in a timely manner is the requirement for a valid prescription.
“It is important that if the OCP is to reach its maximum efficacy it must be taken without interruption.
“Whilst peak medical bodies can insist that patients visit them for all of their health needs and not utilise other health professionals within their scope of practice – this is not a patient centric view and out of touch with the realities of the challenges faced by patients in accessing care.”