Greater role for pharmacists in contraceptive management

woman looking at birth control

A new report has called for an overhaul of medical services offered to women seeking contraception, as researchers reveal that half of all pregnancies are unplanned.

And pharmacists could play a greater role in contraceptive management, it says.

The report by the Australian Healthcare and Hospitals Association, which was funded by MSD in Australia, states that inadequate Medicare rebates are one of the key reasons women are not offered more effective and less user-dependent methods of contraception.

The A Health System that Supports Contraception Choice report identifies unplanned pregnancy as “a key health issue for women in Australia”. It calls for increased Medicare funding for contraception services, including the extension of Medicare items to include nurses working in GP clinics who insert and remove different types of long-acting reversible contraceptive devices.

“The current Medicare Benefits Schedule review process is an opportunity to address this, ensuring that MBS items reflect best contemporary practice,” said CEO of the Australian Healthcare and Hospitals Association, Alison Verhoeven.

Dr Deborah Bateson, Medical Director at Family Planning NSW, told a Women’s Health Summit in Sydney that “while the pill remains a useful contraceptive option, it is important for women to be informed about long-acting reversible contraceptive methods and be able to easily have one inserted if this is their choice”.

“Use of the pill is high in Australia, however oral contraceptives rely entirely on the woman remembering to take a pill each day which can make them less effective in the real-world than most people assume,” she said.

“In countries like Sweden, one in four women use a long-acting contraceptive. This compares to one in ten in Australia. There appear to be several reasons for this difference, including a lack of awareness, as well as misinformation about these effective methods of contraception which can be used by most women.”

Dr Philip Goldstone, Medical Director for Marie Stopes International, Australia’s largest provider of pregnancy termination services, says that long-acting reversible contraceptive methods have the potential to significantly reduce unintended pregnancy compared with the more commonly used contraceptive pills.

“Despite this, our experience is that currently only a quarter of women chose a long-acting contraceptive after a termination. A lack of awareness and education is a major barrier to changing contraceptive methods,” he says.

“However, in lower socio-economic areas the uptake of long-acting reversible contraceptives by women following termination is less than that in more affluent areas, suggesting cost barriers to reliable contraception may also contribute to this lower uptake.”

In addition to increased Medicare funding, the Australian Healthcare and Hospitals

Association report calls for:

  • Greater education of Australian women on contraception choice, including materials adapted for those with low literacy, or addressed to specific population groups.
  • A single ‘gold standard’ guideline across all health professions and practice environments to support use of appropriate contraception methods.
  • Increased training and involvement of nurses in the provision of contraception services, including the insertion and removal of long-acting reversible contraceptive devices.
  • An increased role for pharmacists in providing counselling on contraceptive options, most notably when dispensing emergency contraception (i.e. the morning-after pill).

The Women’s Health Summit, which is being attended by doctors, nurses and health policy experts with an interest in reducing the rate of unintended pregnancies, will be told that:

  • 200,000 unplanned pregnancies are estimated to occur annually in Australia.
  • According to one survey, the majority of women experiencing an unplanned pregnancy were using at least one form of contraception at the time of their pregnancy;
  • More than 80,000 terminations are estimated to occur annually in Australia.
  • Emergency contraception was dispensed by pharmacists on more than 600,000 occasions last year alone.

Both the Australian Healthcare and Hospitals Association Report and Women’s Health Summit were supported through educational grants provided by MSD in Australia.

Pharmacists interviewed as part of the research report agreed that opportunities exist for greater involvement in contraception management. One respondent said that pharmacists could “be more proactive in discussing LARCs as an option for contraception with the provision of emergency contraception”.

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