Missing an opportunity


Australian pharmacists may be missing a major opportunity to expand their professional role by being unaware of continued dispensing provisions

A survey of Australian pharmacists’ attitudes to medicine reclassification (ie. down-scheduling) has found they are generally supportive of downscheduling, but with serious reservations for medicines linked with risk of misuse or abuse. It has also revealed they consider opposition from medical professionals as the biggest barrier to downscheduling.

And, surprisingly, it indicates that there may be a widespread lack of awareness of pharmacists’ current ability to be qualified to provide continuation of supply, without further prescriptions, of oral contraceptives and statins. 

Speaking at the World Self-Medication Industry conference, held in Sydney this week, pharmacy academic Denise Hope said “surprisingly, given current continued dispensing indications, pharmacists identified both oral contraceptives and statins as potential candidate medicines for OTC switches.

“This really is more than a little surprising, and indicates a lack of awareness, and also probably that many pharmacists are missing an opportunity here if patient are requesting these medicines,” she said.

Ms Hope, from the School of Pharmacy and Pharmacology at Griffith University, Qld, and her colleagues surveyed 302 pharmacy staff (95% of them pharmacists) to ascertain their views on medicine ‘switching’.

The researchers found that 70% of the respondents said they were asked at least weekly for non-prescription access to a prescription medicine.

“Australian pharmacies are regularly asked for non-prescription supply of numerous prescription only medicines, the most frequently requested often align with those considered potential targets for reclassification such as antibiotics or contraceptives,” Ms Hope said. 

Antibiotics were the most commonly requested class, followed by analgesics, contraceptives, corticosteroids and Proton Pump Inhibitors.

The medicines pharmacists would most like to see available OTC largely mirrored this, with the exception of a much lower ranking for analgesics, over which respondents expressed concerns about addiction and misuse.

The medicines considered suitable for reclassification aligned with those available as non-prescription medicines in many overseas jurisdictions, for example trimethoprim for UTIs, Ms Hope said.

The survey also asked pharmacists what they saw as barriers to OTC switches, as “Australia has been identified as having fewer recent reclassifications and more barriers to reclassification when compared to the UK and New Zealand,” she said.

The primary perceived barrier to downscheduling, pharmacists believed, was opposition from the medical profession. The vast majority of respondents (89%) “agreed or strongly agreed that opposition from other health professional bodies is the major barrier”, the study found.

This was followed by: lack of patient medical history; risk averseness of medicines scheduling committees; complexity of the reclassification application process; and concern over medicine misuse or abuse.

The researchers recommended that there should be measures to increased awareness of continued dispensing provisions by pharmacists, and that regulators should consider expanding the medicines  available under continued dispensing to include chronic medications such as some anti-hypertensives.

They also said consideration should be given to other S4 provision pathways such as those available in the UK or NZ – such as accredited provision of oseltamivir or trimethoprim for UTI.

Pharmacy itself should identify and campaign for further potential S3 switch candidates, such as more potent or larger packs of topical corticosteroids, she added. 

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