Pharmacist OCP prescribing ‘naive and potentially dangerous’


packet of contraceptive pills on pink background

A GP and academic has penned a piece in The Conversation saying that pharmacist prescribing of the oral contraceptive pill risks women’s health for several reasons

“In bypassing their GPs to get the pill directly from the pharmacy, women could lose out on reproductive health care and preventive health care more broadly,” writes Mark Wilson, Associate Professor, University of Wollongong.

He observes that the TGA recently held consultations concerning whether the OCP should be downscheduled to S3, with pharmacists saying this could reduce the need for GP presentations, thus providing convenience and lower costs for patients.

“But to continue to provide a high standard of reproductive health care, Australian doctors should still be required to prescribe the pill,” he writes.

“A GP consultation to discuss the pill requires considerable time taking the patient’s history, measuring her blood pressure and weight, and discussing contraceptive options.

“There may be a number of reasons a particular woman should not take the pill. A doctor will work with the patient to determine the choice of contraception that’s going to best meet her needs. The pill is only one of many modern contraceptive options.”

Women who use the OCP as their form of contraception require regular monitoring by GPs, he writes.

Women need a new script for an OCP each year, he writes, because of the side effect profile of OCPs, which can include “bloating, fluid retention, breast tenderness and nausea”.

“Serious complications from the pill are rare, but can include blood clots or, more rarely, heart attack and stroke.”

The risk of these events is increased when the OCP is prescribed “without regular blood pressure monitoring”.

“An annual GP consultation offers an opportunity to discuss and monitor any pill side effects, as well as each woman’s individual contraceptive needs.”

Mr Wilson also discusses fragmentation of care and opportunities to discuss women’s health issues such as obesity and domestic violence, as well as potential adverse effects from such a downscheduling, identified in the same study which showed that the move could save the health system $96 million each year and potentially 22 lives over 35 years.

“But they also acknowledged possible adverse health impacts from rescheduling the pill. These include 122 more cases of sexually transmitted infection, 97 more cases of depression, five more strokes and four more heart attacks each year.”

“It is naive and potentially dangerous to attempt to separate the potential health and cost benefits derived from pharmacy access to the contraceptive pill from the health and cost benefit of comprehensive reproductive and broader health care provided for women in the primary care setting,” he writes.

“Australian pharmacists are not trained to conduct consultations regarding contraceptive options and reproductive health. These are more appropriately conducted in mainstream general practice, or in specialised women’s health clinics.

“But pharmacists do know a great deal about the range of contraceptive medications that are prescribed by doctors, and have an important role in educating women about correct medication use and potential side effects.

“Education by both GPs and pharmacists is vital for Australian women to understand the diverse range of contraceptive options available to them, and how their informed choice of contraceptive method can best fit into a healthy lifestyle during their reproductive years.”

Dr Wilson is one of a large number of doctors expressing concern about such an initiative: following the study’s release, Dr Chris Zappala, Vice President of the Australian Medical Association, told ABC’s News Breakfast that “you can’t just give out a pill and expect that that’s actually good medical care”.

The AMA has also strongly opposed the Queensland pharmacy trial, which will see pharmacists given limited prescribing powers over the OCP as well as other medicines.

After the AMA moved that it call for an “urgent and immediate” end to this trial, Queensland Pharmacy Guild state president Trent Twomey expressed disappointment, telling the AJP that at the grass-roots level, doctors were supportive of the trial.

Read Mark Wilson’s full article in The Conversation here.

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