Trial misconstrued as ‘pro-life’


A trial where pharmacists would discuss contraceptive options with patients seeking EC has sparked a public backlash, with comments about “Bible bashing chemists” and “gatekeeping”

Pharmacy researchers have expressed disappointment at the way a new trial has been reported by the Daily Telegraph – and the way Australians have responded.

Monash University’s ALLIANCE trial— which is expected to see 21 pharmacies in NSW, Victoria and the Blue Mountains offering counselling and potential referral to women seeking emergency contraception or early medical abortion—has been granted nearly $2.5 million by the Federal Government.

The Daily Telegraph reported this headlined, “Talk before birth control… Pharmacists to offer counselling”.

“Instead of simply handing over the pills, pharmacists would instead ask if a woman would take part in a private-room counselling session on the available birth control options before referring them to a relevant clinic,” wrote chief reporter Linda Silmalis.

Gabrielle Williams, Victorian Minister for Prevention of Family Violence, Women & Aboriginal Affairs, tweeted her concern, saying the Government “pushes a not-so-subtle pro-life agenda”.

A social media storm ensued, with Australians referring to the trial as “paternalistic gatekeeping” and “a pharmacist asking humiliating questions in public”.

One person referred to “bible bashing chemists” and said they felt this was a return to the “dark ages”.

University Department of General Practice Head, Professor Danielle Mazza, said on social media that “The ALLIANCE trial will train pharmacists who have a private consulting room and support them to deliver contraceptive counseling to these women should they want to better understand their contraceptive options”.

She wrote that the trial hoped to “help women get access to contraception that works best for them”.

It is based on the successful BRIDGE-IT trial undertaken in Scotland, which saw increased uptake of long-acting contraceptive options.

Adjunct Senior Lecturer at the School of Primary and Allied Health Care, Monash University and NHMRC Centre for Research Excellence in Sexual and Reproductive Health in Primary Care (SPHERE)’s Safeera Hussainy told the AJP that the intent – and the likely mechanism, which is still being finalised – of the trial had been misconstrued and poorly reported in the mainstream media.

She said that while she and the research team were “thrilled” to receive government funding, she was very surprised at the reaction.

She said ALLIANCE refers to quality family planning services in community pharmacy, and expanding the scope of practice of pharmacists, while at the same time alluding to the therapeutic alliance pharmacists form with patients when they are providing medicines advice and information – as well as their alliance with GPs and local family planning and sexual and reproductive health care providers.

“It’s not like we’re trying to shove this down people’s throats,” said Dr Hussainy. “We’re trying to promote a public health policy.”

She highlighted that the finer details of the trial’s methodology still need to be determined, given the proposal has only just been given funding.

“You don’t necessarily work out [at this stage] things like, for example, how will that woman be made aware of her opportunity to engage in such a conversation? Is it going to be verbally done, or is there a tick box option on the form when she requests EC… or a leaflet in the bag?”

“They’re details we work through when we do the co-design workshop with consumer input,” she said, pointing out the significant involvement of consumer partners.

She noted that the uptake of long-acting reversible contraceptives is low in Australia, though “we know they are the most reliable form of contraception”.

“If women still prefer to be on the oral contraceptive pill or any other form, that’s of course her choice,” Dr Hussainy said.

“This is just another mechanism in the health care system to provide easier access to LARCS. Not many women are aware of them, and there are a lot of misconceptions around their use.

“This is just to educate them on their advantages, and break those myths, around side-effects, for example – it’s just another care pathway that we’re trialling.

“When I saw that Daily Telegraph article on Twitter, it was a huge shock to me – especially the headline.

“The headline completely misrepresents the aim of this trial and the role of pharmacists.”

The use of the term “counselling” is particularly problematic, she said, as it has different meanings in different settings.

“Counselling, to most people, means to seek psychosocial support from a psychologist, a therapist, a psychiatrist… it doesn’t usually refer to information about medicines use, that pharmacists give when supplying medicines.”

Dr Hussainy said the intervention point was also misinterpreted.

“The reason we chose emergency contraception or early medical abortion is that we’re trying to find an opportune time, when a person presents to a pharmacy, to flag these options for them, because we understand that it’s a stressful time, it’s a very difficult time for a lot of women, and pharmacists are already trained in handling these scenarios – and they already do.

“It’s an opportune time to get a woman thinking about long-term contraception if she desires.”

She said that participating pharmacists would be expected to utilise existing skills in determining whether or not such an intervention was appropriate.

Prof Mazza noted on social media, in response to a question, that the offer to discuss contraceptive options would take place after the medicine had been given to the patient.

Victorian branch president of the Pharmacy Guild Anthony Tassone also expressed concern about the way the trial had been reported.

“Initiatives that seek to explore ways that empower patients and help them receive more information about their treatment options from a health professional in a primary care setting are always worthy of further exploration,” he said.

“This is particularly when it can help increase collaboration amongst the healthcare team for the patient’s benefit.

“Pharmacists have never simply ‘handed over pills’ as medicines are not normal items of commerce. Their supply comes with professional and legal obligations of the pharmacist to act in the best interests of patients and they are accountable to their registration board in doing so.

“Some readers of initial media reports have questioned and perhaps misunderstood the term ‘counselling’ and whether it is appropriate that pharmacists do this. In the context of a pharmacist’s practice, ‘counselling’ refers to the provision of medicines information and other advice to suit the needs and enquires of the patient.

“As disappointing as it is to read some of the initial reactions by some individuals with reporting of this trial—it shows more needs to be done to help the public understand the role of pharmacists in our everyday practice.”

 

He said that this was despite the public being largely satisfied with the service they receive from community pharmacies and having a high level of trust in pharmacists.

“Pharmacists have been entrusted to provide emergency contraception without a prescription for over a decade and have done so by following a protocol that is underpinned by professional guidelines to ensure it is done so safely and appropriately for patients,” he noted.

“Like many of my pharmacist colleagues I imagine I’ve lost count of the times speaking with a patient they weren’t aware of other contraceptive options, the timeframe that emergency contraception is effective and what actions to take should certain adverse effects occur.

“As pharmacists we are not part of any not so subtle ‘pro-life agenda’, we are pro-patient informed choice and pro-evidence based.”

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