‘You can’t just give out a pill and expect that that’s actually good medical care.’

packet of contraceptive pills on pink background

A leading doctor has criticised the findings of an Australian study which found a significant cost saving in downscheduling oral contraceptives to Pharmacist Only

The study, conducted by researchers at Macquarie University, used Household, Income and Labour Dynamics in Australia (HILDA) survey data which showed about 55% of Australian women aged between 15 and 49 use some form of contraceptive, with 33% of these using the oral contraceptive pill. The OCP was the most commonly-used method.

From this data, they calculated that “reclassifying OCPs resulted in 85.70 million quality-adjusted life-years experienced and costs of $46,910.14 million over 35 years, vs. 85.68 million quality-adjusted life-years experienced and costs of $50,274.95 million with OCPs remaining prescription-only”.

Dr Chris Zappala, Vice President of the Australian Medical Association, appeared on ABC’s News Breakfast with Virginia Trioli and Paul Kennedy and said the organisation is “very much opposed” to such a downschedule taking place.

Ms Trioli highlighted that the study was commissioned by the then Australian Self-Medication Industry (now Consumer Healthcare Products Australia) and asked what medical interest there could be in such a switch.

Dr Zappala pointed out that patients can currently obtain a script for a year’s worth of the OCP, and that in this time medical needs could change.

“So it’s worth having an opportunity to discuss that with a trusted, known, family general practitioner and also look at other contraceptive options,” he said.

“The second thing is that many GPs use what might, in some ways, be a brief consultation as an opportunity for preventive health. So, a skin check, a breast examination, a pap smear, and that opportunity really is very precious in people’s otherwise busy lives, and in busy general practice.

“And the third thing is that you really shouldn’t probably be just handing out a pill and a contraception like that without having some sense of people’s sexual history and understanding, for example, their STD risk.”

He said that “anything that shifts patients away from GP-centred care is not a good idea”.

When asked whether this opposition was due to “protecting their turf,” he said that the study required careful interpretation.

“Iin the same issue of the journal—the PharmacoEconomics journal that published this—it showed that the main reasons, when women were surveyed, that they choose their contraceptive method is based on the risks to them, the side effects and so on and how it might affect them, but also the frequency with which they must take it,” Dr Zappala said.

“And there are some methods of contraception that only need to be renewed or replaced every year or three years, and for many women that is something that is more convenient.

“We agree that there needs to be access to good-quality health care, of course there does.

“But you can’t just give out a pill and expect that that’s actually good medical care.

“It’s the conversation and knowing that individual properly that makes it good medicine, and that’s why the AMA is very much opposed to this.

“We need to keep people having those conversations with their general practitioner.”

Meanwhile Consumer Healthcare Products Australia welcomed the findings.

“Increased access to non-prescription medicines means that more Australians are empowered to practice Self Care with confidence and better self-manage their health,” said Dr Deon Schoombie, CEO of CHP Australia.

“The findings from Macquarie University should serve as a prompt for all key stakeholders to investigate whether it would be appropriate for oral contraceptives to ‘switch’ from prescription to non-prescription.

“Increasing access to non-prescription medicines, where appropriate, will substantially benefit consumers, healthcare professionals, government and industry.”

He said that both sides of politics have recognised the potential benefit of such a switch, with the Queensland Labor Government having instigated the trial for continued dispensing of oral contraceptives in April (a trial which has been repeatedly condemned by doctor groups).

Meanwhile Federal Labor had committed to tasking the TGA to investigate ways to increase access to oral contraceptives during the 2019 Federal Election, and the Liberal Opposition in Victoria committed to making oral contraceptives available over-the-counter during the 2018 State Election, Dr Schoombie said.

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