General Practice best placed to advise patients on sexual health

The Australian Medical Association (AMA) has told the Therapeutic Goods Administration (TGA) that it strongly opposes any move to allow pharmacists to dispense oral contraceptive pills without prescription because of the risks it presents to patient safety.

A GP consults with a woman in her surgery.

Two proposals to make oral contraceptive pills (OCP) available at pharmacies without a prescription will be considered at a meeting of the TGA’s Advisory Committee on Medicines Scheduling in late June 2021.

AMA President Dr Omar Khorshid said the AMA is strongly opposed to allowing oral contraceptive pills to be dispensed over the counter because pharmacists are not trained to properly assess patients for key risk factors or provide advice on other, potentially more effective forms of contraception.

“Taking the oral contraceptive is not without risks and it is best for patients to talk to their GP about which contraceptive option is right for them,” he said.

“It can take time and expertise to determine which contraceptive option is right for an individual patient and this is best done under the advice of a doctor because pharmacists may not know a patient’s full medical history and are not qualified to assess whether the benefits of taking an OCP outweighs the risks.

“In fact, an OCP might not be the most suitable form of contraception for a patient. For example, intrauterine devices and implants are more effective forms of contraception.”

Taking an OCP may increase the risk of blood clots, stroke and heart attacks, all of which can be exacerbated if a patient is overweight or a smoker. Age can also increase the risk of adverse effects.

Dr Khorshid said a pilot study in 2021 had found that 96 per cent of GPs had diagnosed a secondary health issue when an OCP prescription was sought by their patient.

GPs also conducted preventative health checks and discussed wider and more detailed medical and personal circumstances of the patient, including mental health.

Dr Khorshid said pharmacies operate as retail shops and are not an appropriate setting to discuss intimate details of a patient’s sexual health and their detailed medical history.

“Patients may face additional out-of-pocket costs as Medicare will not cover these services,” he said.

Dr Khorshid said any move to make OCPs available over the counter would further fragment health care by excluding the patient’s GP from involvement in their patient’s sexual, reproductive and overall health.

Australia is moving to embrace the concept of the medical home, built around the proven model of comprehensive and coordinated GP-led care. This leads to better healthcare outcomes for patients, particularly when pharmacists work in conjunction with general practitioners, focussing on those areas where they are best equipped, including medication adherence, medication management, and providing education about medication safety.

AMA submission link can be viewed here

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