I think it’s been a while since my last pharmacy-related post about something topical (and, no, not “topical” as in applied to the skin, but “topical” in the usual sense of the word). Can’t be entirely sure that I’ve ever written one, actually… Well, it doesn’t matter; I’m going to write one today. In this technological age, I’m probably a bit late pitching in my two cents’ now, but I’m busy, ok?
Over the week-end, I watched part of this talk show-type thing, and they were discussing a proposal received by the TGA to make the oral contraceptive pill (OCP) available in Australia without a prescription. For those of you unfamiliar with the Australian health system, the TGA (Therapeutic Goods Administration) is the organisation that determines what medicines are allowed in Australia and how they can be accessed (e.g. from a pharmacy with/without a prescription). It’s basically our equivalent of America’s FDA. Also, you can currently only access the OCP with a script, which, depending on how many repeats you are given, may allow you to have up to a year’s supply before seeing your doctor again.
There doesn’t seem to be an awful lot of information available publicly about the details of the proposal, except that pharmacists will need to get patients to complete a “minor questionnaire” and also measure their blood pressure before supplying the OCP. This is because there are some potential risks for certain people.
From what I gather, there’s a lot of opposition from doctors to this move. That’s kind of a given, though, since any move to give pharmacists more responsibility or an expanded role in healthcare is usually not taken well by doctors. And, ok, fair enough – doctors go through a lot of training to be able to do what they do. I would never suggest that my pharmacist training is enough to enable me to take on the roles of a GP. However, with the right training, I do believe that managing the supply of the OCP is something that pharmacists can greatly assist GPs with. Wouldn’t it be good to clear waiting rooms of people who are just there to get another OCP script, and allow GPs to focus on patients who need their attention?
Yes, I know there are benefits of having OCP patients visit their GPs on a regular basis, and some women who take the OCP need GP attention too. That’s precisely why I’m not advocating a “down-scheduling”, but rather something along the lines of increasing the expiry of OCP scripts. If, for example, a script written for an OCP was valid for three years, instead of the current one year, it would still be up to the patient’s prescriber to decide whether they want to give them two repeats or eight repeats (or however many repeats they judge to be appropriate for that particular patient).
If the TGA wants to proceed with down-scheduling, I reckon there will need to be more than just a “minor questionnaire” in place to prevent inappropriate supply, and to also ensure timely referrals. Yes, some guidelines or mandatory training would be great, but it shouldn’t stop there. Perhaps there should be some sort of an agreement between the patient and their pharmacy – an official document that helps ensure that the patient has received the appropriate counselling, and whereby the patient agrees to return to their doctor for regular reviews (time frame set by the GP? Maybe the GP should get in on this? There is the danger of making this more trouble than it’s worth… This is why I reckon the increased expiry and repeats thing could work better.)
Additionally, pharmacies will definitely need to provide private consultation rooms for this. Ideally this would be a separate room, and not just a table and a couple of chairs with a bunch of screens around them. Of course, I guess there is also the consideration of whether pharmacies will find it worthwhile to send a pharmacist out of the dispensary for 5-10 minutes for what could be just one sale (or just a referral and no sale). Pharmacies might end up asking for government reimbursements for these services.
I feel like the more I write about this, the more issues and problems I think of in relation to this proposal. I have hopes that this could be a positive step for the profession, but it needs to be done right. I remember a friend once told me about how, when she goes overseas, she can just walk into a pharmacy and buy any random OCP she wants – no questions, no forms, no history checks. The very thought of it still stuns me. Just have to remember that although we have rules and regulations in place for a reason, there may be equally valid reasons for these to be changed.