Irish pharmacists are seeking to join Boots pharmacy chain in offering emergency contraception (EC) directly to patients without having to attend a GP. The previously prescription-only “morning after pill’ is now being sold in Boots following a one-to-one consultation with specially-trained pharmacists.
Since the new service was introduced on Wednesday, 12 January, it has been widely welcomed by pharmacists, family planning services, most health professionals and members of the public.
Although the Irish College of General Practitioners (ICGP) has voiced concern surrounding the quality of patient consultations, all parties agree that enhanced availability and rapid access to emergency contraception is a very positive development.
Boots is offering the EC service under a “patient group direction” (PGD), which was developed in Ireland by Dr Graham Marshall, Boots Medical Director. Boots already offer seasonal flu vaccination under a previous PGD.
While the Irish Pharmacy Union has campaigned for a number of years for EC to be available over-the-counter in pharmacies, without a medical director to prepare and issue a PGD on their behalf, the union’s 1,600 members cannot offer the service.
However, this situation may change in the near future, irishhealth.com has learned, as the IPU confirmed it is planning to recruit a medical director in the near future.
“I can’t commit to a date but we need a medical director and we are working to try to employ a medical director as soon as possible. There will be PGDs coming into our pharmacies but we can’t commit to an exact timeframe yet,” said Kathy Maher, a pharmacist in Co Meath and member of the Irish Pharmacy Union executive committee.
She said the new Boots EC service is “a very positive development” and one that has been available in the UK since 2001, as well as in the majority of other countries in Europe.
"It is important that patients get timely access to emergency contraception. More often than not the requests for emergency contraception are at weekends or on holidays when GP surgeries are closed. Pharmacies have extended hours, they don’t close for lunch, they work after six and on weekends, the access is there."
“A study in the UK found that, when women could access emergency contraception from their pharmacists, it was taken commonly within about 16 hours, whereas if a patient had to wait for a consultation with their doctor and a prescription and then go back to a pharmacy to have it dispensed, that can extend to 38 to 42 hours,” Ms Maher added.
While EC can be taken for up to 72 hours after unprotected sex, the sooner a woman takes it the more effective it is, according to Niall Behan, Chief Executive of the Irish Family Planning Association.
“What this initiative by Boots does is it allows women to access emergency contraception sooner. That’s the key issue. Allied to that is the fact that emergency contraception is such a safe drug, there really are no contraindications with it. There wouldn’t be any fear that it would damage health to women,” he remarked.
Dr Mel Bates, spokesperson for the ICGP, agrees that the College has no concerns about the safety of the emergency contraceptive pill but has some concern that its widespread availability could lead to overuse or misuse.
Mr Brehan countered this stating: “all of the evidence we have is that you’re not getting that sort of misuse - the vast majority of women see it as a back up to their regular contraception. We strongly recommend that it wouldn’t be used as a regular form of contraception, and part of the Boots protocol is to direct women towards a more stable and effective methods of contraception.”
He highlighted a widely-cited study on this issue, which was published in the British Medical Journal in 2005. The research found that the availability of EC from pharmacists did not lead to an increase in its use, to an increase in unprotected sex, or to a decrease in the use of more reliable methods of contraception.
“We have carried out smaller pieces of research in our clinic looking at who is going forward for emergency contraception and how soon after unprotected sex they are presenting. And one of the reasons we backed this new service offer by Boots is that we found that a significant number of women not taking emergency contraception at the optimal time, which is in the first 24 hours. The main issue seemed to be one of access.”
But the ICGP is concerned that pharmacists, who have less experience than GPs in patient consultations, may be biting off more than they can chew.
“There have been some mistruths in the media coverage since this initiative was announced about the concerns of doctors. The fact is GPs are not concerned either about the safety of the drug or how this will impact on our bottom line - in terms of the actual income, out of 14 million consultations a year, the number for emergency contraception is very small,” said Dr Bates.
“But the ICGP has some concerns surrounding patient consultations. Our pharmacy colleagues just don’t have the same level of experience or training in this area asGPs. Patients seldom come into our office with just one complaint. It’s the ‘while I’m here doctor’ scenario. GPs find it a challenge, we don’t get it right all the time, and I’d imagine Boots pharmacists are about to get a crash course in this.”
Mary Rose Burke, Chief Pharmacist at Boots Ireland, emphasised that as part of the service, in addition to providing emergency contraception, the pharmacist will provide advice on long-term contraception and sexual health, and will link in with family planning and sexual health clinics in each locality.
She added that each Boots pharmacy would retain the information relating to the provision of the EC service. “We keep comprehensive records in accordance with best pharmacy practice. If the pharmacist has any concerns about the suitability of the customer, he or she will refer her to her GP or family planning clinic,” Ms Burke told irishhealth.com
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