Despite being pitched as a way to up accessibility, the NSW pharmacist-led contraceptive prescribing trial was mainly used by wealthy women in areas with more GPs.
The formal evaluation of the NSW pharmacist-led oral contraceptive resupply trial shows that it was mainly used by women who were highly educated, worked full time, and lived in affluent, metropolitan areas – a demographic which has not traditionally struggled to access care.
Released earlier this week, the University of Newcastle report looked at the experiences of around 2000 women who accessed a resupply of the oral contraceptive pill from a community pharmacy in NSW over a 12-month period in 2023 and 2024.
The trial was run concurrently to the pharmacist-led UTI prescribing trial, the final report for which was also released this week.
Even though the final reports were not made public until now, the NSW government has already moved to make pharmacist prescribing for cystitis permanent and has expanded the contraceptives trial beyond resupply.
The primary endpoint for the contraceptives trial was patient experience.
By this metric, it excelled; for the 1,751 consultations with self-reported follow-up data, the mean composite score of participants experience measures was 91.6 out of a maximum of 100.
According to the paper, this “suggests a high level of positive participant experience associated with the service”.
“Women commonly experienced the [oral contraceptive] resupply service as being ‘convenient’, and this was described in many ways,” the report said.
“Some saw convenience as the ability to walk-in without requiring advance planning or a making a booking.
“Others appreciated being able to access the service at a time that fit in with life schedules, with examples of longer opening hours allowing them to access their contraceptive supply outside of usual GPs or business hours, or times that aligned with shift work or lunch breaks.
“Women appreciated accessing care from a location that was close to their home, work, or other amenities such as an education facility or shopping centre. They also recognised there were more pharmacies than GP clinics.”
One participant said she found going to a pharmacy was “less repetitive” than going to the GP and having them tell her “the same thing every time, ask … the same questions”.
“It was just simple, over the counter… a lot more convenient and faster,” she said,
Around 92% of patients walked out of the pharmacy with a medication having been supplied.
Around 80% of participants hailed from an MM1 metropolitan area, and there was no representation at all from patients in MM6 or MM7 locations. Further to this, 46% of participants came from the least disadvantaged socioeconomic quintile.
AMA NSW GP chair Dr Ken McCroary told The Medical Republic that this did not sit well with him.
“[Part of the] hook of the trial was that it’s geared towards people that they said needed it for access, but the women using the service in the trial were those that live in areas with the greatest concentrations of GPs per head of population in the state,” he said.
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“It’s only been used by those that already have twice as many GPs than everybody else, which just confuses me a lot.
“I’ve got half the amount of GPs per population than a lot of these areas that use the service, we’ve got increased disability refugee Aboriginal Torres and stuff, but they seem to be neglected for these trials, so I don’t know if it’s so much going to make any difference to overall health.”
He said he was also concerned that the women who had been treated would have missed out on other opportunities for care.
“With women that age, and we’re supposed to be screening their diabetes from their previous pregnancies, we’re supposed to be screening their proteinuria and the blood pressure,” Dr McCroary said.
“… We’ll talk about CST, we’ll talk about STIs, we’ll talk about screening, mammography, et cetera.
“One woman’s consult takes me 30 minutes, at least, because we cover lots of different issues.”
He doubted that pharmacists would be able to jam this all into a five or 10-minute timeslot.
“There is a lot of stuff to talk about, but I can’t get any of that done in five minutes,” Dr McCroary said.
“So, hats off to the pharmacists that are so fast that Superman or the Flash would be proud.”
