Emergency contraception, sometimes misleadingly referred to as the ‘morning after’ pill, is used by women, and individuals presumed female at birth, to protect against unintended pregnancy. The need for emergency contraception might result from contraceptive failure (condom breakage, missed oral contraceptive pills), lack of contraception or sexual assault. Women seeking emergency contraception from their local pharmacist are sensibly trying to protect themselves from the potentially devastating consequences of an unintended pregnancy and they display a degree of bravery to seek out the support of health professionals. Contemporary pharmacists should be well trained to manage these consultations with empathy, compassion, and professionalism. However, these traits shouldn’t include stigmatising the patient through the use of intrusive checklists.
Oral emergency contraception entails provision of one of two different Pharmacist-Only medicines: levonorgestrel or ulipristal. These medicines are time-sensitive with their approved effectiveness limited respectively to 72 and 120 hours, following unprotected intercourse. To establish the therapeutic need, safety and appropriateness of the supply, pharmacists need to take sensitive and detailed personal, medical, menstrual, and sexual history from a patient. Required information includes how long since the unprotected sex occurred, whether there is any likelihood of unintended conception having occurred earlier in the same menstrual cycle, and detailed medical and medication history. To establish whether potential drug interactions or contraindications exist for either of the medicines, these questions (ideally) are asked during a private and consented face-to-face consultation.
Patient assessment checklists, requesting answers to some of these questions, were first established in Australia in 2004, when levonorgestrel became the first oral emergency contraceptive to become available without prescription.
Professional pharmacist organisations provided education for pharmacists and developed supportive documents, including guidelines and check lists, to help pharmacists best manage the newly available emergency contraceptive. Research on the use of checklists published a decade ago identified that the patient assessment check lists were well accepted by pharmacists and their staff.
However, in the decades since, generations of pharmacy graduates are now fully conversant in these medicines and well-trained in communication techniques to sensitively interview their patients without use of a physical check list.
Since 2022, guidelines for pharmacists on emergency contraception, published by the Pharmaceutical Society of Australia, have discouraged the use of a check list or form to gather information, acknowledging that patients and their representatives can perceive them as barriers to care.
It was disappointing to read of one patient’s negative experience following a recent pharmacy request for emergency contraception in which the use of such a check list, and the lack of acknowledgement and support offered in response to her honest confession of having been sexually assaulted, left her frustrated.
A pharmacist’s first priority is the health and wellbeing of the patient, as per the Code of Ethics for Pharmacists, and professional guidelines recommend offering support and assistance if there is reason to believe that the patient has been a victim of sexual assault. Patients may be encouraged to consult a doctor or sexual assault service and can be provided with information to access the National Sexual Assault, Domestic Family Violence Counselling Service on 1800RESPECT (1800 737 732) or at 1800respect.org.au.
Pharmacists must meet a multitude of legal and professional obligations in their everyday practice but simply handing a patient a questionnaire or check list form to complete somewhat depersonalises the interaction and lacks an individualised patient focus. It also treats emergency contraception differently to other Pharmacist-Only medicines, which include other emergency medicines such as salbutamol inhalers (Ventolin®) and adrenaline auto-injectors (Epipen®).
It is hoped that potentially stigmatising check lists are becoming a relic of history, being replaced by more empathetic in-person pharmacist history-taking and counselling, which should provide patients with sensitivity and support.
Denise Hope is Senior Lecturer in Pharmacy Practice in the School of Pharmacy and Medical Sciences at Griffith University. Denise has been a practising Pharmacist for over 35 years.
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