NEWS 15
ausdoc . com . au 13 SEPTEMBER 2024
NEWS 15
| THE | WOMEN ’ S AND MEN ’ S HEALTH SPECIAL
State launches contraceptive pilot
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Rachel Fieldhouse PHARMACISTS in Queensland can now initiate 12-month scripts of depot medroxyprogesterone acetate injections , oral contraceptives and vaginal rings to patients aged 16 and up .
Launched on 8 August , the new pilot is open to pharmacists who have completed the full pharmacy pilot training through James Cook University or just a five- or six-hour hormonal contraceptives course .
Pharmacists will take patient
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history , assess STI risk , monitor blood pressure and discuss long-acting reversible contraception before prescribing , according to the pilot ’ s clinical guidelines .
The guidelines advise pharmacists to perform a clinical review 3-4 months after initiating contraception to screen for adverse effects , followed by yearly reviews , involving blood pressure checks .
“ Patients taking a regular contraceptive should have a review with a medical practitioner or other
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appropriate health service at least every two years ,” they state .
GP Dr Kathleen McNamee , the medical director of Sexual Health Victoria , said it was important to be open-minded .
“ Because contraception is such a time-sensitive thing , it is important to have options open to people ,” she said .
“ It is ideal for contraception to be part of comprehensive GP care , but it ’ s not always possible , particularly in some rural areas .”
However , RACGP Queensland chair
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Dr Cathryn Hester said any changes “ should be focused squarely on GPs being able to dispense these medications directly ”.
“ To further suggest that patients living in rural and remote areas should be happy to tolerate a lower level of care is frankly offensive .”
She pointed to the TGA ’ s 2021 decision to keep oral contraceptives S4 , which said pharmacy consultations were insufficient “ to ensure safety , particularly over extended periods of time ”.
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Dr Cathryn Hester . |
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Minister Butler ’ s real interest ? |
Why consider LAGEVRIO ?
Demonstrated efficacy 7 *
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In MOVe-OUT , LAGEVRIO reduced the risk for hospitalisation or death vs . placebo through Day 29 by 30 % ( adjusted relative risk reduction ) in adult patients with mild to moderate COVID-19 7
( 95 % CI : 1 %, 51 %; 6.8 % ( 48 / 709 ] vs 9.7 % ( 68 / 699 ). Adjusted risk difference -3.0% ( 95 % CI -5.9%, -0.1%), p-value not available ). Based on a planned interim analysis of LAGEVRIO vs placebo : The adjusted risk difference was -6.8% ( 95 % CI : -11.3%, -2.4; 7.3 % ( 53 / 377 ) vs 14.1 % ( 28 / 385 ); p = 0.0024 ).
Real-world studies , 10-13 including the local Victorian study published in 2023 , 13 also support the use of LAGEVRIO in treating older vaccinated patients with mild to moderate COVID-19 .
Treatment-related adverse events ≥ 1 % ( MOVe-OUT , LAGEVRIO vs placebo ): 7 Diarrhoea ( 2 % vs 2 %), nausea ( 1 % vs 1 %), dizziness ( 1 % vs 1 %)
A simple † treatment for appropriate patients 7 , 9
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No known drug interactions based on limited data available 7
▼This medicine is subject to additional monitoring in Australia . This will allow quick identification of new safety information . Healthcare professionals are asked to report any suspected adverse events at www . tga . gov . au / reporting-problems .
Selected Safety Information 7
INDICATION : LAGEVRIO has provisional approval for the treatment of adults with COVID-19 who do not require initiation of oxygen due to COVID-19 and who are at increased risk for hospitalisation or death . The decision to approve this indication was based on efficacy and safety data from a Phase 3 trial . Continued approval of this indication depends on additional data .
CONTRAINDICATIONS : Hypersensitivity to the active substance or any of the excipients . Hypersensitivity reactions have been reported with LAGEVRIO . If signs or symptoms of a clinically significant hypersensitivity reaction occur , immediately discontinue LAGEVRIO and initiate appropriate medications and / or supportive care .
PRECAUTIONS : Pregnancy Category D : The use of LAGEVRIO is not recommended during pregnancy . In women of childbearing potential , health care providers should discuss the chance that they may be pregnant and consider the need for a pregnancy test . Contraception : Advise women of childbearing potential to use effective contraception for the duration of treatment and for 4 days after the last dose of LAGEVRIO . Sexually active men with a partner of childbearing potential should use contraception during and for 3 months after treatment . Based on animal data , LAGEVRIO may cause foetal harm when administered to pregnant women . Breastfeeding : Based on the potential for adverse reactions on the infant from LAGEVRIO , breastfeeding is not recommended during treatment and for 4 days after the last dose of LAGEVRIO . Paediatric patients : Use in patients under the age of 18 years is not recommended .
ADVERSE REACTIONS : Common : nausea , diarrhoea , dizziness . The following have been reported in post-marketing experience : hypersensitivity , angioedema , erythema , pruritus , rash , urticaria , vomiting .
References : 1 . Australian Bureau of Statistics . COVID-19 mortality in Australia : Deaths registered until 31 January 2024 . https :// www . abs . gov . au / articles / covid-19-mortality-australia-deaths-registered-until-31-january-2024 ( accessed May 2024 ). 2 . Australian Bureau of Statistics . Health conditions prevalence ( 2022 ). Available at https :// www . abs . gov . au / statistics / health / health-conditions-and-risks / health-conditions-prevalence / latest-release ( accessed February 2024 ). 3 . Ross SB et al . JAMA Netw Open 2022 ; 5 ( 7 ): e2220184 . 4 . Shini Rubina SK et al . Diabetes Metab Syndr 2022 Mar ; 16 ( 3 ): 102451 . 5 . University of Liverpool . COVID-19 Drug Interaction Checker . Available at https :// www . covid19- drugintractions . org / checker ( accessed March 2024 ). 6 . Paxlovid ( nirmatrelvir-ritonavir ) Product Information . February 2024 . 7 . LAGEVRIO Product Information . October 2023 . 8 . Australian Government Department of Health and Aged Care . COVID-19 Oral treatments fact sheet . https :// www . health . gov . au / sites / default / files / 2023-01 / covid-19-oral-treatments-fact-sheet . pdf ( accessed May 2024 ). 9 . Pharmaceutical Benefits Scheme . www . pbs . gov . au ( accessed March 2024 ). 10 . Gentry CA et al . J Infect 2023 ; 86 ( 3 ): 248 – 255 . 11 . Lin DY et al . JAMA Netw Open 2023 ; 6 ( 9 ): e2335077 . 12 . Park HR et al . Infect Chemother 2023 ; 55 ( 4 ): 490 – 499 . 13 . Van Heer C et al . Lancet Reg Health West Pac 2023 ; 41:100917 .
Before prescribing , please review the full Product Information available at www . msdinfo . com . au / lagevriopi or by scanning the QR code .
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No dose adjustments required in patients with renal and / or hepatic impairment 7
Scan to access study design for the MOVe-OUT registration trial .
Copyright © 2024 Merck & Co ., Inc ., Rahway , NJ , USA and its affiliates . All rights reserved . Merck Sharp & Dohme ( Australia ) Pty Limited . Level 1 – Building A , 26 Talavera Road , Macquarie Park NSW 2113 . MSDA0137 . AU-ANV-00563 . Issued June 2024 .
PAGE 13 missing in patient rebates as a result of the six-year freeze , practices will remain trapped in a resourcestarved ecosystem , severely limited in what they can actually do in terms of innovative care .
The risk of MyMedicare is that it ends up as a reform of control not an escape from the limitations of fee-for-service .
So far , the limited excitement in MyMedicare has been around new block payments to help practices keep ‘ frequent flyer ’ patients out of hospital .
It is still a big mystery . We are awaiting confirmation of the dollar value of the Frequent Hospital Users Incentive , which aims to reward GP practices that care for patients who rack up 10 or more hospital attendances a year .
We know nothing about the model of care . All this is being rolled out through a handful of primary health networks ( just nine in total ), but even here we do not know their identity . The department is not saying .
And given the policy ’ s potential cost-saving to the hospital system if it works , it is worth stressing that just $ 99 million over four years has been pledged — that is a very minimal commitment in contrast to the splurge on urgent care clinics .
Is the problem the desperation for easy politics ?
Urgent care clinics as a concept have never been mentioned as a serious fix for anything by any of the numerous health reform task forces over the past decade .
But they make good headlines and photo opportunities for a minister whose remit does not allow him the chance to open big shiny hospitals .
Mr Butler ’ s response in his speech was that serious change takes time : “ We are building [ MyMedicare ] very deliberately slowly but steadily .
“ No-one wants another chronic condition pilot that fails to get off the ground . As the Grattan Institute said , we have had more pilots in this space than Qantas .”
But that is because the most recent ones were done on the cheap .
Fundamentally , despite the “ record ” Medicare investments , general practice needs much more money to deliver on the reforms it has been promised .
It would be good for the minister to acknowledge that hard truth .