Following an application from MS Health, the Therapeutic Goods Administration (TGA) has made changes to restrictions on prescribing and dispensing MS-2 Step. The changes broaden the number and type of health professionals able to prescribe the medication, without the need for specific certification. Importantly, this will now mean nurse practitioners can prescribe MS-2 Step.
Previously, this medication was only able to be prescribed by a doctor who had undertaken specific certification and could then only be dispensed by a pharmacist who was a registered dispenser. The restrictions on pharmacists dispensing the medication have been removed.
ASHM Clinical Nurse Lead Melinda Hassall says the change in part reflects an important recognition of the role of nurse practitioners in reproductive healthcare.
“At ASHM, we have always recognised the expertise of nurse practitioners and their critical role in health promotion, prevention, diagnosis, treatment, and management of sexual and reproductive healthcare across Australia,” says Hassall.
The change has been welcomed by many; however some have expressed a need for caution. To understand why this change occurred, and what it means for healthcare workers in Australia, we spoke to several registered nurses (RNs) in our network about what they anticipate the change to mean.
Why the change?
The amendment to restrictions around MS-2 Step is primarily about improving access and addressing one of the barriers to medical abortion for people who are less than nine weeks pregnant.
Emma Knowland, President of the Australasian Sexual Health and HIV Nurses Association (ASHHNA) and sexual health nurse practitioner, says the change will have a significant benefit.
“The TGA’s decision to revise and lift previous restrictions on the prescribing of MS-2 Step will improve access to medical terminations of pregnancy for people who are experiencing very early pregnancy in Australia. The TGA’s decision to remove the need for certification reduces unnecessary red tape, for a medication which is known to be safe and effective for this essential medical service,” says Knowland.
“By allowing appropriately qualified nurse practitioners and endorsed midwives prescribing rights to MS-2 step, as well as reducing barriers for care provision for all health care practitioners (including GPs), access to prescribers will significantly improve for people needing access to medical abortion,” says Knowland.
Hassall echoes this sentiment, further reflecting on how the change will improve nurse practitioners’ ability to provide holistic reproductive healthcare.
“The TGA’s changes to prescribing MS-2 Step will enable nurse practitioners to provide timely and comprehensive reproductive healthcare, reducing fragmented service provision and financial barriers for people seeking early abortion care,” says Hassall.
In turn, Knowland says the removal of the restrictions could help destigmatise abortion care.
“[The decision] normalises abortion care as essential and is in line with community needs. It enables access and equity for our patients seeking comprehensive reproductive health care as well as improving the availability of pharmacists to the person seeking medical termination of pregnancy,” she says.
In addition, Hassall says the change will improve choice for many people looking to access medical abortion.
“One of the best things about the lifting of restrictions is that it acknowledges the expertise and skills of nurse practitioners and authorised midwives to provide this care and gives patients a choice about who they receive this care from, where they have a choice of provider,” says Hassall.
However, despite these positive benefits, there is still more work to be done.
What doesn’t the change address?
Knowland emphasises that while positive, the change to how MS-2 Step is prescribed and dispensed is not a silver bullet to improving access.
“Having more available prescribers will not be enough if the healthcare systems and funding models do not also adapt to remove barriers to care. Other barriers, such as access to services, specific MBS billing codes (so that bulk billing can occur), ongoing funding for telemedicine consultations and access to MBS funded pelvic ultrasounds for all prescribers such as nurse practitioners,” says Knowland.
Similarly, nurse practitioner, remote area nurse and midwife Lyn Byers says that while the change is a great step and should be supported, it must be recognised that the change will not improve access for everyone.
“I can’t see it addressing access issues for any except literate women from urban areas who are in tune with their bodies, can accurately date their pregnancies and can seek help appropriately if needed. It is a good thing for them, but won’t address access issues for the majority of the rural and remote population who don’t fit this demographic,” says Byers.
While restrictions on prescribing and dispensing the medication have changed, the way the drug works has not. MS-2 Step hinges on accurate understanding of when pregnancy occurred, proper timing between dosages and confirmation that the pregnancy isn’t ectopic via pelvic scan. While the recent change includes updated warning/instruction included in the Product Information, Byers warns it is vital for healthcare workers to understand the risk factors and what to do if someone presents.
“The Product Information is of little use to those who are not literate and to those for whom English is a second language. It is complex for those with little medical knowledge,” says Byers.
Byers also emphasises the importance of continued education and training for practitioners, to ensure they are informed on how the medication works and how it needs to be used.
“It is crucial that general RNs know what to do if someone follows the Product Information directions and presents. The use of MS-2 Step really hinges on having an accurate pregnancy date. We need mechanisms in order to be absolutely confident of this before providing it.”
What does this change mean for healthcare workers?
As with any change to regulation, the key for healthcare workers is to remain informed and access training when relevant to them.
“We need to be sure the health practitioner does have the appropriate qualifications and training, also that they remain current in both knowledge and practice. Some health practitioner professional peak bodies already have mechanisms in place for this, which could be utilised. Women need to be confident that the health practitioner they are seeing is competent and current in this area,” says Byers.
So while the change is a positive step in improving access to medical abortion in Australia and removes the need for certification, it remains critically important for healthcare workers to keep up to date and informed.
For primary care professionals looking to increase their knowledge of reproductive healthcare, ASHM’s Sexual and Reproductive Health in Primary Care course is a great place to start; please email firstname.lastname@example.org to express interest. Health practitioners can also register on MS Health’s MS-2 Step website for additional information and guidance.