Birth control within reach: a national survey on women's attitudes toward and interest in pharmacy access to hormonal contraception

Perceptions of the safety of oral contraceptives among a predominantly Latina population in Texas

BACKGROUND

Fear of side effects and previous negative experiences are common reasons for contraceptive nonuse.

STUDY DESIGN

We collected information about perceptions of oral contraceptive (OC) safety from 1271 women 18-49 years old in El Paso, TX, and compared their responses to a medical evaluation by a nurse practitioner. We also asked participants about their interest in obtaining OCs over the counter (OTC).

RESULTS

Among 794 women potentially at risk of unintended pregnancy, 56.0% said that OCs were medically safe for them. Reasons given for OCs being unsafe were related to fears of side effects and prior negative experiences rather than true contraindications. Older women and participants recruited at the less affluent recruitment site were significantly more likely to report that OCs were medically unsafe for them (p<.05). Nonusers who thought OCs were medically unsafe for them were as likely to be medically eligible for use as current hormonal users. Among nonusers or nonhormonal users and potential OC candidates (n=601), 60.2% said they would be more likely to use OCs if they were available OTC.

CONCLUSIONS

Women's perception of OC safety does not correlate well with medical eligibility for use. More education about the safety and health benefits of hormonal contraception is needed. OTC availability might contribute to more positive safety perceptions of OCs compared to a prescription environment.

Pharmacist interest in and attitudes toward direct pharmacy access to hormonal contraception in the United States

OBJECTIVES

To assess pharmacist interest, comfort level, and perceived barriers regarding providing pharmacist-initiated access to hormonal contraceptives (i.e., tablets, patches, rings, injectables, emergency contraception [EC]).

DESIGN

Descriptive, nonexperimental, cross-sectional study.

SETTING

United States between November 2004 and January 2005.

PARTICIPANTS

2,725 pharmacists working in community chain pharmacies (64%), community independent pharmacy (31%), and other practice settings, including hospitals and home care facilities (5%).

INTERVENTION

Survey sent electronically by the American Pharmacists Association to a random sample of 14,142 of its 50,000 pharmacist members nationally.

MAIN OUTCOME MEASURES

Pharmacist interest and comfort level in providing pharmacy access to hormonal contraception (HC), perceived barriers and training needs, and familiarity with and provision of EC.

RESULTS

2,725 survey responses (19% response rate) were received. Pharmacists reported being very familiar with HC. The majority of respondents were comfortable and interested in providing direct access to HC in the pharmacy. Perceived barriers to providing HC in the pharmacy included lack of time, no mechanism of reimbursement for the service, and possible resistance from physicians.

CONCLUSION

Strong interest, comfort level, and capability from pharmacists, combined with a documented demand for direct pharmacy access from patients, indicate that pharmacy access to HC has the potential to meet patient needs and increase access to HC. Education about current clinical practice recommendations-which no longer require pelvic examinations and Papanicolaou (Pap) smears before hormonal contraception is initiated-may increase pharmacist support for providing hormonal methods directly.

Behind-the-counter status and availability of emergency contraception

OBJECTIVE

The objective of the study was to determine whether the 2006 Food and Drug Administration approval of Plan B for behind-the-counter status increased availability.

STUDY DESIGN

We conducted a survey in 2005 and 2007 of pharmacies listed in Atlanta, GA, Boston, MA, and Philadelphia, PA. We measured ability to dispense Plan B within 24 hours. Also measured were reasons for lack of availability and cost of Plan B.

RESULTS

Pharmacists were interviewed at 1087 pharmacies (75% response rate) in 2005 and 795 pharmacies (82% response rate) in 2007. In 2007, 8% of pharmacies were unable to provide Plan B within 24 hours, compared with 23% of pharmacies in 2005 (P < .001). The total refusal rate in 2007 was half the rate of 2005 (2% vs 4%, P = .004). The average cost of Plan B was $43.

CONCLUSION

Availability of Plan B in Atlanta and Philadelphia increased after it was awarded behind-the-counter status.

Pharmacist prescribing of hormonal contraceptives: results of the Direct Access study

OBJECTIVE

To describe implementation of a collaborative drug therapy protocol to screen and counsel women for safe use of hormonal contraceptives prescribed by community pharmacists.

DESIGN

Community-based intervention study.

SETTING

Metropolitan Seattle, Wash., from June 2003 to December 2005.

PARTICIPANTS

26 community pharmacists and 214 women enrollees.

INTERVENTION

Pharmacists identified women at risk of unintended pregnancy and offered to evaluate them to determine whether they could safely use oral contraceptives, contraceptive patches, or the contraceptive vaginal ring. Interested women self-administered medical and contraceptive history questionnaires. Pharmacists measured weight and blood pressure and prescribed hormonal contraceptives according to the protocol guidelines. Study interviewers followed up with women via telephone at 1, 6, and 12 months.

MAIN OUTCOME MEASURES

Effectiveness of pharmacist interventions was measured by continuation of hormonal methods by women. Feasibility was determined by measuring acceptability and sustainability. Acceptability was measured by interviewing women and pharmacists. Sustainability was measured by evidence of willingness to pay for the services.

RESULTS

195 women (91%) were prescribed hormonal contraceptives by participating pharmacists. A self-administered screening tool and physical measurement of weight and blood pressure enabled pharmacists to evaluate women for safe use of contraceptives. Most women (87%) were experienced users of hormonal contraceptives. More than 80% of women paid for the pharmacists' services out of pocket. After 12 months, 70% of women responding to an interview reported continuing use of hormonal contraceptives. Women reported that they would want to obtain a gynecologic exam within 3-year intervals while taking hormonal contraceptives. Both women and pharmacists were satisfied with the experience. Nearly all respondents expressed willingness to continue to see pharmacist prescribers and to receive other services from them.

CONCLUSION

Community pharmacists can efficiently screen women for safe use of hormonal contraceptives and select appropriate products. Women and pharmacists were satisfied with the services, and women were willing to pay for them.

Medical Barriers to Effective Contraception

Medical barriers to contraception can prevent women from obtaining, initiating, and continuing their contraceptive method of choice. The barriers include lack of appropriate counseling, delaying initiation for menses or laboratory tests, inappropriate contraindications or mandated warnings, untrained clinicians, and financial or regulatory barriers preventing access by low-income, undocumented, or adolescent women. These barriers may partially explain why almost half of pregnancies in the United States are unintended and occur predominantly in the small proportion of sexually active women not using contraception.