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Stevenson TB, Thapaliya K, Moore V, Mazza D, Grzeskowiak LE. Accessibility of oral emergency contraceptives in Australian community pharmacies. Contraception 2024; 137:110480. [PMID: 38710355 DOI: 10.1016/j.contraception.2024.110480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVES To assess the availability of over-the-counter emergency contraceptive pills in the Australian community pharmacy setting. STUDY DESIGN Representative national telephone survey. RESULTS Only 70% of the 233 pharmacies surveyed stocked ulipristal acetate (UPA) emergency contraceptive pills, compared to levonorgestrel, which was stocked in 98%. When ulipristal acetate was stocked, it was on average $13 more expensive. CONCLUSIONS Despite being recommended as the first-line oral emergency contraceptive, UPA is less likely to be available, and when available, it is likely to be more expensive. These findings support anecdotal reports UPA is challenging to access and less commonly used. IMPLICATIONS Strategies are urgently required to improve equitable access to all methods of oral emergency contraception within the Australian community pharmacy setting and ensure pharmacists are aware of key differences between the available methods. This will ensure that they are prepared to facilitate shared decision making based on the individual needs of each woman.
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Affiliation(s)
- Tahlee B Stevenson
- School of Public Health, Faculty of Health and Medical Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Kailash Thapaliya
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Vivienne Moore
- School of Public Health, Faculty of Health and Medical Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Danielle Mazza
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Luke E Grzeskowiak
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; SAHMRI Women and Kids, Level 7, Clarence Rieger Building, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
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Li X, Vojnovic I, Ligmann-Zielinska A. Spatial accessibility and travel to pharmacy by type in the Detroit region. J Am Pharm Assoc (2003) 2024; 64:102052. [PMID: 38401841 DOI: 10.1016/j.japh.2024.102052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Community pharmacies are a critical part of the health care provision system. Yet less is understood about the spatial accessibility to pharmacies and how people travel to reach these services. OBJECTIVES This study compared spatial accessibility and actual travel to different types of pharmacies among selected neighborhoods in the Detroit region. METHODS Three types of neighborhoods were selected and compared, including two lower income Black urban neighborhoods of high-density and four upper income White suburbs (two of low density and two of high density). Spatial accessibility was computed by pharmacy type and compared among neighborhoods using ANOVA. Pharmacy trips reported in a travel survey were geocoded and linked with community pharmacies in a list generated from ReferenceUSA business data. Destination choices were mapped and the relationship between spatial accessibility and actual distance traveled was examined using ordinary least squares regressions. RESULTS On average, urban residents in Detroit had higher access to local independent pharmacies (0.74 miles to the nearest one) but relatively lower access to national chains (1.35 miles to the nearest one), which most residents relied on. Urban residents also tended to shop around more for services even among national chains. In fact, they bypassed nearby local independent pharmacies and traveled long distances to use farther pharmacies, primarily national chains. The average trip distance to pharmacy was 2.1 miles for urban residents, but only 1.1 miles and 1.5 miles for residents in high-density suburbs and low-density suburbs, respectively. CONCLUSION Supposedly good spatial access considering all pharmacies together may mask excessive burden in reaching the pharmacy services needed in low-income minority urban communities, as shown in the case of Detroit. Thus, when mapping pharmacy deserts, it is important to distinguish spatial accessibility among different pharmacy types.
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Ashcraft AM, Ponte CD, Montgomery C, Farjo S, Murray PJ. Levonorgestrel Emergency Contraception Information Accuracy From West Virginia Community Pharmacies: A Mystery Caller Approach. Womens Health Issues 2023; 33:489-496. [PMID: 37414715 DOI: 10.1016/j.whi.2023.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/17/2023] [Accepted: 04/06/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND To ensure access to effective levonorgestrel (LNG) emergency contraception (EC), pharmacies must keep medication in stock or available for quick delivery, and pharmacists must be knowledgeable about sales restrictions and the therapeutic window for EC. We conducted a mystery caller study to assess LNG EC availability and information accuracy provided by staff in West Virginia community pharmacies. METHODS A female research team member posed as a 16-year-old caller to ask pharmacy staff questions about whether LNG EC was in stock, the requirements for purchase, and when it should be taken for effectiveness. Data were analyzed with SPSS using the Pearson's χ2 test to determine if there was a relationship between pharmacy type and response accuracy to our questions about point-of-sale requirements and timing for effectiveness for LNG EC. RESULTS Of the 506 pharmacies in the sample, 275 (54.3%) were chain pharmacies and 231 (45.7%) were independent. Overall, chain pharmacies provided significantly more accurate answers than independent pharmacies on all point-of-sale requirements. Regarding timing for effectiveness, 49.2% of all pharmacies provided an accurate response (62.9% for chain pharmacies vs. 32.9% for independent pharmacies). CONCLUSIONS Overall, availability and accuracy regarding LNG EC were poor in West Virginia pharmacies. Pharmacists, particularly those at independent pharmacies serving rural communities, are in a critical and powerful position to influence community health by providing accurate and timely information and access to all contraceptive options, including LNG EC.
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Affiliation(s)
- Amie M Ashcraft
- Department of Family Medicine, West Virginia University, Morgantown, West Virginia.
| | - Charles D Ponte
- Department of Family Medicine, West Virginia University, Morgantown, West Virginia; Department of Clinical Pharmacy, West Virginia University, Morgantown, West Virginia
| | | | - Sara Farjo
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia; Department of Family Medicine, West Virginia University, Morgantown, West Virginia
| | - Pamela J Murray
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
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Lungfiel G, Mandlmeier F, Kunow C, Langer B. Oral emergency contraception practices of community pharmacies: a mystery caller study in the capital of Germany, Berlin. J Pharm Policy Pract 2023; 16:68. [PMID: 37237301 DOI: 10.1186/s40545-023-00565-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND In Germany, oral emergency contraception (EC) with the active ingredients levonorgestrel (LNG) and ulipristal acetate (UPA) is available as over-the-counter (OTC) medicine only from community pharmacies (CPs). Because of the window of effect, which is limited to only a few days, CPs have a great responsibility to provide rapid and unimpeded access, while also ensuring "adequate" counseling. The aim was-for the first time in Europe and thus also in Germany for the methodology used in this study-to investigate immediate availability, pricing, and aspects of counseling. METHODS Covert mystery calls were conducted in a random sample of CPs stratified by districts in the German capital Berlin. Each of the 263 CPs included was called once at random by one of two trained female student mystery callers. They simulated a product-based scenario for the UPA original ellaOne®, citing a contraceptive failure one day ago as the reason. RESULTS Of 257 successfully called CPs, UPA preparations were immediately available in 98.4% (253/257) and LNG preparations in 86.8% (184/212) of CPs. Prices for UPA preparations varied from €15.95 to €42.95 (∆ 169%; median €35.00 [interquartile range (IQR) €5.91]) and for LNG preparations from €10.60 to €32.49 (Δ 207%; median €22.00 [IQR €5.76]). Information about the correct different window of effect of UPA and LNG preparations was provided in 69.8% (127/182) of CPs. UPA preparations were recommended in 63.1% (111/176) and LNG preparations in 17.2% (30/174) of CPs. Information was provided on how to take them as soon as possible in 30.8% (44/143) of CPs and on how to use them after vomiting in 46.0% (64/139). CONCLUSIONS Berlin CPs support access through high immediate availability, especially to UPA preparations. However, access is hampered by high absolute price ranges of both UPA and LNG preparations, which could ideally be minimized by a comparison app. It is positive that CPs promote the benefits of UPA preparations by recommending them noticeably more often than LNG preparations. However, there are deficiencies in giving advice, so there is a need to raise awareness among pharmacy staff to ensure "adequate" counseling in advance over the phone.
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Affiliation(s)
- Gwenda Lungfiel
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - Franca Mandlmeier
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - Christian Kunow
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - Bernhard Langer
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany.
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Gawron LM, He T, Lewis L, Fudin H, Callegari LS, Turok DK, Stevens V. Oral Emergency Contraception Provision in the Veterans Health Administration: a Retrospective Cohort Study. J Gen Intern Med 2022; 37:685-689. [PMID: 36042074 PMCID: PMC9481759 DOI: 10.1007/s11606-022-07596-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/01/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND In the USA, oral emergency contraception (EC) use to prevent unintended pregnancy is increasing. Oral EC methods include levonorgestrel (LNG) and ulipristal acetate (UPA), with increased UPA efficacy over LNG in high BMI users and those beyond 3 days post intercourse. The Veterans Health Administration (VHA) provides oral EC at low or no cost, yet prescription-level Veteran data are lacking. OBJECTIVE To describe oral EC provision in VHA, including method type and Veteran user and prescriber characteristics. DESIGN A retrospective cohort study using VHA administrative data. PARTICIPANTS All VHA oral EC prescriptions from January 1, 2016, to December 31, 2020. MAIN MEASURES We linked Veteran-level sociodemographic and military characteristics and provider-level data with each prescription to identify variables associated with oral EC method. KEY RESULTS A total of 4280 EC prescriptions (85% LNG) occurred for 3120 unique Veterans over 5 years. While prescriptions remained low annually, the proportion of UPA prescriptions increased from 12 to 19%. Compared to LNG users, UPA users were older (34% vs 25% over age 35 years, p <0.001); more likely to identify as white (57% vs 46%) and non-Hispanic (84% vs 79%) (p <0.001); and more likely to have a BMI ≥ 25 (76% vs 67%, p <0.001). UPA prescriptions originated most frequently from VA Medical Centers (87%) and women's health clinics (76%) compared to community-based or other clinic types. In multivariable regression models, race, ethnicity, BMI ≥30, and prescriber facility type of a VA Medical Center or a women's clinic location were predictive of UPA prescription. CONCLUSIONS Oral EC provision in VHA remains low, but UPA use is increasing. LNG prescription occurs frequently in high BMI Veterans who would benefit from increased efficacy of UPA. Interventions to expand oral EC access in VHA are essential to ensure Veterans' ability to avert unwanted pregnancies.
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Affiliation(s)
- Lori M Gawron
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30N 1900E Rm 2B-200, Salt Lake City, UT, 84132, USA. .,VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
| | - Tao He
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Division of Epidemiology Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Lacey Lewis
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Division of Epidemiology Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Hannah Fudin
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Lisa S Callegari
- VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - David K Turok
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30N 1900E Rm 2B-200, Salt Lake City, UT, 84132, USA
| | - Vanessa Stevens
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Division of Epidemiology Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
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Ashcraft AM, Farjo S, Ponte CD, Murray PJ. The impact of caller characteristics on levonorgestrel emergency contraception access in West Virginia community pharmacies. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 33:100765. [PMID: 36037669 DOI: 10.1016/j.srhc.2022.100765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/10/2022] [Accepted: 08/16/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Access to levonorgestrel (LNG) emergency contraception (EC) has increased since the FDA removed age restrictions on over-the-counter (OTC) LNG EC in 2013, but availability is highly variable and numerous barriers to access remain. The purpose of this study was to assess availability and accessibility of LNG EC at community pharmacies in West Virginia (WV). METHODS A mystery caller cross-sectional study was conducted to assess availability and accessibility of LNG EC. Inquiries were made by identified 'research' staff and by staff presenting as a 16 y/o. RESULTS Nearly half of community pharmacies reported having LNG EC in stock. Pharmacy staff were significantly more likely to tell research callers LNG EC was in stock (53%) and more likely to report willingness to order it (50%) than 'teen' callers (45% and 34%, respectively). There was no significant difference between caller types on the five barriers assessed. CONCLUSION Lack of availability may contribute to teen and unintended pregnancies.
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Affiliation(s)
- Amie M Ashcraft
- West Virginia University, Department of Family Medicine, Morgantown, WV, USA.
| | - Sara Farjo
- West Virginia University, Department of Family Medicine, Morgantown, WV, USA; West Virginia University, Department of Emergency Medicine, Morgantown, WV, USA.
| | - Charles D Ponte
- West Virginia University, Departments of Clinical Pharmacy and Family Medicine, Morgantown, WV, USA.
| | - Pamela J Murray
- Boston Children's Hospital, Division of Adolescent/Young Adult Medicine, Boston, MA, USA.
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Batra A, Candon M. Price Transparency for Primary Care Office Visits and Routine Tests: Results From a 2016 Audit Study. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221092122. [PMID: 35412869 PMCID: PMC9008822 DOI: 10.1177/00469580221092122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Price transparency is a central component of the shift from volume to value in healthcare delivery. Price transparency in primary care, the most common point of contact with the healthcare system for patients in the U.S., has not been widely studied. Methods: Using an audit study across 10 states in 2016, we examined the characteristics of primary care practices that were able to provide price information for office visits and routine tests. Results: Most primary care practices were able to disclose some price information for office visits and routine tests. Results indicate that larger, integrated primary care practices in urban areas and in areas with a higher percentage of minority residents were less likely to provide prices than smaller, standalone practices. Conclusion: These findings suggest that future efforts to increase price transparency in primary care should be tailored to practice characteristics, including practice location and whether the practice is embedded in an integrated health system.
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Affiliation(s)
| | - Molly Candon
- University of Pennsylvania, Philadelphia, PA, USA
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Stone RH, Gross S, Reardon B, Young HN. Emergency Contraception Access and Counseling in Metropolitan and Nonmetropolitan Pharmacies in Georgia. J Pharm Pract 2021; 36:523-531. [PMID: 34881653 DOI: 10.1177/08971900211052821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Emergency contraception (EC) efficacy is dependent on timing of administration. Adequate pharmacy stock information and accurate patient counseling are important to ensure timely access. Objective: This study evaluates pharmacist reported availability and counseling for levonorgestrel (LNG) and ulipristal acetate (UPA), and identifies differences between caller type and pharmacies in metropolitan vs nonmetropolitan areas of Georgia. Methods: This prospective, randomized, telephone-based study included 25% of Georgia community pharmacies, stratified by geographic location. Calls were made by investigators, first posing as a mystery shopper inquiring about EC stock and efficacy, then 3-6 weeks later as a researcher inquiring about EC stock. Analysis utilized descriptive statistics, chi Square, and logistic regression. Results: Of 600 pharmacies, the mystery shopper caller reached 86%: 74% of pharmacists initially discussed LNG, 57.1% had it stocked, more often in metropolitan areas (OR 1.7, 95% CI 1.08-2.6). Ulipristal acetate was discussed by 1.9% and reported in-stock < 1%. Of those who discussed window of efficacy, 79% indicated LNG would either not work 4 days after intercourse or they were unsure. The research caller successfully completed a second call for 64% of pharmacies: 57% stocked LNG, 3% stocked UPA, and UPA was more likely to be stocked in metropolitan pharmacies. Conclusion: In Georgia, UPA availability is poor, and nonmetropolitan pharmacies were less likely to stock LNG and UPA. A minority of pharmacists correctly indicated that LNG may work up to 120 hours after intercourse. Strategies are needed to overcome barriers to EC availability in community pharmacies and support pharmacists' EC counseling.
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Affiliation(s)
- Rebecca H Stone
- Department of Clinical and Administrative Pharmacy, 1355University of Georgia College of Pharmacy, Athens, GA, USA
| | - Savannah Gross
- 15506University of Georgia College of Pharmacy, Athens, GA, USA
| | - Brielle Reardon
- Department of Pharmacy, 1466Johns Hopkins Hospital, Baltimore, MD, USA
| | - Henry N Young
- Department of Clinical and Administrative Pharmacy, 1355University of Georgia College of Pharmacy, Athens, GA, USA
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Khorsandi N, Chiccarelli E, Dumas SA, Pasternak RH. Louisiana Pharmacies' Availability of Emergency Contraception and Counseling Accuracy to Adolescent and Physician Callers. J Pediatr Adolesc Gynecol 2021; 34:693-698. [PMID: 33631348 DOI: 10.1016/j.jpag.2021.02.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/29/2021] [Accepted: 02/14/2021] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE Adolescents face many barriers to obtaining emergency contraception (EC), despite it being an approved and recommended method to prevent unintended pregnancy. This study examined pharmacy-related barriers to adolescents' access to EC in Louisiana. DESIGN Prospective, telephone-call secret shopper study to pharmacies to assess same-day EC availability and barriers to purchase. SETTING A total of 182 pharmacies in 5 Louisiana cities. PARTICIPANTS Responses provided by pharmacists or other pharmacy staff assessed between July 2018 and November 2019. INTERVENTIONS Collected data from secret shopper phone calls and compared responses provided to callers between male and female callers and physician and adolescent callers. MAIN OUTCOME MEASURES Same-day levonorgestrel (LNG) availability, same-day ulipristal acetate (UPA) availability, age restrictions on purchase, requirement of parental consent for purchase, and type of staff member that advised the caller. RESULTS Of 364 calls to 182 pharmacies, 66% of pharmacists or other pharmacy staff reported same-day LNG access and 5% reported same-day UPA access. An inaccurate age restriction regarding EC purchase was reported in 15% of calls. Female callers were cited this age restriction more frequently than their male counterparts (20% vs 10%). Pharmacists were more likely than other pharmacy staff to counsel female callers compared to male callers (52% vs 27%) and physician callers compared to adolescents (50% vs 30%). CONCLUSIONS Many pharmacies in Louisiana have limited same-day availability of EC and often report inconsistent and inaccurate age and consent regulations for its use. Continued outreach and education to pharmacies is necessary to address these barriers to adolescent EC access.
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Affiliation(s)
- Nikka Khorsandi
- Louisiana State University Health Sciences Center, School of Medicine, New Orleans, Louisiana.
| | - Elvira Chiccarelli
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - S Amanda Dumas
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Ryan H Pasternak
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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Ashcraft AM, Ponte CD, Farjo S, Dotson S, Murray PJ. The [underutilized] power of independent pharmacies to promote public health in rural communities: A call to action. J Am Pharm Assoc (2003) 2021; 62:38-41. [PMID: 34556429 DOI: 10.1016/j.japh.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/27/2021] [Accepted: 09/02/2021] [Indexed: 11/18/2022]
Abstract
Independent community pharmacies are in a unique and powerful position to promote public and individual health in their communities. Independent pharmacies are particularly important in rural communities where there are few chain pharmacies and accessible health clinics. West Virginia received national attention recently when they opted out of the Federal Pharmacy Program collaborating with CVS and Walgreens and developed their own plan for COVID-19 vaccine distribution and administration, heavily relying on independent pharmacies and the infrastructure they already have in local communities. However, in other areas of public health with urgent, unmet need, such as pregnancy prevention, there is considerable room for independent pharmacies to improve. The pandemic has allowed independent pharmacies to shine during the vaccination effort and has demonstrated what can be accomplished when policymakers, providers, and pharmacists work together for the benefit of community health. Expanding such collaboration to include contraceptive provision and counseling in a timely, nonjudgmental manner could play a pivotal role in preventing unintended and unwanted pregnancies.
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Orr K, Chin J, Cuddeback M, Zimo J, Judge-Golden C, Jarlenski M, Borrero S. Pharmacy availability of emergency contraception in southwestern Pennsylvania: A simulated patient study. Contracept X 2021; 3:100068. [PMID: 34401743 PMCID: PMC8355831 DOI: 10.1016/j.conx.2021.100068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To assess the availability of oral emergency contraception in southwestern Pennsylvania pharmacies. Study design We conducted a simulated patient study to assess on-the-shelf availability of levonorgestrel emergency contraception and immediate availability of ulipristal acetate emergency contraception. Results Only 44% of pharmacies stocked levonorgestrel on-the-shelf and only 5% of pharmacies had ulipristal acetate immediately available. Conclusions We found significant barriers to obtaining timely oral emergency contraception in southwestern Pennsylvania. Implications statement Timely access to emergency contraception is important for people's ability to determine if, when, how, and under what circumstances to have children. Pharmacies in southwestern Pennsylvania need to expand access to oral emergency contraception.
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Affiliation(s)
- Katherine Orr
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Jennifer Chin
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
- Corresponding author.
| | - Maris Cuddeback
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Jessica Zimo
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Colleen Judge-Golden
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, PA, United States
| | - Marian Jarlenski
- Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sonya Borrero
- Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
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A Nationwide Mystery Caller Evaluation of Oral Emergency Contraception Practices from German Community Pharmacies: An Observational Study Protocol. Healthcare (Basel) 2021; 9:healthcare9080945. [PMID: 34442082 PMCID: PMC8391881 DOI: 10.3390/healthcare9080945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/04/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022] Open
Abstract
To prevent unwanted pregnancies, oral emergency contraception (EC) with the active ingredients levonorgestrel (LNG) and ulipristal acetate (UPA) is recommended by the guidelines of the German Federal Chamber of Pharmacists (BAK). In this respect, community pharmacies (CPs) in Germany have a major responsibility for information gathering, selecting the appropriate medicine, availability and pricing, among other things. Therefore, it would be appropriate to conduct a study with the aim of investigating information gathering, a possible recommendation as well as availability and pricing for oral EC in German CPs. A representative nationwide observational study based on the simulated patient methodology (SPM) in the form of covert mystery calls will be conducted in a random sample of German CPs stratified according to the 16 federal states. Each selected CP will be randomly called once successfully by one of six both female and male trained mystery callers (MCs). The MCs will simulate a product-based scenario using the request for oral EC. For quality assurance of the data collection, a second observer accompanying the MC is planned. After all mystery calls have been made, each CP will receive written, pharmacy-specific performance feedback. The only national SPM study on oral EC to date has identified deficits in the provision of self-medication consultations with the help of visits in the CPs studied. International studies suggest that UPA in particular is not always available. Significant price differences could be found analogous to another German study for a different indication.
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Emergency Contraception Access and Counseling in Urban Pharmacies: A Comparison between States with and without Pharmacist Prescribing. PHARMACY 2020; 8:pharmacy8020105. [PMID: 32575655 PMCID: PMC7355476 DOI: 10.3390/pharmacy8020105] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/30/2022] Open
Abstract
Pharmacists are often the primary source of emergency contraception (EC) access and patient information. This study aims to identify differences in pharmacist-reported EC access and counseling between states which do or do not permit pharmacist-prescribed EC. This prospective, mystery caller study was completed in California (CA), which permits pharmacist-prescribed EC after completion of continuing education, and Georgia (GA), which does not. All community pharmacies that were open to the public in San Diego and San Francisco, CA, and Atlanta, GA were called by researchers who posed as adult females inquiring about EC via a structured script. Primary endpoints were EC availability and counseling. Statistical analyses completed with SPSS. Researchers called 395 pharmacies, 98.2% were reached and included. Regarding levonorgestrel (LNG), CA pharmacists more frequently discussed (CA 90.4% vs. GA 81.2%, p = 0.02), stocked (CA 89.5% vs. GA 67.8%, p < 0.01), and correctly indicated it “will work” or “will work but may be less effective” 4 days after intercourse (CA 67.5% vs. GA 17.5%, p < 0.01). Ulipristal was infrequently discussed (CA 22.6% vs. GA 3.4%, p < 0.01) and rarely stocked (CA 9.6% vs. GA 0.7%, p < 0.01). Pharmacists practicing in states which permit pharmacist-prescribed EC with completion of required continuing education may be associated with improved patient access to oral EC and more accurate patient counseling.
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