Do Swiss community pharmacists address the risk of sexually transmitted infections during a consultation on emergency contraception? A simulated patient study

Pharmacist recommendations for emergency contraception in Belgium: a simulated user study

BACKGROUND

Emergency contraception reduces the risk of unintended pregnancy, after unprotected sexual intercourse or contraceptive failure. In Belgium, emergency contraception is available without a prescription and pharmacists play therefore a crucial role in dispensing emergency contraception.

AIM

This study assesses the dispensing practices of emergency contraception by pharmacists in two regions of Belgium.

METHOD AND DESIGN

Simulated patient study, using a predefined scenario, evaluating a request for emergency contraception. The scenario involves a 25-year-old woman not using contraception, who had unprotected sexual intercourse 84 h (3.5 days) ago. Her last menstrual period was 10 days ago.

POPULATION

260 pharmacies were randomly selected. Principal outcome: proportion of pharmacists who deliver the adequate emergency contraception. We considered the following responses as adequate: Prescribing ulipristal acetate or redirecting to another pharmacy, in case of unavailability, or referring for a copper IUD.

RESULTS

We analysed the data obtained in 216 pharmacies (216/260 = 83.1%). In 64% of cases, adequate dispensing of emergency contraception (dispensing of ulipristal acetate or referral for intrauterine device insertion) occurred. There was an association between correct dispensing and asking appropriate questions, such as the date of the last menstrual period and the date of the risky sexual intercourse.

CONCLUSION

More than one-third of visited pharmacies did not distribute appropriate emergency contraception, underlining the need for improvement. We hypothesise that this may be achieved with appropriate training, use a dispensing checklist.

Reproductive health services: attitudes and practices of Saudi community pharmacists

BACKGROUND

Sexual and reproductive health (SRH) services are a crucial provision of public health. The consequences of having suboptimal SRH services include unplanned pregnancies, unsafe abortions, reproductive cancers, and sexually transmitted and bloodborne infections. This study was conducted to assess the role community pharmacists play in providing SRH, their practices, and their attitudes toward fulfilling the exciting demand.

METHODS

A cross-sectional, self-administered questionnaire was used. The study was conducted among community pharmacies across the Asir region.

RESULTS

A total of 196 community pharmacists were included in this study. The majority of pharmacy chains reported selling pregnancy tests (93.9%) compared to independent pharmacies (72.9%), p value (0.0001). Similarly, community pharmacists working in pharmacy chains educated patients on pregnancy tests (78.2%) more often than those working in independent pharmacies (62.6%), p value (0.03). Ovulation tests were sold more frequently in pharmacy chains (74.3%) than in independent pharmacies (52.08%), p value (0.004). Providing education on these products followed the same pattern with (72.9%, 47.9%), respectively, p value (0.003).

CONCLUSION

The majority of pharmacists reported selling pregnancy tests and ovulation and educated patients regarding both these test kits. However, these services were more widely available in pharmacy chains than in independent pharmacies. Pharmacists exhibited a positive attitude toward SRH, exhibiting social accountability and an ethical responsibility to fulfill their role.

Knowledge and counseling preferences of the public and pharmacy staff on emergency contraception: results of a cross-sectional study in Belgium

OBJECTIVE

To assess the knowledge and counseling preferences of the public ('individuals') and pharmacy staff ('professionals') in Belgium on emergency contraceptive pills (ECPs).

STUDY DESIGN

Cross-sectional study using two different anonymous, online surveys (one addressing the public and one professionals).

RESULTS

Overall, 1518 individuals and 1118 professionals participated, obtaining a mean knowledge score of 6.3(±1.8)/10 and 5.0(± 1.6)/10, respectively. For the public, a lower level of knowledge was found among men, non-healthcare workers and low educated individuals with no prior ECP use/purchase. For professionals, a lower level of knowledge was observed among pharmacy-technicians, French-speaking persons, and professionals with ≥5 years of experience and poorly involved in continuous education.

CONCLUSIONS

Limited knowledge on ECPs was observed among the public and pharmacy staff in Belgium, underscoring educational and counseling opportunities on ECPs.

From request to dispensation: how adolescent and young adult females experience access to emergency contraception in pharmacies

PURPOSE

Emergency contraception (EC) access was liberalised in 2002 in Switzerland by making it accessible in pharmacies without medical prescription. However, its dispensation still requires a confidential interview with a pharmacist. This qualitative study aims to explore experiences of adolescent and young adult (AYA) females who have gone to a pharmacy in order to obtain EC.

MATERIALS AND METHODS

Thirty interviews were conducted from April to August 2019 with females aged between 15 and 25 years old at the interview. Inclusion criteria was to have requested at least one EC in a pharmacy between 2014 and 2019. A thematic content analysis was performed to extract themes brought up by the participants.

RESULTS

Some participants reported that the most difficult moment in the process was the request at the counter. The majority of participants were escorted in a private back room but opinions were divided regarding this isolation. Experiences were sometimes negative due to lack of information and knowledge regarding the dispensation process. The interview also has also a preventive aim, but the information given during it often focussed solely on the risk of vomiting. Several participants reported having perceived or received moral judgements from pharmacists.

CONCLUSIONS

Pharmacists are key resources and EC dispensation an opportunity for sexual health. This exploratory study presents several elements requiring the adaptation of practices in order to prevent them from becoming barriers for AYA to access EC. Concerns are regularly expressed by young women about privacy, embarrassment and judgement in the pharmacy context regarding contraception.

Development and Pilot Testing of a Dispensing Protocol on Emergency Contraceptive Pills for Community Pharmacists in Belgium

Community pharmacists in Belgium frequently dispense emergency contraceptive pills (ECPs). However, variable and insufficient counseling practices exist across pharmacies, highlighting the need for standardization and quality improvement strategies. The aim of this project was to develop and test an ECP dispensing protocol for pharmacists. An ‘experience-based’ co-design approach involving academic and practicing pharmacists was applied, followed by a 4-month test period and interviews to assess users’ experiences. In total, eight geographically dispersed pharmacies participated. Pharmacists (n = 15) reached a consensus on most items to be included in the protocol, which was subsequently tested in seven pharmacies, with overall 97 registered ECP conversations. Pharmacists considered the protocol complete but felt that not all items should be mentioned/questioned during all conversations. They suggested only subtle modifications to be made prior to delivering a final protocol ready for nationwide distribution. Despite attributing positive effects to having a protocol, no single pharmacist ‘actively’ used it at-the-counter but used it instead as a ‘checklist’ after the encounter. Pharmacists found that the paper-based format of the protocol hindered protocol-based dispensing. Future research is needed to provide evidence on the actual benefits of protocol application, as well as to identify factors influencing the implementation of ECP dispensing using a software-integrated protocol.

Physicians' Opinion Regarding Extended Access to Hormonal Contraception in Switzerland

(1) Background: Access to hormonal contraceptives (HC) strongly differs between countries and varies from over the counter (OTC) to prescription-only availability. This study aimed to identify opinions among physicians in Switzerland regarding extended access to HC. (2) Methods: Web-based survey among physicians (gynecologists, general practitioners, and pediatricians) in Switzerland. (3) Results: Hundred sixty-three physicians, mainly gynecologists, participated in this survey and 147 (90%) were included for analysis. A total of 68% (n = 100) answered that prescription-only status could be extended under certain conditions but physicians were concerned about patients' safety (97%, n = 142). Moreover, there was concern about insufficient patient education on HC (93%, n = 136) and that women may forego preventive examinations (80%, n = 118). Participants did not support OTC availability (93%, n = 136). Pharmacists prescribing (including initiation of HC) revealed controversial results, but a combined access model (initial prescription from physician and follow-up prescriptions by pharmacists) found acceptance in 70% (n = 103). (4) Conclusions: Participating physicians stated that prescription-only status for HC could be lifted under certain conditions but also some concerns, e.g., patients' safety or neglection of preventive examinations, were raised. Future research should focus on specific conditions in which extended access to HC could be agreed on.

Who Is Best to Test? A Systematic Review of Chlamydia Infections in Switzerland

In many countries, community pharmacies provide sexual-health-related services to limit the spread of sexually transmitted infections (STIs), including chlamydia testing. To identify suitable target groups for pharmacy-based chlamydia testing in Switzerland, we aimed to assess chlamydia prevalence, identify risk groups, and delineate screening strategies. We conducted a systematic literature search up to December 2019 in PubMed, EMBASE, and Web of Science, according to the PRISMA guidelines, using as keywords “chlamydia”, “screening”, and “Switzerland”. Two researchers screened the title, abstract, and full-text article and assessed the methodological quality. The literature search generated 108 hits, and nine studies were included. Chlamydia prevalence ranged between 0.8 and 12.8%. Most frequently affected were undocumented women undergoing voluntary termination of pregnancy (12.8%, 95% CI: 8.4–18.9), HIV-positive men who have sex with men (10.9%, 95% CI: 9.2–17.6), and adult offenders (6.5%, 95% CI: 3.2–9.0). Systematic screening was suggested for the first two risk groups and women suffering a miscarriage. To conclude, chlamydia infections are prevalent in Switzerland, but the identified risk groups are difficult to reach for a pharmacy-based testing service. More studies are needed to identify suitable target groups, including customers seeking sexual health services, particularly emergency contraception users who already receive counselling for STIs at community pharmacies.

The Quality of Counselling for Oral Emergency Contraceptive Pills-A Simulated Patient Study in German Community Pharmacies

Background: In Germany, there are two different active substances, levonorgestrel (LNG) and ulipristal acetate (UPA), available as emergency contraception (the “morning after pill”) with UPA still effective even 72 to 120 h after unprotected sexual intercourse, unlike LNG. Emergency contraceptive pills have been available without a medical prescription since March 2015 but are still only dispensed by community pharmacies. The aim of this study was to determine the counselling and dispensing behaviour of pharmacy staff and the factors that may influence this behaviour in a scenario that intends that only the emergency contraceptive pill containing the active substance UPA is dispensed (appropriate outcome). Methods: A cross-sectional study was carried out in the form of a covert simulated patient study in a random sample of community pharmacies stratified by location in the German state of Mecklenburg-Vorpommern and reported in accordance with the STROBE statement. Each pharmacy was visited once at random by one of four trained test buyers. They simulated a product-based request for an emergency contraceptive pill, stating contraceptive failure 3.5 days prior as the reason. The test scenario and the evaluation forms are based on the recommended actions, including the checklist from the Federal Chamber of Pharmacies. Results: All 199 planned pharmacy visits were carried out. The appropriate outcome (dispensing of UPA) was achieved in 78.9% of the test purchases (157/199). A significant correlation was identified between the use of the counselling room and the use of a checklist (p < 0.001). The use of a checklist led to a significantly higher questioning score (p < 0.001). In a multivariate binary logistic regression analysis, a higher questioning score (adjusted odds ratio [AOR] = 1.41; 95% CI = 1.22–1.63; p < 0.001) and a time between 12:01 and 4:00 p.m. (AOR = 2.54; 95% CI = 1.13–5.73; p = 0.024) compared to 8:00 to 12:00 a.m. were significantly associated with achieving the appropriate outcome. Conclusions: In a little over one-fifth of all test purchases, the required dispensing of UPA did not occur. The use of a counselling room and a checklist, the use of a checklist and the questioning score as well as the questioning score and achieving the appropriate outcome are all significantly correlated. A target regulation for the use of a counselling room, an explicit guideline recommendation about the use of a checklist, an obligation for keeping UPA in stock and appropriate mandatory continuing education programmes should be considered.