Compliance with mandated emergency contraception in New Mexico emergency departments

Scoping Review of Access to Emergency Contraception for Sexual Assault Victims in Emergency Departments in the United States

OBJECTIVE

We conducted a scoping review of the literature to assess the prevalence of hospital policies regarding emergency contraception (EC) and the frequency that U.S. emergency departments (EDs) provide EC to sexual assault survivors.

STUDY DESIGN

We searched PubMed, Embase, the Cochrane Library, and CINAHL from inception to January 2019 for studies that assessed access to EC for sexual assault survivors in EDs. We included English-language studies that surveyed ED staff at U.S. hospitals and reported the weighted mean of the percentage of hospitals with an EC policy for sexual assault survivors and the percentage that provided EC counseling, offered or dispensed EC onsite. Secondary outcomes were rates of testing and prophylaxis for sexually transmitted infections (STIs) and HIV.

RESULTS

From 390 articles retrieved, 14 studies met the inclusion criteria; all studies were published between 2000 and 2013. Eligible studies surveyed staff at 3,314 hospitals. Overall, 60% (weighted mean) of hospitals had a policy on EC, 75% provided EC counseling, 44% offered EC, and 62% had EC available to dispense onsite. Four studies reported secondary outcomes: 81% of hospitals provided STI testing, 84% provided STI prophylaxis, 64% provided HIV testing, and 53% provided HIV prophylaxis.

CONCLUSION

Existing literature demonstrates significant variability in EC policies and practices for sexual assault survivors in U.S. hospital EDs. Future research should assess whether EC access for survivors has improved in ED settings as well as evaluate persistent or new barriers to access.

Pediatric emergency health care providers' knowledge, attitudes, and experiences regarding emergency contraception

OBJECTIVES

The objective was to describe knowledge, attitudes, and experiences regarding emergency contraception (EC) among pediatric emergency health care providers (HCPs).

METHODS

This multicenter, focus group study elicited thoughts and experiences from pediatric emergency HCPs about EC. Participants were physicians, nurse practitioners (NPs), and nurses in one of three urban, geographically distinct, pediatric emergency departments (EDs). A professional moderator used a semistructured format for sessions, which were audiotaped, transcribed, and analyzed for recurrent themes. Participants provided demographic information and completed a written survey evaluating EC knowledge.

RESULTS

Eighty-five HCPs (41 physicians, eight NPs, and 36 nurses) participated in 12 focus groups. Overall knowledge about EC was poor. Participants identified barriers including cost, privacy, knowledge, and provider refusal. Provision of EC for adolescents was supported by the majority of physicians and NPs; however, many nurses were not supportive, especially following consensual intercourse. The authors identified use of social judgment by nurses as a novel barrier to EC provision. The majority of HCPs did not support screening for potential EC need. The majority of physicians and NPs felt obligated to provide adolescents with all contraceptive options, while more nurses supported provider refusal to provide EC.

CONCLUSIONS

This study identified important HCP perceptions and barriers about EC provision in the pediatric ED. These findings may inform future efforts to improve EC provision for adolescents. Specifically, future studies to evaluate the differences in attitudes between nurses, physicians, and NPs, and the use of social judgment in EC provision, are warranted.