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Allen RH, Bartz D. Opill: The Over-the-Counter Contraceptive Pill. Obstet Gynecol 2024; 143:184-188. [PMID: 37944139 DOI: 10.1097/aog.0000000000005455] [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: 08/20/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023]
Abstract
The U.S. Food and Drug Administration has approved the first oral contraceptive pill (OCP) for over-the-counter status. This progestin-only pill contains norgestrel 0.075 mg taken daily, with a Pearl Index estimated at 4.4 (95% CI, 1.9-8.8). This formulation has an excellent safety profile, with current breast cancer as the only absolute contraindication and few relative contraindications. Ultimately, this approval has great potential to improve the accessibility of effective contraception for many pregnancy-capable Americans, especially those who have poor access to the health care system for prescription-required contraception, most notably people who hold marginalized identities. The pill's overall success in reducing rates of unintended pregnancy will rely on its availability, particularly in rural communities that may rely on one pharmacy, and affordability, especially for uninsured or underinsured individuals. However, given the need for improved contraceptive provision, particularly in abortion-restrictive settings, the over-the-counter approval of this daily OCP is a major advancement in the nation's contraceptive ecosystem.
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Affiliation(s)
- Rebecca H Allen
- Warren Alpert Medical School of Brown University, Providence, Rhode Island; and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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2
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Nappi RE, Farris M, Gallina Toschi A, Michieli R, Moccia F, Orthmann N, Arisi E. Overcoming barriers to oral contraception in Italy an expert opinion to empower women. Gynecol Endocrinol 2023; 39:2254400. [PMID: 37666276 DOI: 10.1080/09513590.2023.2254400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/06/2023] Open
Abstract
Oral contraceptives are among the most commonly used contraceptive methods. However, Italian women underused reliable hormonal contraceptives as compared with other European women. There is a need to streamline access to oral contraception, with expected benefits on emotional well-being of women and potential savings for health system in Italy. Indeed, women can only access to oral contraceptives through mandatory medical prescription. This is one of the most important barrier experienced by women. We hereby provide an expert opinion on the potential reclassification, extending pharmacy services to include responsible and appropriate use of POP, as an opportunity also in Italy to increase the use of safe and effective contraceptive methods.
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Affiliation(s)
- Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
| | - Manuela Farris
- AIED (Italian Association for Demographic Education), Rome, Italy
| | | | | | | | - Nicoletta Orthmann
- Onda Foundation - National Observatory of Women's and Gender Health, Milano, Italy
| | - Emilio Arisi
- SMIC (Italian Medical Society of Contraception), Milano, Italy
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3
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Otto AK, Klein DA, Lau M, Santelli J, Dhar CP, Vyver E, Hwang LY. It's Time for Over-the-Counter Oral Contraceptive Pills. J Adolesc Health 2023; 72:829-830. [PMID: 37032214 DOI: 10.1016/j.jadohealth.2023.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/03/2023] [Accepted: 02/26/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Alana K Otto
- Division of Adolescent Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.
| | - David A Klein
- Departments of Family Medicine and Pediatrics, Uniformed Services University, Bethesda, Maryland; Department of Family Medicine, David Grant Medical Center, Travis Air Force Base, California
| | - May Lau
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - John Santelli
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York; Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York
| | - Cherie P Dhar
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ellie Vyver
- Department of Pediatrics, Section of Adolescent Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Loris Y Hwang
- Division of Adolescent & Young Adult Medicine, Department of Pediatrics, University of California, Los Angeles, Los Angeles, California
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4
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Grindlay K, Key K, Bradford RD, Amato C, Blanchard K, Grossman D. Pilot label comprehension study for an over-the-counter combined oral contraceptive pill in the United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:28-37. [PMID: 36351550 DOI: 10.1363/psrh.12214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
CONTEXT A growing body of evidence supports over-the-counter access to oral contraceptives in the United States. An important consideration for over-the-counter approval is consumers' ability to understand key package label messages related to safety and effectiveness without clinician involvement. We developed a prototype over-the-counter Drug Facts Label for a combined oral contraceptive pill and conducted a pilot label comprehension study to evaluate consumer understanding of key messages for use. METHODS In November-December 2020, we conducted interviews with 163 adults and teens in the United States who were aged 12-49 years and identified as female or another gender but had a uterus and the ability to become pregnant. We developed 11 primary endpoints based on assessment of clinical risks that could occur if consumers fail to heed them, including messages about contraindications and directions for use; 11 secondary endpoints represented additional important information but with lower potential for clinical consequences if not understood. We evaluated endpoint comprehension by computing frequencies, percentages, and 2-sided Exact (Clopper-Pearson) 95% confidence intervals for observed proportions. RESULTS Ten of the 11 primary endpoints and 10 of the 11 secondary endpoints were each understood by ≥95% of participants. The remaining primary endpoint on use with prior blood clots was understood by 89% of participants. The remaining secondary endpoint on the product being designed for "people who have the ability to become pregnant" was understood by 83% of participants. CONCLUSION Participants understood the key label information required for safe and effective combined oral contraceptive use without clinician involvement.
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Affiliation(s)
- Kate Grindlay
- Ibis Reproductive Health, Cambridge, Massachusetts, USA
| | - Katherine Key
- Ibis Reproductive Health, Cambridge, Massachusetts, USA
| | | | | | | | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California, USA
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Grindlay K, Key K, Zuniga C, Wollum A, Grossman D, Blanchard K. Experiences using a progestin-only pill in an over-the-counter environment in the United States: a cross-sectional survey. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:27-34. [PMID: 36270780 DOI: 10.1136/bmjsrh-2022-201637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Efforts are underway to make a progestin-only pill (POP) over the counter (OTC) in the United States (US); however, little is known about POP user experiences, which could impact uptake and continuation. METHODS From January 2020-September 2021, we conducted a cross-sectional online survey with individuals who used OTC POPs in a US trial. We calculated descriptive statistics and Pearson chi-square and Fisher's exact tests to assess menstrual bleeding acceptability, how OTC POP experiences compared with prior contraceptive methods, and preferred ways to get answers to questions during OTC POP use. RESULTS Among 550 adult and 115 adolescent participants, 80% (n=531) felt their menstrual bleeding was acceptable. Participants reported a range of menstrual bleeding experiences compared with prior long-acting or hormonal methods used; 58% (n=84) said the POP bleeding was similar or better and 36% (n=53) said it was worse. Among participants who used contraception in the month prior to the trial, 77% (n=201) said their overall OTC POP experience was similar or better. Top benefits compared with prior methods included less worry about pregnancy, ease of access, fewer side effects, and greater decision-making power. Adults preferred to get answers about OTC POPs via webpage or app, whereas teens preferred asking pharmacists or other healthcare providers. CONCLUSIONS Overall, OTC POP users in a trial setting found the menstrual bleeding acceptable and the method similar to or better than previous methods. POP labelling should provide clear messaging about bleeding changes users may experience.
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Affiliation(s)
- Kate Grindlay
- Ibis Reproductive Health, Cambridge, Massachusetts, USA
| | - Katherine Key
- Ibis Reproductive Health, Cambridge, Massachusetts, USA
| | | | | | - Daniel Grossman
- Department of Obstetrics, Gynecology and Reproductive Sciences, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California San Francisco, Oakland, California, USA
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6
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Guillard H, Laurora I, Sober S, Karapet A, Brass EP, Glasier A. Modeling the potential benefit of an over-the-counter progestin-only pill in preventing unintended pregnancies in the U.S. Contraception 2023; 117:7-12. [PMID: 36257375 DOI: 10.1016/j.contraception.2022.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To develop a model to estimate the possible impact of use of an over-the-counter (OTC) progestin-only pill (POP) on the number of unintended pregnancies in the United States. STUDY DESIGN Using typical use failure rates (7% for POPs), we compared the expected number of unintended pregnancies for two theoretical cohorts of 100,000 women: one which purchased and used an OTC POP exclusively for contraception, the other using contraceptive methods at proportions obtained from an actual-use clinical trial simulating OTC use of norgestrel 0.075 mg (including 35% using no method and only 19% using hormonal contraception or long-acting contraceptives). Sensitivity analyses were conducted using alternative model inputs such as different failure rates for OTC POPs and varied alternative contraceptive method mix. RESULTS An estimated 37,624 unintended pregnancies would occur annually if 100,000 women continued their usual contraceptive method as used at baseline in the actual use trial. This would be reduced by 81% to 7,000 pregnancies with the exclusive use of an OTC POP - a net reduction of 30,624 unintended pregnancies annually. While the number of unintended pregnancies prevented varied as the model parameters were modified (ranging from 1,461 to 34,124), a net benefit of OTC POP use was observed over a wide range of input values. CONCLUSIONS Using data from a real-world contraception user profile, our model suggests that use of an OTC POP could reduce the overall number of unintended pregnancies in the United States. This conclusion remains true across a wide range of modeled scenarios. IMPLICATIONS The estimates suggested by this model are supportive of an OTC switch for a POP.
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Affiliation(s)
| | | | | | - Artin Karapet
- LyonaPharm Consulting, Collonges-Au-Mont-D'Or, France
| | - Eric P Brass
- David Geffen School of Medicine at UCLA, Rancho Palos Verdes, CA, United States
| | - Anna Glasier
- Department of Obstetrics and Gynaecology, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, United Kingdom
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Development of a Protocol Using the Delphi Method for the ad interim Supply of Hormonal Contraceptives in Swiss Pharmacies. PHARMACY 2022; 10:pharmacy10060168. [PMID: 36548324 PMCID: PMC9785210 DOI: 10.3390/pharmacy10060168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 12/04/2022] Open
Abstract
(1) Background: Pharmacists are often challenged with situations where women are already on hormonal contraceptives (HC) but have no valid prescription. By Swiss law, pharmacists are allowed to supply prescription-only drugs in exceptional situations without a physician's prescription. Because eligibility for HC can change, women at risk for complications, such as serious side effects, need to be identified. We aimed to develop a protocol to assist pharmacists in clarifying and documenting eligibility for HC. (2) Methods: We conducted a survey using the Delphi method to identify relevant clarifications and develop a protocol for pharmacists. Proposed material was created based on the literature and existing toolkits/protocols aimed at verifying eligibility for HC. A multidisciplinary expert panel, consisting of gynecologists and pharmacists, reviewed the proposed material and provided anonymized feedback over two survey cycles. (3) Results: This Delphi survey revealed items essential to the clarification of eligibility for HC in pharmacies for women who are already using it. This resulted in a protocol that maps "best practices" regarding these ad interim supplies of HC given without a prescription in Switzerland. (4) Conclusions: This survey, made using the Delphi method, allowed us to create a protocol for pharmacists that aims to verify and document eligibility for HC in Switzerland, where HC is frequently supplied without a prescription.
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Jensen KHR, McCulloch DEW, Olsen AS, Bruzzone SEP, Larsen SV, Fisher PM, Frokjaer VG. Effects of an Oral Contraceptive on Dynamic Brain States and Network Modularity in a Serial Single-Subject Study. Front Neurosci 2022; 16:855582. [PMID: 35774557 PMCID: PMC9237452 DOI: 10.3389/fnins.2022.855582] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 05/25/2022] [Indexed: 12/03/2022] Open
Abstract
Hormonal contraceptive drugs are used by adolescent and adult women worldwide. Increasing evidence from human neuroimaging research indicates that oral contraceptives can alter regional functional brain connectivity and brain chemistry. However, questions remain regarding static whole-brain and dynamic network-wise functional connectivity changes. A healthy woman (23 years old) was scanned every day over 30 consecutive days during a naturally occurring menstrual cycle and again a year later while using a combined hormonal contraceptive. Here we calculated graph theory-derived, whole-brain, network-level measures (modularity and system segregation) and global brain connectivity (characteristic path length) as well as dynamic functional brain connectivity using Leading Eigenvector Dynamic Analysis and diametrical clustering. These metrics were calculated for each scan session during the serial sampling periods to compare metrics between the subject’s natural and contraceptive cycles. Modularity, system segregation, and characteristic path length were statistically significantly higher across the natural compared to contraceptive cycle scans. We also observed a shift in the prevalence of two discrete brain states when using the contraceptive. Our results suggest a more network-structured brain connectivity architecture during the natural cycle, whereas oral contraceptive use is associated with a generally increased connectivity structure evidenced by lower characteristic path length. The results of this repeated, single-subject analysis allude to the possible effects of oral contraceptives on brain-wide connectivity, which should be evaluated in a cohort to resolve the extent to which these effects generalize across the population and the possible impact of a year-long period between conditions.
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Affiliation(s)
- Kristian Høj Reveles Jensen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Psychiatric Center Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Anders Stevnhoved Olsen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Applied Mathematics and Computer Science, DTU Compute, Kongens Lyngby, Denmark
| | - Silvia Elisabetta Portis Bruzzone
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Vinther Larsen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Vibe Gedsoe Frokjaer
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Psychiatric Center Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- *Correspondence: Vibe Gedsoe Frokjaer,
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9
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Association of Pharmacist Prescription of Contraception With Breaks in Coverage. Obstet Gynecol 2022; 139:781-787. [DOI: 10.1097/aog.0000000000004752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/27/2022] [Indexed: 10/18/2022]
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Bradford RD, Farnsworth SJ, Laurora I, Sober S, Guillard H, Glasier A, Shiffman S. Adherence among a cohort taking progestin-only pills prescribed by a healthcare provider: Results of the BENCHMARK study. Contraception 2022; 112:48-53. [PMID: 35472334 DOI: 10.1016/j.contraception.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To measure adherence over 6 months of progestin-only pill (POP) use. STUDY DESIGN Prospective observational cohort study measuring adherence to daily dosing and timing of dose in patients prescribed a POP, with up to six months of follow-up, conducted from January to October 2020. A pharmacy benefit manager identified potential participants with a newly prescribed POP and extended an invitation to participate. We enrolled qualified respondents by telephone, trained them to use an electronic diary to report daily whether they had taken their POP and at what time. We followed participants for up to six months. We calculated adherence to daily pill taking as the proportion of evaluable days in which a participant took a POP, and the proportion of participants reporting ≥85% adherence. We calculated adherence to same time each day as the proportion of doses taken no later than three hours after the previous dose time of day. RESULTS The user population comprised 199 participants, 154 (77.4%) of whom completed six months of follow-up. The majority (n=170, 85.4%) were taking norethindrone. Norethindrone users reported POP intake on 22,327 (96.4%) of 23,156 evaluable days, with 155 (91.2%) participants reporting ≥85% adherence; less than half (n=73, 42.9%) reported 100% adherence. Participants reported adherence to same time each day on 21,698 of 22,157 (97.9%) evaluable days. CONCLUSIONS Among participants taking a prescribed POP, participants demonstrated high adherence for daily pill taking and the same time of day, though the majority were not 100% adherent. IMPLICATIONS This study reports data specific to adherence among those taking a progestin-only pill (POP) in the prescription setting. Clinicians who counsel patients about POP use should be aware that majority of patients were not 100% adherent, although most report ≥ 85% adherence.
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Affiliation(s)
- Russell D Bradford
- PEGUS Research, Inc, 331 S. Rio Grande, Suite 100, Salt Lake City, UT 84101, United States.
| | - Sarah J Farnsworth
- PEGUS Research, Inc, 331 S. Rio Grande, Suite 100, Salt Lake City, UT 84101, United States.
| | - Irene Laurora
- HRA Pharma, 36 Cattano Ave., Suite 400, Morristown, NJ 07960, United States.
| | - Stephanie Sober
- HRA Pharma, 36 Cattano Ave., Suite 400, Morristown, NJ 07960, United States.
| | | | - Anna Glasier
- Department of Obstetrics and Gynaecology, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom.
| | - Saul Shiffman
- Departments of Psychology, Psychiatry, Pharmaceutical Sciences, and Clinical Translational Science, University of Pittsburgh, Sennott Square, 3rd Floor, 210 South Bouquet Street, Pittsburgh, PA 15260, United States and Pinney Associates, 201 North Craig Street, Suite 320, Pittsburgh, PA, 15213, United States.
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11
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Parry RA, Seamon G, Scott MA, Tak CR. North Carolina Pharmacists' Support for Hormonal Contraception Prescription Status Change. J Pharm Pract 2022:8971900221074966. [PMID: 35325584 DOI: 10.1177/08971900221074966] [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: 11/17/2022]
Abstract
BACKGROUND Pharmacist-prescribed hormonal contraception (HC) may offer additional avenues of access for patients; however, it is unknown whether pharmacists would support over-the-counter access to contraception over pharmacist-prescribed models. OBJECTIVE The objective of this study was to understand how North Carolina (NC) pharmacists believed HC should be classified and how pharmacist and pharmacy characteristics were associated with those beliefs. METHODS This study was a secondary analysis of a cross-sectional, anonymous, online survey completed by 587 licensed NC pharmacists. The primary outcome of interest was how pharmacists believed HC should be classified: prescription-only, pharmacist-prescribed, behind-the-counter, or over-the-counter. Multinomial bivariate and multivariable regression analyses were conducted to describe the association between pharmacist and pharmacy characteristics with the outcomes of interest through odds ratios and adjusted odds ratios, respectively. Chi-square tests were used to examine the association of geographic location with distribution of attitudes toward HC classification. RESULTS Fifty-one percent of NC pharmacists supported classification of HC as pharmacist-prescribed, while 23% supported non-prescription (behind- or over-the-counter) classification. Controlling for pharmacist demographics and pharmacy characteristics, completing residency training was significantly associated with supporting pharmacist-prescribed vs prescription-only classification (adjusted odds ratio (aOR) = 2.55, P = .02). Pharmacists had higher odds of supporting pharmacist-prescribed vs prescription-only HC if they agreed that they were well trained to do so (aOR = 3.14, P < .01). Distribution of attitudes about classification of HC did not significantly differ by geographic location (P = .14). CONCLUSIONS Most NC pharmacists support deviating from the current prescription-only classification of HC, with more support for pharmacist-prescribed classification. Continuing education programs should focus on training pharmacists to feel more confident prescribing HC.
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Affiliation(s)
- Rachel A Parry
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, 2331The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gwen Seamon
- Mountain Community Health Partnership, Burnsville, NC, USA
| | - Mollie Ashe Scott
- UNC Health Sciences, Mountain Area Health Education Center, Asheville, NC, USA.,Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, 2331The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Casey R Tak
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, 2331The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
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12
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Steenland MW, Geiger CK, Chen L, Rokicki S, Gourevitch RA, Sinaiko AD, Cohen JL. Declines in contraceptive visits in the United States during the COVID-19 pandemic. Contraception 2021; 104:593-599. [PMID: 34400152 PMCID: PMC8570647 DOI: 10.1016/j.contraception.2021.08.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/02/2021] [Accepted: 08/07/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To document the change in contraceptive visits in the United States during the COVID-19 pandemic. STUDY DESIGN Using a nationwide sample of claims we analyzed the immediate and sustained changes in contraceptive visits during the pandemic by calculating the percentage change in number of visits between May 2019 and April 2020 and between December 2019 and December 2020, respectively. We examined these changes by contraceptive method, region, age, and use of telehealth, and separately for postpartum individuals. RESULTS Relative to May 2019, in April 2020, visits for tubal ligation declined by 65% (95% CI, -65.5, -64.1), LARCs by 46% (95% CI, -47.0, -45.6), pill, patch, or ring by 45% (95% CI, -45.8, -44.5), and injectables by 16% (95% CI -17.2, -15.4). The sustained change in visits in December 2020 was larger for tubal ligation (-18%, 95% CI, -19.1, -16.8) and injectable (-11%, 95% CI, -11.4, -9.6) visits than for LARC (-6%, 95% CI, -6.6, -4.4) and pill, patch, and ring (-5%, 95% CI, -5.7, -3.7) visits. The immediate decline was highest in the Northeast and Midwest regions. Declines among postpartum individuals were smaller but still substantial. CONCLUSIONS There were large declines in contraceptive visits at the start of the COVID-19 pandemic and visit numbers remained below pre-pandemic levels through the end of 2020. IMPLICATIONS Declines in contraceptive visits during the pandemic suggest that many people faced difficulties accessing this essential health service during the COVID-19 pandemic.
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Affiliation(s)
- Maria W. Steenland
- Population Studies and Training Center, Brown University, Providence, RI, United States,Corresponding author
| | - Caroline K. Geiger
- Interfaculty Initiative in Health Policy, Harvard University, Cambridge, MA, United States
| | - Lucy Chen
- Interfaculty Initiative in Health Policy, Harvard University, Cambridge, MA, United States
| | - Slawa Rokicki
- Department of Health Behavior, Society, & Policy, Rutgers School of Public Health, Piscataway, NJ, United States
| | - Rebecca A. Gourevitch
- Interfaculty Initiative in Health Policy, Harvard University, Cambridge, MA, United States
| | - Anna D. Sinaiko
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Jessica L. Cohen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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13
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Yous T, Allemann S, Lutters M. Physicians' Opinion Regarding Extended Access to Hormonal Contraception in Switzerland. PHARMACY 2021; 9:pharmacy9040184. [PMID: 34842813 PMCID: PMC8628942 DOI: 10.3390/pharmacy9040184] [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: 10/13/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
(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.
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Affiliation(s)
- Tamara Yous
- Department of Medical Sciences, Private University of the Principality of Liechtenstein, 9495 Triesen, Liechtenstein
- Correspondence:
| | - Samuel Allemann
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, 4051 Basel, Switzerland;
| | - Monika Lutters
- Clinical Pharmacy, Cantonal Hospital of Baden, 5404 Baden, Switzerland;
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14
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Soon JA, Whelan AM, Yuksel N, Rafie S. Enhancing access to contraception through pharmacist prescribing across Canada. Can Pharm J (Ott) 2021; 154:356-362. [PMID: 34777642 PMCID: PMC8581806 DOI: 10.1177/17151635211034534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/02/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Judith A. Soon
- Faculty of Pharmaceutical Sciences, University of British Columbia
- Department of Family Practice, University of British Columbia
| | | | - Nesé Yuksel
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta
| | - Sally Rafie
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California–San Diego, California
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15
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Howard D. Over-the-Counter Hormonal Contraception: The Time Has Come. Popul Health Manag 2021; 24:436-438. [PMID: 34406090 DOI: 10.1089/pop.2020.0244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Denise Howard
- Department of Obstetrics and Gynecology, Geisinger Health System, Danville, Pennsylvania, USA
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16
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Stotland NL, Shrestha AD, Stotland NE. Reproductive Rights and Women's Mental Health: Essential Information for the Obstetrician-Gynecologist. Obstet Gynecol Clin North Am 2021; 48:11-29. [PMID: 33573782 DOI: 10.1016/j.ogc.2020.11.002] [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: 11/15/2022]
Abstract
Reproductive health care is crucial to women's well-being and that of their families. State and federal laws restricting access to contraception and abortion in the United States are proliferating. Often the given rationales for these laws state or imply that access to contraception and abortion promote promiscuity, and/or that abortion is medically dangerous and causes a variety of adverse obstetric, medical, and psychological sequelae. These rationales lack scientific foundation. This article provides the evidence for the safety of abortion, for both women and girls, and encourages readers to advocate against restrictions.
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Affiliation(s)
| | - Angela D Shrestha
- Howard Brown Health Center 4025 N Sheridan Road, Chicago, IL 60613, USA
| | - Naomi E Stotland
- University of California, San Francisco, Zuckerberg/San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, USA.
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17
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Edelman A, Hemon A, Creinin M, Borensztein P, Scherrer B, Glasier A. Assessing the Pregnancy Protective Impact of Scheduled Nonadherence to a Novel Progestin-Only Pill: Protocol for a Prospective, Multicenter, Randomized, Crossover Study. JMIR Res Protoc 2021; 10:e29208. [PMID: 33970869 PMCID: PMC8262664 DOI: 10.2196/29208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 01/26/2023] Open
Abstract
Background Progestin-only contraceptive pills (POP) are commonly reserved for women with medical comorbidities but in actuality, POPs can be safely used by anyone wanting to prevent pregnancy. This wide safety profile makes them an ideal candidate for being available over the counter without a prescription, but adherence issues may be more common with over-the-counter use. We need a better understanding of the ability of POPs to prevent pregnancy when adherence issues occur in the form of a missed or delayed pill. Objective This study aims to determine cervical mucus characteristics following a 6-hour delayed pill intake or after one missed pill as compared to typical daily use of norgestrel 75 mcg. Methods This prospective, multicenter, randomized, crossover study assesses the effect of norgestrel 75 mcg (Opill) on cervical mucus and ovarian activity during reported compliant daily use, after a 6-hour delayed intake mid cycle, and after a mid-cycle missed pill. Subject participation will last approximately 4.5 months. We will recruit at 2 US sites: Oregon Health & Science University, Portland, Oregon and University of California Davis Health, Sacramento, California. Reproductive-aged subjects with regular menstrual cycles (21-35 days), BMI <32 kg/m2, and proven ovulation (screening luteal phase progesterone >3 ng/mL [>10 nmol/L]) are eligible to enroll. Participants cannot be at risk for pregnancy during the study period and not use other hormonal methods. Norgestrel 75 mcg will be taken at the same time daily except for one day in each of treatment periods 2 and 3, when the pill will be taken either 6 hours late (delayed pill) or omitted completely (missed pill). Every 3-4 days, we will monitor subjects for follicular activity with transvaginal ultrasound (TVUS) examination, cervical mucus, and blood sampling for ovarian hormones and gonadotropins. Subjects will undergo serial cervical mucus sampling on the days with missed and delayed pill intake at 8 hours after pill intake on the day before the delayed or missed pill, 3 hours following the scheduled time of pill intake if intake was delayed, 6 hours after the scheduled time if intake was omitted, and on the next day 30 minutes before the time of scheduled pill intake. The primary objective of the study is to determine the effect of a delayed or omitted pill intake on cervical mucus characteristics based on a modified Insler score compared to reported daily use. Results Our protocol was successfully approved by a central institutional review board (Advarra, Columbia, MD), received ethical approval on March 23, 2018, and was registered with ClinicalTrials.gov (NCT03585712). As of January 2020, the study completed enrollment of 52 subjects. Analyses are pending. Conclusions Our protocol was approved by a central review board, and study procedures were successfully executed with completed proposed enrollment. Trial Registration ClinicalTrials.gov NCT03585712; https://clinicaltrials.gov/ct2/show/NCT03585712 International Registered Report Identifier (IRRID) DERR1-10.2196/29208
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Affiliation(s)
- Alison Edelman
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, United States
| | | | - Mitchell Creinin
- Department of Obstetrics & Gynecology, University of California, Davis Health, Sacramento, CA, United States
| | | | | | - Anna Glasier
- Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
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18
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Extended Access to Hormonal Contraception in Pharmacies: A Survey among Swiss Pharmacists. PHARMACY 2020; 8:pharmacy8040210. [PMID: 33182547 PMCID: PMC7712984 DOI: 10.3390/pharmacy8040210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/21/2020] [Accepted: 11/06/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Worldwide the availability to Hormonal Contraceptives (HC) varies from over the counter (OTC) to prescription-only access. In various countries pharmacists are allowed to prescribe HC, although conditions may be different. In Switzerland, HC require a prescription from a physician, although Swiss law allows pharmacists to dispense prescription-only medications in justified exceptional cases without a valid physician’s prescription. This study aimed to identify current dispensing practices for HC in Swiss pharmacies, pharmacists’ knowledge about HC, and their opinion and interest about expanding access to HC. Methods: Web-based survey among Swiss pharmacists. Results: This survey was completed by 397 registered pharmacists and 331 (83%) were included for analysis. The survey showed that 21% of respondents regularly dispense HC without prescription and that a high number of participants are either very interested (57%, n = 189) or rather interested (33%, n = 110) in extended pharmacy access to HC. The majority did not or rather not support physician’s prescription-only status (77%, n = 256) or OTC availability (94%, n = 310). Furthermore, surveyed pharmacists are willing to train for contraception services (90%, n = 299). According to participants, resistance of physicians is the most relevant barrier to this service (88%, n = 292). Conclusion: Surveyed pharmacists are interested in extended access to HC.
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Mitchell M, Stauffenberg C, Vernon V, Mospan CM, Shipman AJ, Rafie S. Opposition to Pharmacist Contraception Services: Evidence for Rebuttal. PHARMACY 2020; 8:E176. [PMID: 32977545 PMCID: PMC7711847 DOI: 10.3390/pharmacy8040176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 11/16/2022] Open
Abstract
Pharmacist contraception services are growing across the United States. Several states have authorized pharmacists to prescribe contraception, and the interest in other states continues to grow. Opposition to these practices exists and centers on discussions related to safety, training, cost, and fragmentation of care. We review these arguments and provide evidence refuting these concerns. Pharmacist-prescribed contraception increases access to care, and patients express interest in utilizing this service at the pharmacy. Pharmacists follow evidence-based recommendations. Counseling on preventative services and referral to other providers is part of contraception care by pharmacists. Training programs have been developed to equip both pharmacy students and pharmacists with the knowledge, skills, and tools needed to successfully provide these services. This article can serve as a guide for pharmacists and advocates when discussing pharmacist-prescribed contraception with policymakers, patients, and other healthcare professionals.
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Affiliation(s)
- Madeline Mitchell
- College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN 46208, USA; (M.M.); (C.S.)
| | - Courtney Stauffenberg
- College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN 46208, USA; (M.M.); (C.S.)
| | - Veronica Vernon
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN 46208, USA;
| | | | - Allie Jo Shipman
- National Association of State Pharmacy Associations, North Chesterfield, VA 23235, USA;
| | - Sally Rafie
- Birth Control Pharmacist, San Diego, CA 92122, USA
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Affiliation(s)
- Kunal K Sindhu
- Department of Radiation Oncology, the Icahn School of Medicine, New York, New York
| | - Eli Y Adashi
- Department of Medical Science, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
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21
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O’Connell MB, Samman L, Bailey T, King L, Wellman GS. Attitudes of Michigan Female College Students About Pharmacists Prescribing Birth Control in a Community Pharmacy. PHARMACY 2020; 8:pharmacy8020099. [PMID: 32526878 PMCID: PMC7355889 DOI: 10.3390/pharmacy8020099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/12/2020] [Accepted: 06/03/2020] [Indexed: 11/28/2022] Open
Abstract
In the United States, the overall unintended pregnancy rate is about 45%. Women between 20–24 years old account for 59% of the unintended pregnancies. Continuous birth control use is related to decreasing unintended pregnancies. Therefore, we assessed female college students’ opinions about pharmacists prescribing birth control in a community pharmacy using an intersectionality framework. A survey with 49 items about provider attributes, pharmacy services use and evaluation, advantages and barriers of pharmacists prescribing birth control, sexual and reproductive history, and demographics was distributed by survey link and QR code. Recruitment was done by investigators and students (snowballing technique) via emails, social media posts, and direct student contact. Respondents (n = 859) were 23.0 ± 4.9 years old, 83% white, 64% healthcare students, 32% student pharmacists, 69% sexually active, 68% with at least one episode of unprotected intercourse within a year, and 29% never using condoms. Forty-six percent of students were extremely likely and 26% moderately likely to get birth control from a pharmacist because it would be easier to adhere to birth control, could prevent unintended pregnancies, would be more convenient, and require less time. Concerns included the lack of Pap screenings and prescriptions written for the wrong birth control. Within most student characteristics or attitudes assessed, at least 70% of the students would use this service. Based on student opinions, female college students would use pharmacists prescribing birth control services.
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Affiliation(s)
- Mary Beth O’Connell
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA;
- Correspondence: ; Tel.: +1-313-993-7620
| | - Leah Samman
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA;
| | - Teresa Bailey
- College of Pharmacy, Ferris State University, Big Rapids, MI 49307, USA; (T.B.); (L.K.); (G.S.W.)
- School of Medicine Health Clinics, Western Michigan University Homer Stryker, Kalamazoo, MI 49008, USA
| | - Larissa King
- College of Pharmacy, Ferris State University, Big Rapids, MI 49307, USA; (T.B.); (L.K.); (G.S.W.)
| | - Gregory S. Wellman
- College of Pharmacy, Ferris State University, Big Rapids, MI 49307, USA; (T.B.); (L.K.); (G.S.W.)
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