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Abstract
OBJECTIVE To synthesise evidence around over-the-counter (OTC) emergency contraceptive pills (ECPs) to expand the evidence base on self-care interventions. DESIGN Systematic review (PROSPERO# CRD42021231625). ELIGIBILITY CRITERIA We included publications comparing OTC or pharmacy-access ECP with prescription-only ECPs and measuring ECP uptake, correct use, unintended pregnancy, abortion, sexual practices/behaviour, self-efficacy and side-effects/harms. We also reviewed studies assessing values/preferences and costs of OTC ECPs. DATA SOURCES We searched PubMed, CINAL, LILACS, EMBASE, clinicaltrials.gov, WHO International Clinical Trials Registry Platform, Pan African Clinical Trials Registry, Australian New Zealand Clinical Trials Registry, Cochrane Fertility Regulation and International Consortium for Emergency Contraception through 2 December 2020. RISK OF BIAS For trials, we used Cochrane Collaboration's tool for assessing risk of bias; for other studies, we used the Evidence Project risk of bias tool. DATA EXTRACTION AND SYNTHESIS We summarised data in duplicate using Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence Profile tables, reporting findings by study design and outcome. We qualitatively synthesised values/preferences and cost data. RESULTS We included 19 studies evaluating effectiveness of OTC ECP, 56 on values/preferences and 3 on costs. All studies except one were from high-income and middle-income settings. Broadly, there were no differences in overall ECP use, pregnancy or sexual behaviour, but an increase in timely ECP use, when comparing OTC or pharmacy ECP to prescription-only ECP groups. Studies showed similar/lower abortion rates in areas with pharmacy availability of ECPs. Users and providers generally supported OTC ECPs; decisions for use were influenced by privacy/confidentiality, convenience, and cost. Three modelling studies found pharmacy-access ECPs would lower health sector costs. CONCLUSION OTC ECPs are feasible and acceptable. They may increase access to and timely use of effective contraception. Existing evidence suggests OTC ECPs do not substantively change reproductive health outcomes. Future studies should examine OTC ECP's impacts on user costs, among key subgroups and in low-resource settings.
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Affiliation(s)
- Kaitlyn Atkins
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Patterson S, McDaid L, Saunders K, Battison C, Glasier A, Radley A, Stephenson JM, Johnstone A, Morelli A, Sally D, Stewart N, Cameron ST. Improving effective contraception uptake through provision of bridging contraception within community pharmacies: findings from the Bridge-it Study process evaluation. BMJ Open 2022; 12:e057348. [PMID: 35149574 PMCID: PMC8845311 DOI: 10.1136/bmjopen-2021-057348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To present process evaluation results from the Bridge-it Study, a pragmatic cluster randomised cross-over trial to improve effective contraception uptake through provision of the progestogen only pill (POP) plus sexual and reproductive health (SRH) clinic rapid-access to women presenting to community pharmacies for emergency contraception (EC). RESEARCH DESIGN AND METHODS A multimethod process evaluation was conducted to assess intervention implementation, mechanisms of change and contextual factors. Data were gathered from screening logs (n=599), observations of pharmacist training, analysis of data from 4-month follow-up questionnaires (n=406), monitoring of contemporaneous events and qualitative interviews with 22 pharmacists, 5 SRH clinical staff and 36 study participants in three participating UK sites in Lothian, Tayside and London. RESULTS The intervention was largely delivered as intended and was acceptable. Pharmacists', SRH clinical staff and participants' accounts highlighted that providing a supply of POP with EC from the pharmacy as routine practice may have positive impacts on contraceptive practices in the short term, and potentially longer term. Key mechanisms of change included ease of access, increased awareness of contraception and services, and greater motivation and perceptions of self-efficacy. Few participants took up the offer to attend an SRH service (rapid-access component), and existing barriers within the SRH context were apparent (eg, lack of staff). Participant accounts highlight persistent barriers to accessing and using routine effective contraception remain. CONCLUSIONS Implementation appeared to be acceptable and feasible, highlighting the potential for provision of POP within EC consultations as routine practice in community pharmacies. However, lack of engagement with the rapid access component of the intervention and existing barriers within the SRH context suggest that signposting to SRH services may be sufficient. Wider implementation should consider ways to address key implementation challenges to increase effectiveness and sustainability, and to overcome persistent barriers to accessing and using effective contraception. TRIAL REGISTRATION NUMBER ISRCTN70616901.
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Affiliation(s)
- Susan Patterson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Lisa McDaid
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Kristina Saunders
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - Claire Battison
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Anna Glasier
- Department of Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
| | - Andrew Radley
- Directorate of Public Health, NHS Tayside, Dundee, UK
- Division of Cardiovascular Medicines and Diabetes, Ninewells Hospital and Medical School, Dundee, UK
| | - Judith M Stephenson
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Anne Johnstone
- Department of Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
| | - Alessandra Morelli
- King's College Hospital and King's Centre for Global Health and Health Partnerships, King's College London, London, UK
| | - Deirdre Sally
- Institute for Global Health, University College London, London, UK
| | - Nicola Stewart
- Institute for Global Health, University College London, London, UK
| | - Sharon Tracey Cameron
- Department of Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
- Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
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3
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Jambrina AM, Rius P, Gascón P, Armelles M, Camps-Bossacoma M, Franch À, Rabanal M. Characterization of the Use of Emergency Contraception from Sentinel Pharmacies in a Region of Southern Europe. J Clin Med 2021; 10:jcm10132793. [PMID: 34201980 PMCID: PMC8269101 DOI: 10.3390/jcm10132793] [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: 05/25/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022] Open
Abstract
Numerous studies have been published suggesting that emergency contraception (EC) is used repeatedly, but a lack of information regarding the profile of users makes it difficult to evaluate actual consumer habits. The aim of this study was to obtain information regarding the profile of users who obtain EC and other factors that might play a role, and to provide criteria to evaluate and improve the strategies of current contraceptive programs. This was an observational one-year study based on surveillance data on the provision of EC to women of reproductive age in 60 community pharmacies in Catalonia, Spain. In total, 941 notifications of dispensation of EC in Catalonia were received. A total of 44.2% of users said it was not the first time that they had taken the medication (repeat user). The percentage of users who used condoms was lower in repeat users compared to first-time users (56.7% vs. 64.4%, p < 0.05). A total of 25.7% of users stated that they did not use any barrier contraceptive method. The use of natural methods in repeat users was 53.8% in the subgroup who requested the medication after 48 h, significantly higher than in users who obtained the medication within the first 24 h (p < 0.05). A high percentage of repeat users with risky sexual behaviors were detected, suggesting that new measures must be implemented to provide information for this method, together with educational and preventive strategies.
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Affiliation(s)
- Anna M. Jambrina
- Directorate-General for Healthcare Planning and Regulation, Ministry of Health, Government of Catalonia, 08028 Barcelona, Spain; (A.M.J.); (M.A.)
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain; (M.C.-B.); (À.F.)
| | - Pilar Rius
- Council of the Pharmacist’s Association of Catalonia, 08009 Barcelona, Spain;
| | - Pilar Gascón
- Blanquerna School of Health Sciences, Ramon Llull University, 08022 Barcelona, Spain;
| | - Mercè Armelles
- Directorate-General for Healthcare Planning and Regulation, Ministry of Health, Government of Catalonia, 08028 Barcelona, Spain; (A.M.J.); (M.A.)
| | - Mariona Camps-Bossacoma
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain; (M.C.-B.); (À.F.)
| | - Àngels Franch
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain; (M.C.-B.); (À.F.)
| | - Manel Rabanal
- Directorate-General for Healthcare Planning and Regulation, Ministry of Health, Government of Catalonia, 08028 Barcelona, Spain; (A.M.J.); (M.A.)
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain; (M.C.-B.); (À.F.)
- Correspondence:
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Cameron ST, Glasier A, McDaid L, Radley A, Patterson S, Baraitser P, Stephenson J, Gilson R, Battison C, Cowle K, Vadiveloo T, Johnstone A, Morelli A, Goulao B, Forrest M, McDonald A, Norrie J. Provision of the progestogen-only pill by community pharmacies as bridging contraception for women receiving emergency contraception: the Bridge-it RCT. Health Technol Assess 2021; 25:1-92. [PMID: 33949940 DOI: 10.3310/hta25270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Unless women start effective contraception after using emergency contraception, they remain at risk of unintended pregnancy. Most women in the UK obtain emergency contraception from community pharmacies that are unable to provide ongoing contraception (apart from barrier methods which have high failure rates). This means that women need an appointment with a general practitioner or at a sexual and reproductive health clinic. We conducted a pragmatic cluster randomised cohort crossover trial to determine whether or not pharmacist provision of a bridging supply of a progestogen-only pill plus the invitation to attend a sexual and reproductive health clinic resulted in increased subsequent use of effective contraception (hormonal or intrauterine). METHODS Twenty-nine pharmacies in three UK cities recruited women receiving emergency contraception (levonorgestrel). In the intervention, women received a 3-month supply of the progestogen-only pill (75 µg of desogestrel) plus a card that provided rapid access to a local sexual and reproductive health clinic. In the control arm, pharmacists advised women to attend their usual contraceptive provider. The primary outcome was reported use of an effective contraception (hormonal and intrauterine methods) at 4 months. Process evaluation was also conducted to inform any future implementation. RESULTS The study took place December 2017 and June 2019 and recruited 636 women to the intervention (n = 316) and control groups (n = 320). There were no statistically significant differences in demographic characteristics between the groups. Four-month follow-up data were available for 406 participants: 63% (198/315) of the control group and 65% (208/318) of the intervention group. The proportion of participants reporting use of effective contraception was 20.1% greater (95% confidence interval 5.2% to 35.0%) in the intervention group (58.4%, 95% confidence interval 48.6% to 68.2%) than in the control group (40.5%, 95% confidence interval 29.7% to 51.3%) (adjusted for recruitment period, treatment arm and centre; p = 0.011). The proportion of women using effective contraception remained statistically significantly larger, when adjusted for age, current sexual relationship and history of past use of effective contraception, and was robust to the missing data. There were no serious adverse events. CONCLUSION Provision of a bridging supply of the progestogen-only pill with emergency contraception from a pharmacist and the invitation to a sexual and reproductive health clinic resulted in a significant increase in self-reported subsequent use of effective contraception. This simple intervention has the potential to prevent more unintended pregnancies for women after emergency contraception. TRIAL REGISTRATION Current Controlled Trials ISRCTN70616901. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 27. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sharon T Cameron
- Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK.,Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
| | - Anna Glasier
- Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
| | - Lisa McDaid
- Institute for Social Science Research, The University of Queensland, Brisbane, QLD, Australia.,Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Andrew Radley
- Directorate of Public Health, NHS Tayside, Dundee, UK.,Division of Cardiovascular Medicines and Diabetes, Ninewells Hospital and Medical School, Dundee, UK
| | - Susan Patterson
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Paula Baraitser
- Department of Sexual Health, King's College Hospital NHS Foundation Trust, London, UK
| | - Judith Stephenson
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, UK
| | - Claire Battison
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Anne Johnstone
- Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
| | - Alessandra Morelli
- Department of Sexual Health, King's College Hospital NHS Foundation Trust, London, UK
| | - Beatriz Goulao
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Mark Forrest
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Alison McDonald
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
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Pharmacy-based initiatives to reduce unintended pregnancies: A scoping review. Res Social Adm Pharm 2021; 17:1673-1684. [PMID: 33582078 DOI: 10.1016/j.sapharm.2021.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/30/2021] [Accepted: 01/31/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Community pharmacy contraception services are thought to improve access, with the potential to reduce the persistent sexual and reproductive health inequities observed globally. OBJECTIVES We aimed to identify the range of pharmacy-based initiatives addressing unintended pregnancy in the primary literature and examine their feasibility, acceptability and effectiveness. METHOD Using the Joanna Briggs Institute Methodology for Scoping Reviews, we searched seven bibliographic databases using combinations of keywords and subject headings for related to contraception and community pharmacy. Studies of any design undertaken in high income countries for reproductive-aged women were eligible provided they evaluated intervention or legislation after the implementation of these initiatives. Included articles were critically appraised and findings summarised narratively. RESULTS We identified 49 articles, 80% of which involved pharmacist supply of emergency contraception (EC), 14% of regular contraception methods, and 6% involved adjuncts of EC dispensing: counselling (2%) and bridging initiatives to link clients with regular contraception (4%). EC initiatives were perceived as feasible and were facilitated by interdisciplinary partnerships but there are persistent barriers to the provision of initiatives congruous with the retail pharmacy setting. Furthermore, consumers may be reluctant to receive contraceptive counselling from pharmacists but often value the convenience and anonymity pharmacy services offer. Overall, interventions improved access to contraceptive products but did not consistently reduce inequities, and the health benefits of pharmacy initiatives are either small (EC) or lacking description in the literature (other contraceptive methods and contraceptive counselling). CONCLUSIONS Pharmacy initiatives may not negate all barriers to access or reduce unintended pregnancy rates, however they are valued by pharmacists and consumers. Evidence gaps including the lack of description of health outcomes of regular contraception provision, contraceptive counselling and the perceived barriers and facilitators of access and provision from end-user perspectives, should be pursued in future research, to establish initiatives' utility and effectiveness.
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6
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Shukla P, Pullabhotla HK, Arends-Kuenning M. Choosing Plan B Over Plan A: Risk Compensation Theory and Contraceptive Choice in India. Demography 2021; 58:273-294. [PMID: 33834245 DOI: 10.1215/00703370-8932007] [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: 11/19/2022]
Abstract
Can women's contraceptive method choice be better understood through risk compensation theory? This theory implies that people act with greater care when the perceived risk of an activity is higher and with less care when it is lower. We examine how increased over-the-counter access to emergency contraceptive pills (ECPs) accompanied by marketing campaigns in India affected women's contraceptive method choices and incidence of sexually transmitted infections (STIs). Although ECPs substantially reduce the risk of pregnancy, they are less effective than other contraceptive methods and do not reduce the risk of STIs. We test whether an exogenous policy change that increased access to ECPs leads people to substitute away from other methods of contraception, such as condoms, thereby increasing the risk of both unintended pregnancy and STIs. We find evidence for risk compensation in terms of reduced use of condoms but not for increases in rates of STIs.
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Affiliation(s)
- Pallavi Shukla
- Department of Environmental Health and Engineering, a joint department of the Bloomberg School of Public Health and the Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | | | - Mary Arends-Kuenning
- Agricultural and Consumer Economics Department, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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7
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Glasier A, Baraitser P, McDaid L, Norrie J, Radley A, Stephenson JM, Battison C, Gilson R, Cameron S. Emergency contraception from the pharmacy 20 years on: a mystery shopper study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:55-60. [PMID: 32554399 PMCID: PMC7815628 DOI: 10.1136/bmjsrh-2020-200648] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/07/2020] [Accepted: 05/17/2020] [Indexed: 06/01/2023]
Abstract
BACKGROUND Emergency contraception (EC) was approved in the UK as a pharmacy medicine for purchase without prescription in 2001. Twenty years later we conducted a study to characterise routine practice pharmacy provision of EC. STUDY DESIGN Mystery shopper study of 30 pharmacies in Edinburgh, Dundee and London participating in a clinical trial of contraception after EC. METHODS Mystery shoppers, aged ≥16 years, followed a standard scenario requesting EC. After the pharmacy visit, they completed a proforma recording the duration of the consultation, where it took place, and whether advice was given to them about the importance of ongoing contraception after EC. RESULTS Fifty-five mystery shopper visits were conducted. The median reported duration of the consultation with the pharmacist was 6 (range 1-18) min. Consultations took place in a private room in 34 cases (62%) and at the shop counter in the remainder. In 27 cases (49%) women received advice about ongoing contraception. Eleven women (20%) left the pharmacy without EC due to lack of supplies or of a trained pharmacist. Most women were generally positive about the consultation. CONCLUSIONS While availability of EC from UK pharmacies has undoubtedly improved access, the necessity to have a consultation, however helpful, with a pharmacist introduces delays and around one in five of our mystery shoppers left without getting EC. Consultations in private are not always possible and little advice is given about ongoing contraception. It is time to make EC available without a pharmacy consultation.
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Affiliation(s)
- Anna Glasier
- Obstetrics & Gynaecology, University of Edinburgh, Edinburgh, UK
| | - Paula Baraitser
- Department of Sexual Health, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Lisa McDaid
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Andrew Radley
- Directorate of Public Health, NHS Tayside, Dundee, UK
- Division of Cardiovascular Medicines and Diabetes, Ninewells Hospital and Medical School, Dundee, UK
| | - Judith M Stephenson
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Claire Battison
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Richard Gilson
- Institute for Global Health, University College London (UCL), London, UK
| | - Sharon Cameron
- Obstetrics & Gynaecology, University of Edinburgh, Edinburgh, UK
- Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
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Gonsalves L, Wyss K, Gichangi P, Hilber AM. Pharmacists as youth-friendly service providers: documenting condom and emergency contraception dispensing in Kenya. Int J Public Health 2020; 65:487-496. [PMID: 32472373 PMCID: PMC7275003 DOI: 10.1007/s00038-020-01348-9] [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: 03/20/2019] [Revised: 12/17/2019] [Accepted: 03/11/2020] [Indexed: 12/05/2022] Open
Abstract
Objectives This Kenya-based study ascertained whether pharmacies were an untapped source of ‘youth-friendly’ health services by determining (1) whether young people (aged 18–24) could successfully obtain condoms and emergency contraception (ECP); (2) whether contraceptives were dispensed according to national guidelines; and (3) how young people felt about obtaining ECP and condoms from pharmacy personnel. Methods This study used several methods to capture and cross-check purchasing experiences as reported by young people with those of dispensing pharmacy personnel. These included: focus group discussions; in-depth interviews; key informant interviews; and mystery shoppers. Results When in stock, young people were successfully able to obtain ECP and condoms from pharmacies. Counselling was sporadic: when it happened, it was not always accurate. Despite a lack of counselling, young people reported being satisfied with the quick, transactional interaction with pharmacy personnel. Conclusions The brief, transactional interactions between pharmacy personnel and young clients appear to be ‘youth-friendly enough’. While there is room to strengthen the services provided (improving both accuracy and scope), this should be done in a manner that does not fundamentally alter the current interaction.
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Affiliation(s)
- Lianne Gonsalves
- Department of Sexual and Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland. .,Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Kaspar Wyss
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Peter Gichangi
- International Centre for Reproductive Health Kenya, Mombasa, Kenya.,Department of Human Anatomy, University of Nairobi, Nairobi, Kenya.,Ghent University, Ghent, Belgium
| | - Adriane Martin Hilber
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,University of Basel, Basel, Switzerland
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Cameron ST, Baraitser P, Glasier A, McDaid L, Norrie J, Radley A, Stephenson JM, Trussell J, Battison C, Cameron S, Cowle K, Forrest M, Gilson R, Goulao B, Johnstone A, McDonald A, Morelli A, Patterson S, Sally D, Stewart N. Pragmatic cluster randomised cohort cross-over trial to determine the effectiveness of bridging from emergency to regular contraception: the Bridge-It study protocol. BMJ Open 2019; 9:e029978. [PMID: 31672711 PMCID: PMC6830607 DOI: 10.1136/bmjopen-2019-029978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Oral emergency contraception (EC) can prevent unintended pregnancy but it is important to start a regular method of contraception. Women in the UK usually access EC from a pharmacy but then need a subsequent appointment with a general practitioner or a sexual and reproductive health (SRH) service to access regular contraception. Unintended pregnancies can occur during this time. METHODS AND ANALYSIS Bridge-It is a pragmatic cluster randomised cohort cross-over trial designed to determine whether pharmacist provision of a bridging supply of a progestogen-only pill (POP) plus rapid access to a local SRH clinic, results in increased uptake of effective contraception and prevents more unintended pregnancies than provision of EC alone. Bridge-It involves 31 pharmacies in three UK regions (London, Lothian and Tayside) aiming to recruit 626-737 women. Pharmacies will give EC (levonorgestrel) according to normal practice and recruit women to both intervention and the control phases of the study. In the intervention phase, pharmacists will provide the POP (desogestrel) and offer rapid access to an SRH clinic. In the control phase, pharmacists will advise women to attend a contraceptive provider for contraception (standard care).Women will be asked 4 months later about contraceptive use. Data linkage to abortion registries will provide abortion rates over 12 months. The sample size is calculated on the primary outcome of effective contraception use at 4 months (yes/no) with 90% power and a 5% level of significance. Abortion rates will be an exploratory secondary analysis. Process evaluation includes interviews with pharmacists, SRH clinicians and women. Cost-effectiveness analysis will use a healthcare system perspective and be expressed as incremental cost-effectiveness ratio. ETHICS AND DISSEMINATION Ethical approval was received from South East Scotland REC June 2017. Results will be published in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER ISRCTN70616901.
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Affiliation(s)
- Sharon Tracey Cameron
- Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
- Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
| | - Paula Baraitser
- Department of Sexual Health, King's College Hospital NHS Foundation Trust, London, UK
| | - Anna Glasier
- Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
| | - Lisa McDaid
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Andrew Radley
- Directorate of Public Health, NHS Tayside, Dundee, UK
- Division of Cardiovascular Medicines and Diabetes, Ninewells Hospital and Medical School, Dundee, UK
| | - Judith M Stephenson
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - James Trussell
- Office of Population Research, Princeton University, Princeton, New Jersey, USA
| | - Claire Battison
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Sarah Cameron
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Mark Forrest
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, UK
| | - Beatriz Goulao
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Anne Johnstone
- Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
| | - Alison McDonald
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Alessandra Morelli
- Department of Sexual Health, King's College Hospital NHS Foundation Trust, London, UK
| | - Susan Patterson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Deirdre Sally
- Institute for Global Health, University College London, London, UK
| | - Nicola Stewart
- Institute for Global Health, University College London, London, UK
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Mooney-Somers J, Lau A, Bateson D, Richters J, Stewart M, Black K, Nothnagle M. Enhancing use of emergency contraceptive pills: A systematic review of women’s attitudes, beliefs, knowledge, and experiences in Australia. Health Care Women Int 2018; 40:174-195. [DOI: 10.1080/07399332.2018.1526286] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Julie Mooney-Somers
- Sydney Health Ethics, Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Amber Lau
- School of Public Health, Brown University, Providence, Rhode Island, USA
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona, USA
| | - Deborah Bateson
- Family Planning New South Wales, Sydney, Australia
- Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, Australia
| | - Juliet Richters
- Kirby Institute for Infection and Immunity in Society, University of New South Wales, New South Wales, Australia
| | - Mary Stewart
- Family Planning New South Wales, Sydney, Australia
| | - Kirsten Black
- Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, Australia
| | - Melissa Nothnagle
- Natividad Family Medicine Residency, University of California San Francisco, Salinas, California, USA
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Emergency contraception supply in Australian pharmacies after the introduction of ulipristal acetate: a mystery shopping mixed-methods study. Contraception 2018; 98:243-246. [DOI: 10.1016/j.contraception.2018.04.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/30/2018] [Accepted: 04/30/2018] [Indexed: 12/30/2022]
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12
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French RS, Geary R, Jones K, Glasier A, Mercer CH, Datta J, Macdowall W, Palmer M, Johnson AM, Wellings K. Where do women and men in Britain obtain contraception? Findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). BMJ SEXUAL & REPRODUCTIVE HEALTH 2018; 44:16-26. [PMID: 29103003 PMCID: PMC6283328 DOI: 10.1136/jfprhc-2017-101728] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 06/13/2017] [Accepted: 08/16/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION To estimate the prevalence of use of different sources of contraceptive supplies in Britain and its variation by key demographic and behavioural characteristics. METHODS Cross-sectional probability sample survey of women and men aged 16-74 years, resident in Britain, interviewed between 2010 and 2012. Analyses reported here were of 4571 women and 3142 men aged 16-44 years who reported having vaginal sex in the past year. Those relying exclusively on sterilisation (including hysterectomy) were excluded. Sources of contraceptive supplies were categorised as: general practice, community clinic, retail and other. Prevalence of use of these sources was estimated, and associated factors examined. RESULTS Some 87.0% of women and 73.8% of men accessed at least one source of contraceptive supplies in the previous year. Most women (59.1%) used general practice and most men (54.6%) used retail outlets. Community clinics were less commonly used, by 23.0% of women and 21.3% of men, but these users were younger and at greater sexual health risk. These associations were also observed among the 27.3% of women and 30.6% of men who used more than one source category (general practice, community clinic or retail) for contraceptive supplies. CONCLUSIONS People in Britain use a variety of sources to obtain contraceptive supplies and some sources are more commonly used by those more vulnerable to poorer sexual health. Our findings suggest that national policy changes to increase access to contraceptive methods have had an effect on the diversity of services used.
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Affiliation(s)
- Rebecca S French
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca Geary
- Research Department of Infection and Population Health, University College London, London, UK
| | - Kyle Jones
- Research Department of Infection and Population Health, University College London, London, UK
| | - Anna Glasier
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Catherine H Mercer
- Research Department of Infection and Population Health, University College London, London, UK
| | - Jessica Datta
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Wendy Macdowall
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Melissa Palmer
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Anne M Johnson
- Research Department of Infection and Population Health, University College London, London, UK
| | - Kaye Wellings
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
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Lee JK, Schwarz EB. The safety of available and emerging options for emergency contraception. Expert Opin Drug Saf 2017; 16:1163-1171. [PMID: 28730840 DOI: 10.1080/14740338.2017.1354985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Emergency contraception (EC) is a way to significantly reduce the chance of becoming pregnant after an episode of unprotected intercourse. Considerable data support the safety of all available and emerging options for EC. Areas covered: This review presents a comprehensive summary of the literature regarding the safety of EC as well as directions for further study. PubMed was searched for all relevant studies published prior to June 2017. Expertopinion: All available methods of EC (i.e., ulipristal acetate pills, levonorgestrel pills, and the copper-IUD), carry only mild side effects and serious adverse events are essentially unknown. The copper IUD has the highest efficacy of EC methods. Given the excellent safety profiles of mifepristone and the levonorgestrel IUD, research is ongoing related to use of these products for EC.
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Affiliation(s)
- Jessica K Lee
- a Department of Obstetrics and Gynecology , Johns Hopkins University , Baltimore , MD , USA
| | - Eleanor Bimla Schwarz
- b Department of General Internal Medicine , UC Davis, Division of General Internal Medicine , Sacramento , CA , USA
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Cameron ST, Li HWR, Gemzell-Danielsson K. Current controversies with oral emergency contraception. BJOG 2017; 124:1948-1956. [DOI: 10.1111/1471-0528.14773] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2017] [Indexed: 12/30/2022]
Affiliation(s)
- ST Cameron
- Chalmers Sexual and Reproductive Health Centre; Edinburgh UK
| | - HWR Li
- Department of Obstetrics and Gynaecology; University of Hong Kong; Queen Mary Hospital; Hong Kong Hong Kong
- Shenzhen Key Laboratory of Fertility Regulation; Reproductive Medicine Centre; The University of Hong Kong-Shenzhen Hospital; Shenzhen China
| | - K Gemzell-Danielsson
- Shenzhen Key Laboratory of Fertility Regulation; Reproductive Medicine Centre; The University of Hong Kong-Shenzhen Hospital; Shenzhen China
- Department of Women's and Children's Health; Division of Obstetrics and Gynaecology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
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15
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Murphy LE, Chen ZE, Warner V, Cameron ST. Quick starting hormonal contraception after using oral emergency contraception: a systematic review. THE JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2017; 43:319-326. [PMID: 28663249 DOI: 10.1136/jfprhc-2017-101740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/28/2017] [Accepted: 05/29/2017] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Unprotected intercourse after oral emergency contraception (EC) significantly increases pregnancy risk. This underlies the importance of promptly starting effective, ongoing contraception - known as 'quick starting'. However, theoretical concern exists that quick starting might interact with EC or hormonal contraception (HC) potentially causing adverse side effects. METHOD A systematic review was conducted, evaluating quick starting HC after oral EC [levonorgestrel 1.5 mg (LNG) or ulipristal acetate 30 mg (UPA)]. PubMed, EMBASE, The Cochrane Library, ICTRP, ClinicalTrials.gov and relevant reference lists were searched in February 2016. A lack of comparable studies prevented meta-analysis. RESULTS Three randomised controlled trials were identified. Two biomedical studies suggested HC action was unaffected by quick starting after UPA; one study examined ovarian quiescence (OR 1.27; 95% CI 0.51-3.18) while taking combined oral contraception (COC). Another assessed cervical mucus impenetrability (OR 0.76; 95% CI 0.27-2.13) while taking progestogen-only pills (POP). Quick starting POP reduced the ability of UPA to delay ovulation (OR 0.04; 95% CI 0.01-0.37). Side effects (OR 1.22; 95% CI 0.48-3.12) and unscheduled bleeding (OR 0.53; 95% CI 0.16-1.81) were unaffected by quick starting COC after UPA. Another study reported higher self-reported contraceptive use at 8 weeks among women quick starting POP after LNG, compared with women given LNG alone (OR 6.73; 95% CI 2.14-21.20).
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Affiliation(s)
- Lauren Ee Murphy
- Department of Reproductive and Developmental Sciences, University of Edinburgh, Edinburgh, UK.,Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | | | | | - Sharon T Cameron
- Department of Reproductive and Developmental Sciences, University of Edinburgh, Edinburgh, UK
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Dalton K, Byrne S. Role of the pharmacist in reducing healthcare costs: current insights. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2017; 6:37-46. [PMID: 29354549 PMCID: PMC5774321 DOI: 10.2147/iprp.s108047] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Global healthcare expenditure is escalating at an unsustainable rate. Money spent on medicines and managing medication-related problems continues to grow. The high prevalence of medication errors and inappropriate prescribing is a major issue within healthcare systems, and can often contribute to adverse drug events, many of which are preventable. As a result, there is a huge opportunity for pharmacists to have a significant impact on reducing healthcare costs, as they have the expertise to detect, resolve, and prevent medication errors and medication-related problems. The development of clinical pharmacy practice in recent decades has resulted in an increased number of pharmacists working in clinically advanced roles worldwide. Pharmacist-provided services and clinical interventions have been shown to reduce the risk of potential adverse drug events and improve patient outcomes, and the majority of published studies show that these pharmacist activities are cost-effective or have a good cost:benefit ratio. This review demonstrates that pharmacists can contribute to substantial healthcare savings across a variety of settings. However, there is a paucity of evidence in the literature highlighting the specific aspects of pharmacists' work which are the most effective and cost-effective. Future high-quality economic evaluations with robust methodologies and study design are required to investigate what pharmacist services have significant clinical benefits to patients and substantiate the greatest cost savings for healthcare budgets.
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Affiliation(s)
- Kieran Dalton
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
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von Rosen FT, von Rosen AJ, Müller-Riemenschneider F, Tinnemann P. Awareness and knowledge regarding emergency contraception in Berlin adolescents. EUR J CONTRACEP REPR 2017; 22:45-52. [PMID: 28056564 DOI: 10.1080/13625187.2016.1269162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Lack of information has been described as a major factor in non-use of oral emergency contraception (EC) following unprotected intercourse. Despite the ongoing vociferous debate on liberalisation of access, little evidence is available on EC knowledge in Germany, particularly among adolescents. METHODS We conducted a cross-sectional survey among ninth graders in convenience sample of 13 Berlin schools. We assessed perceived and actual knowledge on the effectiveness, timeframe and availability of EC and on pregnancy risk in six scenarios. RESULTS A total of 1177 students between 13 and 16 years of age participated. Mean age was 14.6 years (standard deviation 0.67); 51.4% of participants were male. Whilst 8.7% had never heard of EC, 38.6% knew of its effectiveness, but only 12.7% knew the timeframe for EC. Of the sources of EC, only gynaecologists were widely known. Most students correctly evaluated pregnancy risk in given scenarios. Girls were more knowledgeable on most topics except for pregnancy risk. Attending a school of lower academic standard and being of immigrant background was associated with lower knowledge on the majority of items. CONCLUSIONS Generally, students were aware of the existence of EC, but many lacked the knowledge of when to take it and how to access it. Especially in the light of the recent liberalisation of EC access in Germany, increased educational efforts are warranted to ensure that the population has the knowledge necessary to make a truly informed choice regarding its use.
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Affiliation(s)
- Frederik T von Rosen
- a Institute for Social Medicine, Epidemiology and Health Economics , Charité-Universitätsmedizin Berlin , Berlin , Germany.,b Department of Public Health and Health Sciences , University of Bremen , Bremen , Germany
| | - Antonella J von Rosen
- a Institute for Social Medicine, Epidemiology and Health Economics , Charité-Universitätsmedizin Berlin , Berlin , Germany.,b Department of Public Health and Health Sciences , University of Bremen , Bremen , Germany
| | - Falk Müller-Riemenschneider
- a Institute for Social Medicine, Epidemiology and Health Economics , Charité-Universitätsmedizin Berlin , Berlin , Germany.,c Saw Swee Hock School of Public Health , National University of Singapore , Singapore
| | - Peter Tinnemann
- a Institute for Social Medicine, Epidemiology and Health Economics , Charité-Universitätsmedizin Berlin , Berlin , Germany
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Pharmacy provision of sexual and reproductive health commodities to young people: a systematic literature review and synthesis of the evidence. Contraception 2016; 95:339-363. [PMID: 28025018 DOI: 10.1016/j.contraception.2016.12.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 11/11/2016] [Accepted: 12/17/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND We conducted a systematic review of peer-reviewed literature on youth access to, use of and quality of care of sexual and reproductive health (SRH) commodities through pharmacies. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, we searched for publications from 2000 to 2016. To be eligible for inclusion, articles had to address the experiences of young people (aged 25 years and below) accessing SRH commodities (e.g., contraception, abortifacients) via pharmacies. The heterogeneity of the studies precluded meta-analysis - instead, we conducted thematic analysis. RESULTS A total of 2842 titles were screened, and 49 met the inclusion criteria. Most (n=43) were from high-income countries, and 33 examined emergency hormonal contraception provision. Seventeen focused on experiences of pharmacy personnel in provision, while 28 assessed client experiences. Pharmacy provision of SRH commodities was appealing to and utilized by youth. Increasing access to SRH commodities for youth did not correspond to increases in risky sexual behavior. Both pharmacists and youth had reservations about the ease of access and its impact on sexual behaviors. In settings where regulations allowing pharmacy access were established, some pharmacy personnel created barriers to access or refused access entirely. DISCUSSION With training and support, pharmacy personnel can serve as critical SRH resources to young people. Further research is needed to better understand how to capitalize on the potential of pharmacy provision of SRH commodities to young people without sacrificing qualities which make pharmacies so appealing to young people in the first place.
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Black KI, Geary R, French R, Leefe N, Mercer CH, Glasier A, Macdowall W, Gibson L, Datta J, Palmer M, Wellings K. Trends in the use of emergency contraception in Britain: evidence from the second and third National Surveys of Sexual Attitudes and Lifestyles. BJOG 2016; 123:1600-7. [PMID: 27245637 PMCID: PMC4995725 DOI: 10.1111/1471-0528.14131] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the changes in the prevalence of, and the factors associated with, the use of emergency contraception (EC) in Britain between 2000 and 2010, spanning the period of deregulation and increase in pharmacy supply. DESIGN Cross-sectional probability sample surveys. SETTING AND POPULATION British general population. METHODS Data were analysed from the second and third British National Surveys of Sexual Attitudes and Lifestyles (Natsal), undertaken in 1999-2001 and 2010-12. Univariate and logistic regression analyses were used to measure change in EC use amongst sexually active women aged 16-44 years not intending pregnancy. MAIN OUTCOME MEASURES Prevalence of EC use and factors associated with use. RESULTS Of the 5430 women surveyed in 1999-2001 and the 4825 women surveyed in 2010-12, 2.3 and 3.6%, respectively, reported using EC in the year prior to interview (P = 0.0019 for change over time). The prevalence of EC use increased amongst single women and those with higher educational attainment (adjusted odds ratio, aOR 1.51; 95% confidence interval, 95% CI 1.04-2.20; P = 0.0308). Increases in EC use were generally greater among women without behavioural risk factors, such as those with no history of abortion within 5 years (aOR 1.57; 95% CI 1.17-2.12; P = 0.0029), or those whose first heterosexual intercourse occurred after the age of 16 years (aOR 1.68; 95% CI 1.21-2.35; P = 0.0021). The increase in EC use was also more marked among women usually accessing contraception from retail sources than among those doing so from healthcare sources, which may reflect a use of condoms amongst EC users. CONCLUSION The increase in EC use among women in Britain in the first decade of the 21st century was associated with some, but not all, risk factors for unplanned pregnancy. Advice and provision may need to be targeted at those at highest risk of unplanned pregnancy. TWEETABLE ABSTRACT Despite pharmacy access, only a small rise in emergency contraception use has been seen in Britain over 10 years.
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Affiliation(s)
- KI Black
- University of SydneySydneyNSWAustralia
| | - R Geary
- London School of Hygiene and Tropical MedicineLondonUK
| | - R French
- London School of Hygiene and Tropical MedicineLondonUK
| | - N Leefe
- University College LondonLondonUK
| | | | - A Glasier
- London School of Hygiene and Tropical MedicineLondonUK
| | - W Macdowall
- London School of Hygiene and Tropical MedicineLondonUK
| | - L Gibson
- London School of Hygiene and Tropical MedicineLondonUK
| | - J Datta
- London School of Hygiene and Tropical MedicineLondonUK
- University of EdinburghEdinburghUK
| | - M Palmer
- London School of Hygiene and Tropical MedicineLondonUK
| | - K Wellings
- London School of Hygiene and Tropical MedicineLondonUK
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Italia S, Brand H. Status of Emergency Contraceptives in Europe One Year after the European Medicines Agency's Recommendation to Switch Ulipristal Acetate to Non-Prescription Status. Public Health Genomics 2016; 19:203-10. [PMID: 27022731 DOI: 10.1159/000444686] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 02/15/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In November 2014, the European Medicines Agency (EMA) recommended switching the emergency contraceptive (EMC) ulipristal acetate to non-prescription status. This study's objective is to assess the current legal status of the two EMCs ulipristal acetate and levonorgestrel in Europe and to report on the development of sales figures for EMCs since they were made freely available. METHODS Health authorities were contacted in autumn 2015 and asked about the current status of EMCs and whether the sales figures had changed after a switch to non-prescription status. Additionally, data on consumption were collected in 18 German community pharmacies. RESULTS As of November 2015, most countries in the European Union (EU) have followed the EMA recommendation. Hungary kept the prescription-only status. In Malta, EMC drugs are not authorized. Germany and Croatia switched levonorgestrel to non-prescription status as well. Of the EU candidate and European Free Trade Association countries, ulipristal acetate is available without prescription in Norway and Bosnia and Herzegovina only. Several countries reported an increase in EMC sales since the switch. CONCLUSIONS An EMA recommendation can strongly contribute to the harmonization of a drug's legal status in the EU. In most European countries, ulipristal acetate and/or levonorgestrel are now freely available.
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Affiliation(s)
- Salvatore Italia
- Department of International Health, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Heller R, Cameron ST. Evaluating the attractiveness of the availability of injectable progestogen contraceptives at the community pharmacy setting in the United Kingdom. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 24:247-52. [PMID: 26875480 DOI: 10.1111/ijpp.12249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 01/03/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Pharmacists have extended opening hours and are located in communities. Many offer sexual and reproductive health services such as emergency contraception. The opportunity to receive injectable contraception from community pharmacists would improve availability of this method and might increase uptake and continuation. A self-administered survey of women attending a large urban sexual and reproductive health clinic was undertaken to determine the acceptability of receiving contraceptive injections from a community pharmacist. METHODS Women aged 16-50 years attending an NHS walk-in sexual and reproductive health clinic were invited to complete questionnaires while they were waiting to attend an appointment with a clinician. Questionnaires asked women if they were current, previous or never users of the progestogen only injectable, their method of contraception and whether availability of the injectable from a local pharmacist would influence their decision to use this method. RESULTS Two hundred and forty questionnaires were distributed and 220 completed (92%). A total of 9% of respondents were past users of the injectable (n = 21), 4% were current users (n = 8) and the remaining 87% were never users. Of those 191 current non-users, 33% (n = 64) indicated that they would consider using this method if it was available at the pharmacy. The main perceived advantages of attending the pharmacy were quicker appointments (52%) and easier access (47%). CONCLUSION Provision of the injectable contraceptive from a pharmacist might make this method attractive to almost one in three women who are not currently using it. This could be a strategy to improve uptake and continuation of this method.
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Affiliation(s)
- Rebecca Heller
- Chalmers Sexual & Reproductive Health Centre, Edinburgh, UK
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Why does increasing public access to medicines differ between countries? Qualitative comparison of nine countries. J Health Serv Res Policy 2015; 20:231-9. [DOI: 10.1177/1355819615593302] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective To identify factors associated with differences between developed countries in reclassifying (switching) medicines from prescription to non-prescription availability. Methods Cross-national qualitative research using a heuristic approach in the US, UK, Japan, Australia and New Zealand, supplemented by data from Canada, Denmark, the Netherlands and Singapore. In-depth interviews with 80 key informants (65 interviews) explored and compared factors in terms of barriers and enablers to reclassification of medicines in each country. Document analysis supplemented interview data. Results Each country had a unique mix of enablers and barriers to reclassification. Enablers included government policy (particularly in UK), pharmacist-only scheduling (particularly in Australia and New Zealand) and large market size (particularly in the US and Europe). Local barriers included limited market potential in small countries, the cost of a reclassification (particularly in the US), competition from distributors of generic medicines, committee inconsistency and consumer behavior. UK had more enablers than barriers, whereas in Australia the opposite was true. Conclusions Different factors limit or enable reclassification, affecting consumer access to medicines in different countries. For countries attempting to reduce barriers to reclassification, solutions may include garnering government support for reclassification, support and flexibility from the medicines regulator, having a pharmacy-only and/or pharmacist-only category, providing market exclusivity, ensuring best practice in pharmacy, and minimizing the cost and delays of reclassification.
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Atkins DN, Bradford WD. Association between Increased Emergency Contraception Availability and Risky Sexual Practices. Health Serv Res 2015; 50:809-29. [PMID: 25367046 PMCID: PMC4450931 DOI: 10.1111/1475-6773.12251] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE We studied whether increased emergency contraception availability for women over age 18 was associated with a higher probability of risky sexual practices. DATA A total of 34,030 individual/year observations on 3,786 women aged 18 and older were extracted from the National Longitudinal Survey of Youth, 1997 from October 1999 through November 2009. STUDY DESIGN We modeled three binary outcome variables: any sexual activity; sexual activity with more than one partner; and any sex without a condom for women with multiple partners for women in states with state-level policy changes (prior to the 2006 FDA ruling) and for women in states subject to only the national policy change both jointly and separately. FINDINGS We found different results when estimating the state and federal changes separately. The national change was associated with a reduction in the probability of sexual activity, a reduction in the likelihood of reporting multiple partnerships, and there was no relationship between the national policy change and unprotected sexual activity. There was no relationship between the probability of sexual activity or multiple partnerships for women in states with their own policy changes, but we did find that women in these states were more likely to report unprotected sex.
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Affiliation(s)
- Danielle N Atkins
- Department of Political Science, University of TennesseeKnoxville, TN
| | - W David Bradford
- Department of Public Administration and Policy, University of GeorgiaAthens, GA
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James‐Hawkins L. Why Female College Students Risk Pregnancy: I Just Wasn't Thinking. J Midwifery Womens Health 2015; 60:169-74. [DOI: 10.1111/jmwh.12272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kismödi E, Cottingham J, Gruskin S, Miller AM. Advancing sexual health through human rights: the role of the law. Glob Public Health 2014; 10:252-67. [PMID: 25539286 PMCID: PMC4318115 DOI: 10.1080/17441692.2014.986175] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 11/06/2014] [Indexed: 11/11/2022]
Abstract
Since the International Conference on Population and Development, definitions of sexuality and sexual health have been greatly elaborated alongside widely accepted recognition that sexual health requires respect, protection and fulfilment of human rights. Considerable progress has also been made in enacting or changing laws that affect sexuality and sexual health, in line with human rights standards. These measures include legal guarantees against non-discrimination and violence, decriminalisation of consensual sexual conduct and guaranteeing availability, accessibility, acceptability and quality of sexual health information and services to all. Such legal actions have had positive effects on health and specifically on sexual health, particularly for marginalised populations. Yet in all regions of the world, laws still exist which jeopardise health, including sexual health, and violate human rights. In order to ensure accountability for the rights and health of their populations, states have an obligation to bring their laws into line with international, regional and national human rights standards. These rights-based legal guarantees, while insufficient alone, are essential for effective systems of accountability, achieving positive sexual health outcomes and the respect and protection of human rights.
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Affiliation(s)
- Eszter Kismödi
- Harvard Law School, Harvard University, Cambridge, MA, USA
| | | | - Sofia Gruskin
- Program on Global Health and Human Rights, Keck School of Medicine, Gould School of Law, Institute for Global Health, University of Southern California, Los Angeles, CA, USA
| | - Alice M. Miller
- Global Health Justice Partnership of the Yale Law School and the School of Public Health, Yale Law School, New Haven, CT, USA
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Li HWR, Lo SST, Ho PC. Emergency contraception. Best Pract Res Clin Obstet Gynaecol 2014; 28:835-44. [DOI: 10.1016/j.bpobgyn.2014.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 04/23/2014] [Accepted: 04/25/2014] [Indexed: 12/30/2022]
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Thomin A, Keller V, Daraï E, Chabbert-Buffet N. Consequences of emergency contraceptives: the adverse effects. Expert Opin Drug Saf 2014; 13:893-902. [DOI: 10.1517/14740338.2014.921678] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Trilla C, Senosiain R, Calaf J, Espinós JJ. Effect of changes to cost and availability of emergency contraception on users' profiles in an emergency department in Catalunya. EUR J CONTRACEP REPR 2014; 19:259-65. [PMID: 24865942 DOI: 10.3109/13625187.2014.913787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Emergency contraception (EC) accessibility has evolved differently in Catalunya as compared with other autonomous communities in Spain. Free-of-charge access within the Public Health System was authorised in 2004, and over-the-counter (OTC) access was implemented in 2009. The aim of the study is to assess the impact of these measures on demand and users' profiles at our institution. METHODS A retrospective study, in our Emergency Department, was conducted to evaluate EC requests in relationship to accessibility modifications. The age of women and which days of the week they attended were analysed. RESULTS The number of EC requests, the distribution by age and the demand over the week remained stable after access to EC became free of charge. However, requests sharply decreased following OTC access implementation. Distribution by age also changed, with a significant increase in requests from women under 25 years (72% vs 56%, p < 0.001). Demand was greatest on Sunday and Monday, and this distribution persisted over the study period. CONCLUSION EC requests remained unchanged following free-of-charge access to EC, but decreased after OTC implementation. Women currently seeking EC at no cost at our institution are more likely to be younger and to request it on a Monday.
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Affiliation(s)
- Cristina Trilla
- Department of Obstetrics and Gynaecology, Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
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Pharmacy-based interventions for initiating effective contraception following the use of emergency contraception: a pilot study. Contraception 2014; 90:447-53. [PMID: 24929889 DOI: 10.1016/j.contraception.2014.05.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 04/23/2014] [Accepted: 05/01/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVES In Scotland most women get emergency contraception (EC) from pharmacies. Pharmacists currently cannot provide effective ongoing contraception after EC. In this pilot study, we aimed to determine the feasibility of a larger study designed to ascertain if pharmacy-based interventions can increase the uptake of effective contraception after EC. STUDY DESIGN This is a pilot study of women presenting for levonorgestrel EC to community pharmacies in Edinburgh, UK, in 2012. Pharmacies were cluster randomized to provide either standard care or one of two interventions: (a) one packet of progestogen-only pills (POPs), giving women 1 month to arrange ongoing contraception; (b) invitation to present the empty EC packet to a family planning clinic (FPC) for contraceptive advice (rapid access). RESULTS One hundred sixty-eight women were recruited from 11 pharmacies to POP (n=56), rapid access (n=58) and standard care (N=54) groups, respectively. Telephone follow-up was conducted successfully in 102 women (61%) 6-8 weeks later to determine current contraceptive use. In the POP arm, 35/39 (90%) women used the pills provided, and 9/28 women (32%) in the rapid access arm attended the FPC. The proportion of women using effective contraception at follow-up was significantly greater in both POP [56% (22/39), p=<0.001] and rapid access [52% (13/25), p=0.006] groups compared to standard care [16% (5/31)]. The relative probability of a woman using an effective method of contraception versus barrier/no method, after use of EC, was 3.13 [95% confidence interval (CI), 1.90-5.13] in the POP group and 2.57 (95% CI, 1.55-4.27) in the rapid access group. CONCLUSIONS This promising pilot study suggests that simple pharmacy-based interventions may increase the uptake of effective contraception after EC. A larger study is required to provide further validation of these findings. IMPLICATIONS STATEMENT For women obtaining EC from a pharmacy, simple interventions such as supplying 1 month of a POP, or offering rapid access to a FPC, hold promise as strategies to increase the uptake of effective contraception after EC.
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Association between increased availability of emergency contraceptive pills and the sexual and contraceptive behaviors of women. J Public Health Policy 2014; 35:292-310. [DOI: 10.1057/jphp.2014.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Michie L, Cameron ST, Glasier A, Greed E. Contraceptive use among women presenting to pharmacies for emergency contraception: an opportunity for intervention. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2014; 40:190-5. [DOI: 10.1136/jfprhc-2013-100730] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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McGowan JG. Improving access to emergency contraception under the Scottish Sexual Health Strategy: can rates of unintended pregnancy be reduced? WOMENS HEALTH 2013; 9:435-42. [PMID: 24007249 DOI: 10.2217/whe.13.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Unintended pregnancy is a global sexual health problem. Outcomes of unintended pregnancy include unwanted childbirth and abortion, which may be associated with negative physical and psychosocial health implications for women. In Scotland, the Scottish Sexual Health Strategy has the stated goal of improving the sexual health of the people of Scotland. One aim of the Strategy is to reduce rates of unintended pregnancy and one policy designed to achieve this is 'widening access to emergency contraception'. This paper examines the success of this policy with reference to the implicit link it makes between expanding access to emergency contraception and increasing its effective use, aiming thereby to reduce rates of unintended pregnancy. Since there is evidence that previous policies and strategies expanding access to emergency contraception have failed to reduce such rates, alternative approaches to achieve a reduction in unintended pregnancies are discussed.
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Mishra A, Saxena P. Over-the-Counter Sale of Emergency Contraception: A Survey of Pharmacists in Delhi. Sex Med 2013; 1:16-20. [PMID: 25356282 PMCID: PMC4184713 DOI: 10.1002/sm2.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction Pharmacists play a key role while dispensing over-the-counter emergency contraception (EC) to the client. Aims The study aims to evaluate the knowledge and over-the-counter services provided by the pharmacists in Delhi. Methods A prestructured questionnaire-based survey was conducted in Delhi, the capital city of India. Results Only 60 out of 85 pharmacies approached agreed to participate in the study. Number of packs sold in a month per pharmacy varied from 2 to 500 packs/month. Sixty-two percent of the pharmacists claimed that majority of the clients repeated use during the same month. Only 18% of the clients were referred by doctors while 82% directly approached the pharmacists. Nearly one third of the clients were adolescents. Sixty-seven percent of the pharmacists had adequate knowledge about EC. Only 3.3% asked about the last menstrual period or the time elapsed since the last unprotected intercourse. No pharmacist inquired whether there were one or multiple unprotected acts of intercourse, if any regular contraceptive method was being used, or explored the reason for EC intake. There were 91.7% who explained the dosage schedule to clients. Only half of them explained that the client may experience side effects. None of the pharmacists advised their clients for a sexually transmitted disease screening, and 35% counseled the clients regarding regular contraception. Conclusion Improving the quality of services provided by the pharmacists can clear misconceptions of the clients and promote subsequent regular contraception along with precautions to avoid sexually transmitted diseases. Mishra A and Saxena P. Over-the-counter sale of emergency contraception: A survey of pharmacists in Delhi. Sex Med 2013;1:16–20.
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Affiliation(s)
- Archana Mishra
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College New Delhi, India
| | - Pikee Saxena
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College New Delhi, India
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Mayhew S, Osei I, Bajos N. Attitudes des professionnels de santé à l'égard de la contraception d'urgence au Ghana et au Burkina Faso. POPULATION 2013. [DOI: 10.3917/popu.1301.0123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Glasier A. Emergency contraception: clinical outcomes. Contraception 2012; 87:309-13. [PMID: 23040128 DOI: 10.1016/j.contraception.2012.08.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 08/13/2012] [Accepted: 08/21/2012] [Indexed: 11/16/2022]
Abstract
Emergency contraception (EC) is widely used to prevent unwanted pregnancy. This review considers the safety and efficacy of three commonly used methods -- levonorgestrel (LNG-EC), ulipristal acetate (UPA) and the copper intrauterine device. All are extremely safe, and side effects are minimal. Concerns about increased risks of ectopic pregnancy after EC use have proved unfounded, and possible teratogenic effects seem unlikely. Although the true effectiveness of EC is impossible to estimate, recent research suggests that LNG-EC prevents around 50% of expected pregnancies in women using the method within 72 h of intercourse, whereas UPA appeared to prevent almost two thirds of pregnancies. Emergency intrauterine device insertion probably prevents over 95% of pregnancies. However, although improved accessibility of EC has clearly led to increased use, it does not appear to have had any public health benefit in reducing unintended pregnancy rates. Most of the data on sexual behavior following improved access to EC do not show any detrimental effect on subsequent use of other more effective methods of contraception or on the incidence of unintended pregnancy or sexually transmitted infection. However, unless these other methods of contraception are also made easily available from pharmacies, improved access to EC risks unlinking its use with use of subsequent ongoing contraception.
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Affiliation(s)
- Anna Glasier
- University of Edinburgh and London School of Hygiene and Tropical Medicine, Edinburgh, UK.
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Denno DM, Chandra-Mouli V, Osman M. Reaching youth with out-of-facility HIV and reproductive health services: a systematic review. J Adolesc Health 2012; 51:106-21. [PMID: 22824440 DOI: 10.1016/j.jadohealth.2012.01.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 01/04/2012] [Accepted: 01/05/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Many young people, particularly those who are marginalized and most at risk for HIV and reproductive health-related problems, cannot or will not seek traditional facility-based health services. Policies and programs are being implemented to provide them with these health services in the community. We sought to review the effectiveness of such approaches in increasing HIV and reproductive health service use. METHODS A systematic literature review was undertaken to identify policies promoting or programs delivering HIV or reproductive health services in the community. We reviewed studies that evaluated uptake of services or commodities. Data from studies meeting inclusion criteria were qualitatively analyzed. RESULTS Twenty studies met inclusion criteria, including 10 containing comparative data (e.g., before and after study or control study design). The studies generally demonstrated positive impact, although results varied across settings and approaches. The most successful approaches included mail-based chlamydia screening in the Netherlands, condom distribution via street outreach in Louisiana, home-based HIV counseling and testing in Malawi, and promotion of over-the-counter access to emergency contraception in various countries. CONCLUSION Overall, this review suggests that out-of-facility approaches can be important avenues to reach youth. Continued evaluation is necessary to better understand specific approaches that can successfully deliver health services.
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Affiliation(s)
- Donna M Denno
- Department of Pediatrics, University of Washington, Seattle, Washington 98195-5065, USA.
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Baird DT, Evers JLH, Gemzell-Danielsson K, Glasier A, Killick SR, Van Look PFA, Vercellini P, Yildiz BO, Benagiano G, Cibula D, Crosignani PG, Gianaroli L, La Vecchia C, Negri E, Volpe A. Family planning 2011: better use of existing methods, new strategies and more informed choices for female contraception. Hum Reprod Update 2012; 18:670-81. [DOI: 10.1093/humupd/dms021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Requests for emergency contraception in community pharmacy: an evaluation of services provided to mystery patients. Res Social Adm Pharm 2012; 9:114-9. [PMID: 22554398 DOI: 10.1016/j.sapharm.2012.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 03/13/2012] [Accepted: 03/13/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Requests for supply of the emergency contraceptive pill (ECP) through community pharmacies require consideration of a range of factors and the application of professional judgment. Pharmacists should therefore be able to follow a structured reasoning process. OBJECTIVES The research involved an assessment of history taking and counseling by pharmacy staff through mystery patient emergency contraception product requests. METHODS Two challenging ECP request case scenarios were developed with assessment tools. Mystery patients were trained to present the scenarios to pharmacies. A project information package and expression of interest form was posted to 135 pharmacies in the Gold Coast, Australia; 23 (17%) pharmacies agreed to participate. RESULTS Pharmacy staff was exposed to 1 of 2 scenarios during December 2010. Staff interactions were recorded, analyzed, and rated to evaluate the management of ECP requests. The results identified practice gaps among pharmacy staff with respect to information gathering and the provision of advice. CONCLUSION Ongoing training is required to enhance the skills, competence, and confidence of pharmacy staff in managing complicated requests for nonprescription medicines, such as the ECP. The impact of time pressures and financial burdens on the provision of pharmaceutical services needs to be acknowledged.
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Kozinszky Z, Sikovanyecz J, Devosa I, Szabó D, Barabás K, Pál A, Arthur J. Determinants of emergency contraceptive use after unprotected intercourse: who seeks emergency contraception and who seeks abortion? Acta Obstet Gynecol Scand 2012; 91:959-64. [PMID: 22524298 DOI: 10.1111/j.1600-0412.2012.01429.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare differences in contraceptive characteristics and the knowledge of emergency contraception (EC) between women who used EC after unprotected intercourse and those who sought abortion. DESIGN A questionnaire survey. SETTING A Hungarian university hospital. SAMPLE Two large clinical groups were enrolled: women who were prescribed EC after unprotected intercourse (n= 952) (EC group) and women who presented for termination of pregnancy who had not taken EC after a contraceptive failure despite being suitable candidates to take EC (n= 577) (control group). METHODS Questionnaire evaluation. MAIN OUTCOME MEASURES Knowledge concerning, previous use of, and other factors related to EC use. RESULTS The EC group experienced a condom failure significantly more often (odds ratio (OR) = 3.07), while the control group reported more failures with the contraceptive pill (OR = 0.69) and with periodic abstinence (OR = 0.09). Use of EC depended on age, education level, place of residence, accurate knowledge of EC (OR = 3.87) and previous EC use (OR = 1.16). Awareness of EC was influenced by information obtained from healthcare providers (OR = 3.63) or by school education (OR = 1.28). CONCLUSIONS Women who use less reliable contraceptive methods should be targeted for health education that stresses the importance of reliable contraception and provides more detailed knowledge on EC and when it should be used.
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Affiliation(s)
- Zoltan Kozinszky
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary.
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Brown D, Portlock J, Rutter P. Review of services provided by pharmacies that promote healthy living. Int J Clin Pharm 2012; 34:399-409. [PMID: 22527479 DOI: 10.1007/s11096-012-9634-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 03/29/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND The recognition that community pharmacies have the potential to make a greater contribution to promoting public health has led to a new concept, called the Healthy Living Pharmacy (HLP). These are designed to meet public health needs through a tiered commissioning framework delivering health and well being services through community pharmacy, tailored to local requirements for tackling health inequalities. AIM To search the literature for quality evidence to support the inclusion of services in the HLP portfolio and suggest areas where more evidence is required. METHOD A systematic review of the research literature covering the period January 1990-August 2011 inclusive, using MEDLINE, EMBASE, Pharmline, NHS Evidence and the Cochrane databases. On-line searching of the grey literature (e.g. conference proceedings) was also carried out. Standard methods of assessing quality were employed. RESULTS A total of 377 papers were included. Over time, there was a marked increase in frequency of publications reflecting a growing pharmacy interest in the public healthcare agenda; over a third (35 %) of papers appeared in the last three-year study period. The body of research had a wide geographical basis; contributions were as follows: UK (51.5 %), US (20.4 %), Australia/New Zealand (9.8 %), Europe (7.7 %) and Canada (7.2 %). The topics of contraception, cardiovascular disease prevention, diabetes and smoking cessation accounted for 40 % of included papers. The literature supports the introduction of specific community pharmacy services, targeted at customer groups, both with and without pre-existing diseases. Good evidence exists for smoking cessation, cardiovascular disease prevention, hypertension and diabetes. Some good evidence exists for interventions on asthma and heart failure. The evidence supporting weight management, sexual health, osteoporosis detection, substance abuse and chronic obstructive pulmonary disease is weak and needs development. CONCLUSION There is strong evidence for the role of community pharmacy in a range of services, not only aimed at improving general health, but also maintaining the health of those with existing disease. In other areas, the evidence is less strong and further research is required to justify their inclusion in a HLP portfolio.
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Affiliation(s)
- David Brown
- University of Portsmouth, Portsmouth, Hampshire, UK.
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The effect on use of making emergency contraception available free of charge. Contraception 2012; 86:366-9. [PMID: 22464407 DOI: 10.1016/j.contraception.2012.02.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 02/23/2012] [Accepted: 02/29/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cost is a barrier to use of emergency contraception (EC). Since 2008, EC has been available free of charge without restriction in pharmacies throughout Scotland. A survey of EC use among women requesting abortion in 2010 allows comparison of use reported in earlier surveys, when EC was only available on prescription and when EC was available from the pharmacy but at a cost. STUDY DESIGN A questionnaire survey about knowledge of the availability of free EC from pharmacies, and its use to prevent the index pregnancy, was performed among 204 women requesting abortion in Edinburgh, Scotland. RESULTS Seventy percent of 204 respondents (n=143) knew that EC was available free from pharmacies; 22 (11%) had used it in the cycle in which conception occurred. EC use was not influenced by knowledge of its availability free of charge. Women from affluent areas were significantly more likely to have used EC to try to prevent the pregnancy than counterparts from less affluent areas (p=.041). CONCLUSIONS Neither availability from the pharmacy nor removal of a charge for EC has increased its use among women having an abortion in Scotland.
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Challenging the "insurance theory" of sexual and reproductive health behaviors. Contraception 2011; 85:9-10. [PMID: 22067797 DOI: 10.1016/j.contraception.2011.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 04/29/2011] [Indexed: 11/22/2022]
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Ongoing contraception after use of emergency contraception from a specialist contraceptive service. Contraception 2011; 84:368-71. [DOI: 10.1016/j.contraception.2011.02.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 02/08/2011] [Accepted: 02/24/2011] [Indexed: 12/30/2022]
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Community pharmacists providing emergency contraception give little advice about future contraceptive use: a mystery shopper study. Contraception 2010; 82:538-42. [PMID: 21074017 DOI: 10.1016/j.contraception.2010.05.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 05/06/2010] [Accepted: 05/10/2010] [Indexed: 11/22/2022]
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Szűcs M, Párduczné Szöllősi A, Bártfai G. Knowledge and attitudes of pharmacists regarding over-the-counter emergency contraception in South-Eastern Hungary. EUR J CONTRACEP REPR 2010; 15:336-42. [DOI: 10.3109/13625187.2010.510225] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Obstetrician-gynecologist physicians' beliefs about emergency contraception: a national survey. Contraception 2010; 82:324-30. [PMID: 20851225 DOI: 10.1016/j.contraception.2010.04.151] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 04/27/2010] [Accepted: 04/29/2010] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although emergency contraception (EC) is available without a prescription, women still rely on doctors' advice about its safety and effectiveness. Yet little is known about doctors' beliefs and practices in this area. STUDY DESIGN We surveyed 1800 US obstetrician-gynecologists. Criterion variables were doctors' beliefs about EC's effects on pregnancy rates, and patients' sexual practices. We also asked which women are offered EC. Predictors were demographic, clinical and religious characteristics. RESULTS Response rate was 66% (1154/1760). Most (89%) believe EC access lowers unintended pregnancy rates. Some believe women use other contraceptives less (27%), initiate sex at younger ages (12%) and have more sexual partners (15%). Half of physicians offer EC to all women (51%), while others offer it never (6%) or only after sexual assault (6%). Physicians critical of EC, males and religious physicians were more likely to offer it never or only after sexual assault (odds ratios 2.1-12). CONCLUSION Gender, religion and divergent beliefs about EC's effects shape physicians' beliefs and practices.
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Hobbs MK, Taft AJ, Amir LH, Stewart K, Shelley JM, Smith AM, Chapman CB, Hussainy SY. Pharmacy access to the emergency contraceptive pill: a national survey of a random sample of Australian women. Contraception 2010; 83:151-8. [PMID: 21237341 DOI: 10.1016/j.contraception.2010.06.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 06/01/2010] [Accepted: 06/02/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND The emergency contraceptive pill (ECP) has the potential to assist in reducing unintended pregnancy and abortion rates. Since its rescheduling to pharmacy availability without prescription in Australia in January 2004, there is little information about Australian women's knowledge, attitudes and use of the ECP. The aim of this study was to measure the knowledge about the ECP and sociodemographic patterns of and barriers to use of the ECP. STUDY DESIGN A cross-sectional study, using a computer-assisted telephone interview (CATI) survey conducted with a national random sample of 632 Australian women aged 16-35 years. RESULTS Most women had heard of the ECP (95%) and 26% had used it. The majority of women agreed with pharmacy availability of the ECP (72%); however, only 48% were aware that it was available from pharmacies without a prescription. About a third (32%) believed the ECP to be an abortion pill. The most common reason for not using the ECP was that women did not think they were at risk of getting pregnant (57%). Logistic regression showed that women aged 20-29 years (OR 2.58; CI: 1.29-5.19) and 30-35 years (OR 3.16; CI: 1.47-6.80) were more likely to have used the ECP than those aged 16-19 years. Women with poor knowledge of the ECP were significantly less likely to have used it than those with very good knowledge (OR 0.28; CI: 0.09-0.77). Those in a de facto relationship (OR 2.21; CI: 1.27-3.85), in a relationship but not living with the partner (OR 2.46; 95% CI 1.31-4.63) or single women (OR 2.40; CI: 1.33-4.34) were more likely to have used the ECP than married women. CONCLUSIONS Women in Australia have a high level of awareness of the ECP, but more information and education about how to use it and where to obtain it are still needed.
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Affiliation(s)
- Melissa K Hobbs
- Mother and Child Health Research, La Trobe University, Melbourne VIC 3000, Australia.
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Use of simulated patients to assess the clinical and communication skills of community pharmacists. ACTA ACUST UNITED AC 2010; 32:353-61. [PMID: 20238164 DOI: 10.1007/s11096-010-9375-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 02/22/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the quality and appropriateness of Emergency Hormonal Contraception (EHC) supply from community pharmacies. SETTING Community pharmacies in the southwest of England during 2007. METHOD Two simulated patient ('mystery shopper') scenarios to each participating pharmacy, one where the supply of EHC would be appropriate (scenario 1) and one where there was a drug interaction between EHC and St John's Wort, and the supply inappropriate (scenario 2). Pharmacy consultations were rated using criteria developed from two focus groups: one with pharmacist academics and one with female university students. Feedback to pharmacists to inform their continuing professional development was provided. MAIN OUTCOME MEASURE Scores on rating scales encompassing the clinical and communication skills of the participating community pharmacists completed immediately after each mystery shopper visit. RESULTS 40 pharmacist visits were completed: 21 for scenario 1 and 19 for scenario 2. Eighteen pharmacists were visited twice. Five pharmacists visited for scenario 2 supplied EHC against professional guidance, although other reference sources conflicted with this advice. Pharmacies which were part of the local PGD scheme scored higher overall in scenario 1 (P = 0.005) than those not part of the scheme. Overall the communication skills of pharmacists were rated highly although some pharmacists used jargon when explaining the interaction for scenario 2. CONCLUSION Formatively assessing communication skills in an integrative manner alongside clinical skills has been identified as an important part of the medical consultation skills training and can be incorporated into the routine assessment and feedback of pharmacy over-the-counter medicines advice.
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Arribas Mir L, Ordóñez Ruiz MJ, Arribas Entrala B. ["Emergency contraception 2010"]. Aten Primaria 2010; 42:129-31. [PMID: 20129707 DOI: 10.1016/j.aprim.2009.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 12/14/2009] [Indexed: 10/19/2022] Open
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