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Mitchell M, Stauffenberg C, Vernon V, Mospan CM, Shipman AJ, Rafie S. Opposition to Pharmacist Contraception Services: Evidence for Rebuttal. PHARMACY 2020; 8:E176. [PMID: 32977545 PMCID: PMC7711847 DOI: 10.3390/pharmacy8040176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 11/16/2022] Open
Abstract
Pharmacist contraception services are growing across the United States. Several states have authorized pharmacists to prescribe contraception, and the interest in other states continues to grow. Opposition to these practices exists and centers on discussions related to safety, training, cost, and fragmentation of care. We review these arguments and provide evidence refuting these concerns. Pharmacist-prescribed contraception increases access to care, and patients express interest in utilizing this service at the pharmacy. Pharmacists follow evidence-based recommendations. Counseling on preventative services and referral to other providers is part of contraception care by pharmacists. Training programs have been developed to equip both pharmacy students and pharmacists with the knowledge, skills, and tools needed to successfully provide these services. This article can serve as a guide for pharmacists and advocates when discussing pharmacist-prescribed contraception with policymakers, patients, and other healthcare professionals.
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Affiliation(s)
- Madeline Mitchell
- College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN 46208, USA; (M.M.); (C.S.)
| | - Courtney Stauffenberg
- College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN 46208, USA; (M.M.); (C.S.)
| | - Veronica Vernon
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN 46208, USA;
| | | | - Allie Jo Shipman
- National Association of State Pharmacy Associations, North Chesterfield, VA 23235, USA;
| | - Sally Rafie
- Birth Control Pharmacist, San Diego, CA 92122, USA
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Michie L, Cameron ST. Emergency contraception and impact on abortion rates. Best Pract Res Clin Obstet Gynaecol 2019; 63:111-119. [PMID: 31362908 DOI: 10.1016/j.bpobgyn.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/21/2019] [Accepted: 06/27/2019] [Indexed: 12/12/2022]
Abstract
Emergency contraception (EC) is a drug or a device that is taken after sexual intercourse to prevent unintended pregnancy. The most effective EC is the copper-bearing intrauterine device (Cu-IUD), but oral EC methods are more commonly used and include a single dose of either levonorgestrel (1.5 mg) or ulipristal acetate (30 mg). Although all EC methods are extremely safe, access to EC is often limited due to prevailing misconceptions over how EC works. Although EC can prevent unintended pregnancy for an individual woman, it has failed to make an impact on abortion rates at a population level. This may be because it is not used after every episode of unprotected sex and because existing oral EC methods are only effective if used before ovulation. Future strategies around EC should focus on maximising uptake of Cu-IUD, facilitating initiation of effective regular contraception after EC and developing a more effective oral EC.
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Affiliation(s)
- L Michie
- The Gatehouse, NHS Ayrshire and Arran, Ayrshire Central Hospital, United Kingdom.
| | - S T Cameron
- Chalmers Sexual and Reproductive Health Centre, NHS Lothian, 2 A Chalmers Street, Edinburgh, EH3 9ES, United Kingdom; Obstetrics and Gynaecology, University of Edinburgh, United Kingdom.
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French VA, Rangel AV, Mattingly TL. Access to emergency contraception in Kansas City clinics. Contraception 2018; 98:482-485. [PMID: 30369407 DOI: 10.1016/j.contraception.2018.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/25/2018] [Accepted: 06/26/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the accessibility of ulipristal acetate (UPA) and copper intrauterine devices (IUDs) for emergency contraception (EC) in reproductive health centers in the Kansas City metropolitan area. STUDY DESIGN Using a secret shopper method, two female investigators called the reproductive health centers listed as EC providers on the nonprofit website bedsider.org that were located within 25 miles of the University of Kansas Medical Center. We categorized clinics as Title X providers vs. not according to the grantee list from the Office of Population Affairs. Investigators inquired about obtaining a UPA prescription by phone, the availability of the copper IUD for EC and time to first available appointment for EC. We evaluated correlates of EC access and provision with Fisher's Exact Tests. RESULTS We identified 40 clinics as potential EC providers. Some clinics reported that UPA could be prescribed by phone to existing patients (13/40, 32%), while others reported that women must meet with a provider first (15/40, 38%). Few clinics offered copper IUDs as EC (3/40, 8%). Title X clinic status did not predict provision of UPA by phone or copper IUDs as EC. The average time to next available appointment was 9±9 days to discuss EC and 13±9 days for a copper IUD. CONCLUSIONS Accessing the most efficacious forms of EC in a timely fashion presents many logistic challenges for women. IMPLICATIONS Healthcare systems should streamline protocols, train providers and improve rapid-access referral networks to facilitate timely provision of UPA and copper IUDs for EC.
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Affiliation(s)
- Valerie A French
- Department of Obstetrics and Gynecology, University of Kansas Medical Center.
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Goodman SR, El Ayadi AM, Rocca CH, Kohn JE, Benedict CE, Dieseldorff JR, Harper CC. The intrauterine device as emergency contraception: how much do young women know? Contraception 2018; 98:S0010-7824(18)30145-8. [PMID: 29679591 PMCID: PMC6546552 DOI: 10.1016/j.contraception.2018.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Unprotected intercourse is common, especially among teens and young women. Access to intrauterine device (IUD) as emergency contraception (EC) can help interested patients more effectively prevent unintended pregnancy and can also offer ongoing contraception. This study evaluated young women's awareness of IUD as EC and interest in case of need. STUDY DESIGN We conducted a secondary analysis of data from young women aged 18-25 years, not desiring pregnancy within 12 months, and receiving contraceptive counseling within a cluster-randomized trial in 40 US Planned Parenthood health centers in 2011-2013 (n=1500). Heath centers were randomized to receive enhanced training on contraceptive counseling and IUD placement, or to provide standard care. The intervention did not focus specifically on IUD as EC. We assessed awareness of IUD as EC, desire to learn more about EC and most trusted source of information of EC among women in both intervention and control groups completing baseline and 3- or 6-month follow-up questionnaires (n=1138). RESULTS At follow-up, very few young women overall (7.5%) visiting health centers had heard of IUD as EC. However, if they needed EC, most (68%) reported that they would want to learn about IUDs in addition to EC pills, especially those who would be very unhappy to become pregnant (adjusted odds ratio [aOR], 1.3; 95% confidence interval, 1.0-1.6, p<.05). Most (91%) reported a doctor or nurse as their most trusted source of EC information, over Internet (6%) or friends (2%), highlighting providers' essential role. CONCLUSION Most young women at risk of unintended pregnancy are not aware of IUD as EC and look to their providers for trusted information. Contraceptive education should explicitly address IUD as EC. IMPLICATIONS Few young women know that the IUD can be used for EC or about its effectiveness. However, if they needed EC, most reported that they would want to learn about IUDs in addition to EC pills, especially those very unhappy to become pregnant. Contraceptive education should explicitly address IUD as EC.
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Affiliation(s)
- Suzan R Goodman
- UCSF Bixby Center for Global Reproductive Health, 3333 California Street, UCSF Box 0744, San Francisco, CA 94143-0744, USA.
| | - Alison M El Ayadi
- UCSF Bixby Center for Global Reproductive Health, 3333 California Street, UCSF Box 0744, San Francisco, CA 94143-0744, USA
| | - Corinne H Rocca
- UCSF Bixby Center for Global Reproductive Health, 3333 California Street, UCSF Box 0744, San Francisco, CA 94143-0744, USA
| | - Julia E Kohn
- Planned Parenthood Federation of America, 123 William Street, New York, NY 10038, USA
| | - Courtney E Benedict
- Planned Parenthood Federation of America, 123 William Street, New York, NY 10038, USA
| | | | - Cynthia C Harper
- UCSF Bixby Center for Global Reproductive Health, 3333 California Street, UCSF Box 0744, San Francisco, CA 94143-0744, USA
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Wong K, Hum S, McCarthy L, Dunn S. Beyond Plan B: A Qualitative Study of Canadian Pharmacists' Emergency Contraception Counselling Practices. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:1021-1027. [DOI: 10.1016/j.jogc.2017.04.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/28/2017] [Accepted: 04/29/2017] [Indexed: 12/30/2022]
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Edwards C, Panjwani D, Pendrith C, Ly A, Dunn S. Knowledge of and Interest in the Copper Intrauterine Device Among Women Seeking Emergency Contraception. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:41-47. [PMID: 28780215 DOI: 10.1016/j.jogc.2017.05.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 05/23/2017] [Accepted: 05/25/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Emergency contraception (EC) includes hormonal pills (levonorgestrel or ulipristal acetate) and the copper IUD (Cu-IUD). The Cu-IUD is more effective for EC than hormonal pills but remains underused, possibly because of lack of knowledge or interest. The objective of this study was to examine knowledge of and interest in the Cu-IUD for EC among Canadian women seeking EC. METHODS The study used a cross-sectional convenience survey of English-speaking women presenting for EC at two sexual health clinics in Toronto. The anonymous paper-based survey was completed in the waiting room. The main outcome measures were women's knowledge of and interest in the Cu-IUD for EC. Demographic and reproductive health data were also collected. RESULTS Between January and December 2013, 124 surveys were completed. Mean age of respondents was 26 years (SD ± 6.9). Most were single (85%), and over one half had completed postsecondary education. Overall, 77% had heard of the Cu-IUD, but only 21% were aware of its use for EC. Over 50% were aware that the Cu-IUD is hormone-free and may be used for long-term contraception. Women were less familiar with the window of administration of the Cu-IUD for EC (26%) and its efficacy (6%). In total, 23% (28 of 124) of women were interested in the Cu-IUD, including eight women scheduled to receive one that day. CONCLUSION Women presenting for EC were unaware of the Cu-IUD but were moderately interested in it once informed. Public education and routine counselling about the Cu-IUD at EC visits may increase the uptake of this method.
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Affiliation(s)
| | - Dilzayn Panjwani
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON
| | - Ciara Pendrith
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, University of Toronto, Toronto, ON
| | - Anna Ly
- Faculty of Medicine, University of Toronto, Toronto, ON
| | - Sheila Dunn
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON; Department of Family and Community Medicine, Women's College Hospital, University of Toronto, Toronto, ON.
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Rafie S, Stone RH, Wilkinson TA, Borgelt LM, El-Ibiary SY, Ragland D. Role of the community pharmacist in emergency contraception counseling and delivery in the United States: current trends and future prospects. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2017; 6:99-108. [PMID: 29354556 PMCID: PMC5774329 DOI: 10.2147/iprp.s99541] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Women and couples continue to experience unintended pregnancies at high rates. In the US, 45% of all pregnancies are either mistimed or unwanted. Mishaps with contraceptives, such as condom breakage, missed pills, incorrect timing of patch or vaginal ring application, contraceptive nonuse, forced intercourse, and other circumstances, place women at risk of unintended pregnancy. There is a critical role for emergency contraception (EC) in preventing those pregnancies. There are currently three methods of EC available in the US. Levonorgestrel EC pills have been available with a prescription for over 15 years and over-the-counter since 2013. In 2010, ulipristal acetate EC pills became available with a prescription. Finally, the copper intrauterine device remains the most effective form of EC. Use of EC is increasing over time, due to wider availability and accessibility of EC methods. One strategy to expand access for both prescription and nonprescription EC products is to include pharmacies as a point of access and allow pharmacist prescribing. In eight states, pharmacists are able to prescribe and provide EC directly to women: levonorgestrel EC in eight states and ulipristal acetate in seven states. In addition to access with a prescription written by a pharmacist or other health care provider, levonorgestrel EC is available over-the-counter in pharmacies and grocery stores. Pharmacists play a critical role in access to EC in community pharmacies by ensuring product availability in the inventory, up-to-date knowledge, and comprehensive patient counseling. Looking to the future, there are opportunities to expand access to EC in pharmacies further by implementing legislation expanding the pharmacist scope of practice, ensuring third-party reimbursement for clinical services delivered by pharmacists, and including EC in pharmacy education and training.
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Affiliation(s)
- Sally Rafie
- Department of Pharmacy, UC San Diego Health, San Diego, CA
| | - Rebecca H Stone
- Department of Clinical and Administrative Pharmacy, University of Georgia, College of Pharmacy, Athens, GA
| | - Tracey A Wilkinson
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Laura M Borgelt
- Department of Clinical Pharmacy.,Department of Family Medicine, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO
| | - Shareen Y El-Ibiary
- Department of Pharmacy Practice, College of Pharmacy, Midwestern University, Glendale, AZ
| | - Denise Ragland
- Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Rafie S, McIntosh J, Shealy KM, Borgelt LM, Forinash A, Shrader SP, Koepf ER, McClendon KS, Griffin BL, Horlen C, Karaoui LR, Rowe EL, Lodise NM, Wigle PR. Roles of the pharmacist in the use of safe and highly effective long-acting reversible contraception: an opinion of the women's health practice and research network of the American College of Clinical Pharmacy. Pharmacotherapy 2014; 34:991-9. [PMID: 24989020 DOI: 10.1002/phar.1457] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The U.S. population continues to experience an alarmingly high rate of unintended pregnancies that have an impact on individual families and society alike. Lack of effective contraception accounts for most unintended pregnancies, along with incorrect use of contraceptives. The most common reversible contraceptive method used in the United States is the oral contraceptive pill, which has significant failure and discontinuation rates. Use of long-acting reversible contraceptive (LARC) methods has been increasing in recent years after efforts to educate providers and patients. Women are more likely to use LARC methods when barriers such as access and cost are removed. An uptake in the use of LARC methods would allow for markedly reduced contraception failure rates and higher user satisfaction and thus higher continuation rates than those seen with current contraception use. Promoting the use of LARC methods is an important strategy in improving both individual and public health outcomes by reducing unintended pregnancies. The pharmacist's role in family planning is expanding and can contribute to these efforts. Although knowledge regarding LARC has not been studied among pharmacists, a knowledge deficit exists among health care professionals in general. Thus pharmacist education and training should include LARC methods along with other contraceptives. The American College of Clinical Pharmacy Women's Health Practice and Research Network advocates for the pharmacist's role in the use of safe and highly effective LARC methods. These roles include educating patients, informing providers, facilitating access by providing referrals, and modifying institutional procedures to encourage provision of LARC methods.
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Affiliation(s)
- Sally Rafie
- Department of Pharmacy, University of California San Diego Health System, San Diego, California
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Pichardo M, Arribas L, Coccio E, Heredia G, Jagroep S, Palermo T. IUDs as EC? Limited awareness and high reported acceptability: evidence from Argentina. Contraception 2014; 90:522-8. [PMID: 24973905 DOI: 10.1016/j.contraception.2014.05.012] [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] [Received: 01/18/2014] [Revised: 05/06/2014] [Accepted: 05/21/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND We explored knowledge and attitudes regarding the copper intrauterine device (IUD) as emergency contraception (EC) among women in Buenos Aires, Argentina. STUDY DESIGN We interviewed a convenience sample of women attending a family planning center at a public hospital. Participants were asked about knowledge and use of contraceptives, including EC (pre-script). Then they were given information about the IUD as EC and subsequently asked about acceptability of using the copper IUD as EC (post-script), the primary outcome in this analysis. RESULTS We analyzed data on 273 women. While only 1.83% of participants knew the IUD served as EC at baseline, 79.85% said they would be willing to use the device as such if the need arose after given relevant information. Multivariate results from a pre-script revealed that women with low levels of education and those born outside of Argentina were less knowledgeable about EC pills. Only previous use of the IUD was associated with high levels of IUD knowledge. Post-script, results indicated that being Argentine [odds ratio (OR)=2.15, 95% confidence interval (CI) 1.21, 3.81] and previous IUD use (OR=2.12, 95% CI=1.07, 4.19) were positively associated with considering the IUD as EC. Nulliparity was negatively associated with willingness to use the IUD as EC (OR=0.44, 95% CI 0.22, 0.86). CONCLUSION We examined acceptability of the copper IUD as EC in a Latin American setting and found that, while prior levels of knowledg'e were low, acceptability of the IUD as EC was high. Implications for programming and policy include outreach and education regarding this highly effective method and advocacy to change existing regulations in Argentina prohibiting the use of IUD as EC. IMPLICATIONS After given information about the IUD as a method of EC, women interviewed said they would be willing to use the IUD EC despite their limited prior knowledge of this method. With more widespread information and availability of the IUD as EC, more women may opt for this highly effective method, which can provide additional protection against unwanted pregnancy for up to 10 years.
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Affiliation(s)
- Margaret Pichardo
- Program in Public Health, Stony Brook University (State University of New York), Stony Brook, NY 11790, USA
| | - Lia Arribas
- Department of Gynecology, Rivadavia Hospital, Buenos Aires Ministry of Health, Buenos Aires, Argentina
| | - Elina Coccio
- Department of Gynecology, Rivadavia Hospital, Buenos Aires Ministry of Health, Buenos Aires, Argentina
| | - Graciela Heredia
- Department of Gynecology, Rivadavia Hospital, Buenos Aires Ministry of Health, Buenos Aires, Argentina
| | - Sherani Jagroep
- Physicians for Reproductive Health (work was conducted while at Stony Brook University), New York, NY 10018-3889, USA
| | - Tia Palermo
- Program in Public Health, Department of Preventive Medicine, Stony Brook University (State University of New York), Stony Brook, NY 11790, USA.
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