Six years after deregulation of emergency contraception in Switzerland: Has free access induced changes in the profile of clients attending an emergency pharmacy in Zürich?

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

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Pharmacy-based initiatives to reduce unintended pregnancies: A scoping review

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.

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

Objectives: Since 2002, Swiss community pharmacists have dispensed emergency contraception (EC) as pharmacist-only medicine ideally using the official Swiss protocol. Our study aimed to determine pharmacists' resolution of an imaginary EC case, compliance with the protocol, and provision of information on the risk of sexually transmitted infections (STIs). Methods: We conducted a simulated patient study with 69 students who each visited a community pharmacy. The scenario started with the student requesting the 'morning after pill'. Current practice was assessed using an online evaluation form adapted from the Medication-Related Consultation Framework. Descriptive and statistical analyses were carried out. Results: All pharmacists correctly identified that the person needed EC. All pharmacists used an EC protocol and asked on average 10.9 (standard deviation 0.68) of 11 compulsory EC assessment questions. In total, 93% of pharmacists addressed EC counselling items and 56% addressed the risk of STIs, mainly by mentioning that condoms offered the best protection (76%). Conclusions: Community pharmacists correctly issued the EC, complied with the dispensing protocol and used their professional judgement to ensure optimal EC use. There is nevertheless room for improvement regarding pharmacists' STI counselling. Finally, the protocol's STI section could be enriched with specific information to guide counselling.

Pharmacy provision of sexual and reproductive health commodities to young people: a systematic literature review and synthesis of the evidence

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.

Trends in Inequalities in the Use of Condom by Urban Teenagers in Spain

Social and economic inequalities in condom use by adolescents have been reported previously. Also, condom use has declined during the last decade. The aim of the study was to describe trends in the use of condoms in our setting, and how these trends may differ between socioeconomic groups in boys, and separately in girls, aged 17-19 years attending school in Barcelona between 2004 and 2012. We analyzed data from three annual surveys on risk factors in secondary students, which included a representative sample of the city's population; individuals who had previously had sexual intercourse (n = 1570) were included in the study. We calculated adjusted prevalence ratios (aPR) and their confidence intervals (95% CI) using robust Poisson regression models. The prevalence of condom use among boys was 87.0% in 2004 and 76.2% in 2012, and 76.7 and 64.7% among girls, respectively. This decrease was greater in adolescents with a low socioeconomic level, both in boys (aPR = 0.80) and girls (aPR = 0.84). The observed increase of socioeconomic inequalities in condom use in adolescents highlights a possible deterioration in good sexual practices and policies during the studied period.

Effect of changes to cost and availability of emergency contraception on users' profiles in an emergency department in Catalunya

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.