47. Hospital Availability of Emergency Contraception For Texas Adolescents

Abstract

Texas has the 5th highest teen pregnancy rate and the 1st highest repeat teen pregnancy rate in the United States. Access to confidential contraceptive services in the state is often challenging. Therefore, emergency contraception (EC) is an invaluable resource for teen pregnancy prevention. A prior study of community pharmacies in Texas showed variable EC availability and inadequate pharmacy staff knowledge of EC. The purpose of this study was to evaluate availability of EC in Texas hospitals providing care for adolescents and to assess hospital pharmacists’ knowledge of EC. A list of Texas hospitals was obtained from the American Hospital Directory. Those hospitals admitting patients under the age of 18 to inpatient care were included in the study. The hospital pharmacy was contacted by phone and verbal consent for participation was obtained. A series of 8 questions regarding EC availability and knowledge were asked. Data were recorded and stored securely using RedCap. Data were de-identified with the exception of zip code. Descriptive statistics and frequencies were calculated. A chi-square test of independence was used to test if EC availability, age requirement, or pharmacist knowledge varied by hospital type. Of 170 hospitals meeting inclusion criteria, 77 pharmacists (45%) verbally consented to participate and answered at least 1 question about EC. Of these, 78% represented primarily adult hospitals admitting pediatric patients, 12% were free-standing children’s hospitals and 10% were psychiatric hospitals. EC was available to be administered for any purpose (not just cases of suspected sexual abuse) in 26% of emergency rooms and 22% of inpatient units. The availability of EC did not vary significantly by hospital type (free-standing children’s hospitals, adult hospitals admitting patients under the age of 18, or psychiatric hospital) (p=0.93 for inpatient availability, p=0.53 for ER availability). Nearly all hospitals with EC availability had levonorgestrel on formulary (97%), though only 40% of those hospitals did not require parental consent to dispense EC to patients under 18 years of age. This finding was significantly different between hospital types as all psychiatric hospitals required parental consent (p=0.025). For hospitals with EC available in the ER, none of them reported patients receiving medication counseling prior to being discharged from the ER. Statewide, only 19% of inpatient pharmacists recognized that there might be a weight limitation with use of LNG EC, and only 5% correctly stated that it could be used up to 120 hours after unprotected intercourse. Despite EC being available over-the-counter and without an age requirement for purchase, multiple barriers exist for Texas adolescents seeking EC in the inpatient and emergency room setting. These barriers include limited availability of the medication for non-sexual assault situations and the requirement of parental consent for administration of the medication. Additionally, pharmacist knowledge of EC is limited, and pharmacy medication counseling is rarely required. While preliminary, results of this study reveal a need to proactively educate patients and hospital pharmacists regarding EC.