Beyond Plan B: A Qualitative Study of Canadian Pharmacists' Emergency Contraception Counselling Practices.

Abstract

Pharmacists are often the front-line health care providers for women seeking emergency contraception (EC). This study explored Ontario pharmacists' EC counselling practices and their perceived barriers to recommending the most effective EC method, the copper IUD (Cu-IUD). This qualitative study used one-on-one, semistructured interviews with 20 pharmacists working in pharmacies located within a 1-km radius of a large sexual health clinic that offered postcoital IUDs in downtown Toronto. All pharmacists provided counselling about levonorgestrel (LNG-EC), and all considered it important. Nevertheless, they rarely discussed the Cu-IUD, even in circumstances where LNG-EC could be less effective, such as delayed presentation or for women with BMI >25 kg/m2. Some pharmacists felt conflicted in their dual roles as health care and customer service provider when counselling about and selling EC, and many felt uncomfortable discussing body weight. Pharmacists were not well informed about the Cu-IUD. They identified many pharmacist-specific barriers to counselling about the Cu-IUD for EC, as well as health systems issues around Cu-IUD provision and insertion. Ontario pharmacists embraced their role in EC counselling, yet their discussions rarely included the most effective Cu-IUD option. Educating and training pharmacists about the Cu-IUD and establishing referral pathways for IUD insertion could expand their counselling about this EC option.