Abstract
BackgroundCombined oral contraceptive (COC) use is the most commonly used reversible method of birth control. The incorrect use of COCs is frequent and one of the most common causes of unintended pregnancies. Community pharmacists (CPs) are in a strategic position to improve COC use because they are the last health professional to interact with patients before drug use.ObjectiveTo evaluate the COC dispensing practices of CPs in a developing country.MethodA cross-sectional study was conducted in community pharmacies of Assis and Ourinhos microregions, Brazil, between June 1, 2012, and October 30, 2012. Four simulated patients (SPs) (with counseled audio recording) visited community pharmacies with a prescription for Ciclo 21® (a COC containing ethinyl estradiol 30 mcg + levonorgestrel 15 mcg). The audio recording of every SP visit was listened to independently by 3 researchers to evaluate the COC dispensing practice. The percentage of CPs who performed a screening for safe use of COCs (i.e., taking of patients’ medical and family history, and measuring of blood pressure) and provided counseling, as well as the quality of the screening and counseling, were evaluated.ResultsOf the 185 CPs contacted, 41 (22.2%) agreed to participate in the study and finished the study protocol. Only 3 CPs asked the SP a question (1 question asked by each professional), and all of the questions were closed-ended, viz., “do you smoke?” (n = 2) and “what is your age?” (n = 1). None of the CPs measured the patient’s blood pressure. Six CPs provided counseling when dispensing COCs (drug dosing, 5 CPs; possible adverse effects, 2 CPs), and one CP provided counseling regarding both aspects.ConclusionThe CPs evaluated did not dispense COC appropriately and could influence in the occurrence of negatives therapeutic outcomes such as adverse effects and treatment failure.
Highlights
The use of combined oral contraceptives (COC) is the most common reversible method of birth control in developed and developing countries
The researchers explained to the Community pharmacists (CPs) that the objective of the study was to evaluate the practice of dispensing using the simulated patients (SPs) method
The form was developed by our research team, given the lack of clinical protocols developed by any pharmaceutical authorities/organizations as a screen for safe use and for counseling on the use of COCs. We developed this form based on the safety aspects identified in the World Health Organization’s Medical eligibility criteria for contraceptive use [13], and from guidelines for pharmacist-patient counseling recommended by a number of pharmaceutical authorities/ organizations [41,42,43,44] (Appendix S1 - Sample data collection sheet)
Summary
The use of combined oral contraceptives (COC) is the most common reversible method of birth control in developed and developing countries. Other frequently reported barriers to COC adherence is a lack of patients’ knowledge of COC contraceptive and noncontraceptive benefits, suggesting that health care professionals need to provide adequate evidence-based contraceptive counseling [4,8]. These results suggest a need for developing practices that improve long-term COC adherence. Conclusion: The CPs evaluated did not dispense COC appropriately and could influence in the occurrence of negatives therapeutic outcomes such as adverse effects and treatment failure
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