Emergency Hormonal Contraception Research Articles

Contraception prescribing in England during the COVID-19 pandemic

BackgroundNational lockdowns in England due to COVID-19 resulted in rapid shifts in healthcare provision, including in primary care where most contraceptive prescriptions are issued. This study aimed to investigate contraception...

Use of path analysis to predict changes to community pharmacy and GP emergency hormonal contraception (EHC) provision in England

ObjectivesIn 2014/2015, 46% of community pharmacies were commissioned by local authorities to provide emergency hormonal contraception (EHC) free without prescription in England. Commissioning EHC services influences EHC prescribing from General...

Describing the impact of community pharmacy organisation type on emergency hormonal contraception services in England.

In England, non-dispensing pharmacy services are commissioned either nationally or locally. For the national service Medicines Use Reviews (MURs), large multiple/chain pharmacies provide more consultations than independents. This study aimed to examine the relationship between community pharmacy organisation type and a local service, Emergency Hormonal Contraception (EHC). It also aimed to explore the influence of deprivation. Freedom of information requests was sent to all 147 local authorities in England. Data included the number of EHC consultations by individual pharmacies across England (2017/18). Public data were used to identify pharmacies, match with MUR data, and group by organisation type. Bivariate correlations and ANOVA described the relationship between service provision, organisation type and deprivation. Pharmacy data were obtained from 76 (52%) local authorities. Following removal of unidentifiable pharmacies, 3069 were analysed - 56% of the estimated 5461 commissioned pharmacies in England. Bivariate correlations indicated a significant negative correlation between EHC provision and Index of Multiple Deprivation score. Greater deprivation correlated to greater EHC provision. A One-way ANOVA demonstrated significant differences between organisation types for MUR provision (larger organisations providing greater volumes). EHC provision demonstrated significant differences between groups and a U-shaped association; large multiple and independent organisations had higher levels than medium and small chains. A two-way ANOVA showed no significant interaction between deprivation and organisation type. EHC provision does not increase linearly with organisation type. Deprivation appears a more reliable indicator of EHC provision. Provision is likely influenced by local factors but could increase with a nationally commissioned service.

Investigating the relationship between community pharmacy and GP Emergency Hormonal Contraception (EHC) provision: a linear regression analysis

Abstract Introduction Emergency Hormonal Contraception (EHC) is contracted by Local Authorities to be provided free-of-charge from 46% of community pharmacies in England. (1) There is no difference in EHC consultation outcomes between community pharmacy and GP surgeries. A study in a rural area demonstrated that introduction of a community pharmacy EHC service can reduce GP EHC prescribing rates by approximately 41%, without influencing Family Planning Clinics or Accident and Emergency departments. (2) However, it is not known whether this relationship is universally present, and this relationship has not previously been quantified. Aim To describe the relationship between rates of GP EHC prescribing and commissioned community pharmacy EHC provision. Methods Freedom of Information (FOI) requests were submitted to all Local Authorities in England for numbers of EHC provisions through commissioned services between March 2019 and April 2020. The data were matched to Clinical Commissioning Group (CCG) GP prescribing data, obtained from openprescribing.net. Using population estimates from the Office of National Statistics, rates of supply per 10,000 female population (aged 12-55) were determined. The data indicated small numbers of outliers, which can distort linear regression; boxplots allowed the removal of data points outside 1.5 times the Inter Quartile Range from the 1st or 3rd quarter. Using SPSS v24, linear regressions were calculated between GP prescribing rates and community pharmacy EHC provision rates. This was repeated for community pharmacy EHC provision rates and the proportion of commissioned pharmacies. Results There were 147 Local Authority commissioners identified across England, 113 (76.9%) responded to the FOI request. Of these, 5 did not commission EHC services from community pharmacy. Local Authority and CCG boundaries were compared, 86 areas were identified as ‘co-terminus’ (i.e., greater than 95% overlap). These 86 areas included 82,822 GP prescriptions and 207,731 community pharmacy provisions. The data reflected an estimated female population aged 12-55 of 9,380,153 (Local Authority mean 109,072, SD 83,899), 60% of the total English female (12-55) population. Removing outliers left 92.5% of the data for analysis. The mean GP prescribing rate was 79.3/10,000 (SD 26.3) and the mean community pharmacy provision rate was 200.2/10,000 (SD 154.9). Linear regression indicated a negative correlation between GP prescribing rates and community pharmacy provision rates (R2=0.21) and a positive correlation between community pharmacy provision rates and the proportion of commissioned pharmacies (R2=0.21). Conclusion This study shows that increasing the community pharmacy provision rate by 100/10,000 decreases the GP prescribing rate by 8/10,000. Increasing the proportion of commissioned pharmacies to 100%, through a national service may change GP prescribing rates. This regression analysis predicts this would decrease the GP EHC prescribing rate by 15% to 66.3/10,000. Whilst this data is not fully representative of commissioning in England, this single commissioning change could move 20,706 GP consultations to community pharmacy annually across England. Comparisons with Wales and Scotland (who have national services) suggest this impact could potentially even be doubled. The strength of this study is it’s use of routine data facilitating replication, however local commissioning arrangements mean the conclusions are not necessarily applicable beyond England. References (1) Mackridge AJ, Gray NJ, Krska J. A cross-sectional study using freedom of information requests to evaluate variation in local authority commissioning of community pharmacy public health services in England. BMJ Open. 2017;7(7):e015511 (2) Lloyd K, Gale E. Provision of emergency hormonal contraception through community pharmacies in a rural area. J Fam Plann Reprod Health Care. 2005;31(4):297-300.

USE AND AWARENESS OF EMERGENCY HORMONAL CONTRACEPTION IN UNIVERSITY STUDENTS

OBJECTIVE: To understand the use and awareness of EHC among university students. MATERIALS AND METHODS: This cross-sectional descriptive observational study with a quantitative approach was conducted with a random sample of university students from Villavicencio using a self-administered survey. A description of the variables was performed, followed by a multinomial regression to evaluate possible associations with the non-use of HEC, obtaining OR. RESULTS: A total of 273 students were surveyed, out of whom 95.97% stated that they were aware of emergency hormonal contraception (EHC) and 4.03% were unaware. 59.34% students had previously used EHC, whereas 40.66% had not. On evaluation of the respondents’ knowledge regarding EHC, it was found that 135 students (49.45%) possessed an acceptable level of knowledge of EHC, whereas 138 students (50.55%) did not pass the evaluation and possessed a very low level of knowledge regarding EHC. It is suggested in the results that there is more predisposition to the use of the EHC method in women (OR 1.89 CI 1.15-3.09, p=0.00009), and in those who have received counseling on contraception (OR 3.09 CI 1.88-5.07, p= 0.0000016. CONCLUSION: The results of the survey suggest that the existing education and communication strategies regarding sexuality and contraceptive use for adolescents and young adults should be rethought.

Time management

Time management is the key to meeting successfully the challenge of new, time-consuming initiatives (such as emergency hormonal contraception supply) and to addressing daily impositions on time. Time management is about developing a different mind set — thinking about time as a resource or commodity that, if not managed, will be wasted. The main benefits […]

Expanding Pharmacy Capacity for Patient-Centered Reproductive Health Services.

In the United States, patients face increasing practical barriers and concerns about stigma when seeking sexual and reproductive healthcare, specifically family planning services involving hormonal contraception, emergency contraception, and abortion. The pharmacist is a member of the interprofessional care team with the ability to provide non-judgmental, high-quality, and patient-centered care. The community pharmacy setting itself offers specific advantages which promote access, including availability in most neighborhoods, broad hours of operation, lack of need for an appointment, and a stigma-free space which is frequented for other goods and services. This commentary suggests specific ways for pharmacies to improve access to contraception, emergency contraception, and abortion in line with national quality recommendations. Particular focus is given to the intersection of sexual and reproductive health resources and referrals within the pharmacy profession as well as the training and technical assistance tools which can help address unmet patient need.

Interactive Clinical Avatar Use in Pharmacist Preregistration Training: Design and Review.

BackgroundVirtual patients are interactive computer-based simulations that are being increasingly used in modern health care education. They have been identified as tools that can provide experiential learning and assessment in a standardized and safe environment. However, the study of high-fidelity virtual patients such as interactive clinical avatars within pharmacy is limited.ObjectiveThe aim of this paper is to describe the design and review of three interactive clinical avatar simulations as part of pharmacist preregistration training.MethodsA multistep design approach was taken to create interactive clinical avatar simulations on the topics of emergency hormonal contraception (EHC), calculation of renal function, and childhood illnesses. All case studies were reviewed by registered pharmacists to establish content and face validity. The EHC case study and data collection questionnaire were also reviewed by a purposive sample of preregistration trainees and newly qualified pharmacists. The questionnaire used Likert ranking statements and open-ended questions to obtain users’ feedback on the design, usability, and usefulness of the interactive clinical avatars as learning tools. Descriptive statistics and content analysis were undertaken on the data.ResultsTen preregistration trainees and newly qualified pharmacists reviewed the EHC interactive clinical avatars and data collection questionnaire. The data collection questionnaire was associated with a Cronbach alpha=.95, demonstrating good reliability. All three interactive clinical avatar simulations were reported as usable and appropriately designed for preregistration training. Users perceived they were developing skills and knowledge from the simulations. The high-fidelity nature of the avatars and relevance of the simulations to real-life practice were reported as aspects that encouraged the application of theory to practice. Improvements were suggested to ensure the simulations were more user-friendly.ConclusionsThe design and creation of the interactive clinical avatar simulations was successful. The multistep review process ensured validity and reliability of the simulations and data collection questionnaire. The in-depth explanation of the design process and provision of a questionnaire may help widen the use and evaluation of interactive clinical avatars or other simulation tools in pharmacy education. The interactive clinical avatars were reported as novel learning tools that promoted experiential learning and allowed users to feel like they were engaging in real-life scenarios, thus developing transferable knowledge and skills. This may be potentially beneficial for many health care training courses as a way to provide standardized experiences promoting active learning and reflection.

Virtual patients as a tool for training pre-registration pharmacists and increasing their preparedness to practice: A qualitative study.

Virtual patients are an active learning pedagogical tool which simulate clinical scenarios in a three-dimensional environment. Their use in pharmacy education is under-researched in comparison to other healthcare professions. In the United Kingdom, pre-registration training refers to a year of workplace based training which pharmacy graduates must complete prior to professional registration as pharmacists. This study aimed to evaluate pre-registration pharmacists' perceptions on the integration, usefulness and enjoyment of completing virtual patient simulations or non-interactive case studies as part of their training. Pre-registration trainees completed three virtual patient simulations or three non-interactive case studies on the topics of: emergency hormonal contraception, renal function and childhood illnesses. Telephone interviews were conducted with twenty pre-registration pharmacists, exploring their perspectives on the use of the virtual patient or non-interactive case studies. Data was analysed using the five-stage framework approach. Four main themes emerged from the data: case study design; usefulness of the case studies as a training tool; support in pre-registration training; utility of the learning tools. Trainees also identified technical issues they had experienced while completing the virtual patient simulations, specifically with keyword recognition. Pre-registration trainees who used the virtual patients provided comments relating to the novelty, realism and enjoyment in completing them. Trainees in both groups reported developing knowledge and skills from completing the case studies; those who used the virtual patient commented on the development of communication skills and an increase in confidence for practice and those who used the non-interactive cases focused on knowledge acquisition and numeracy. Participants were enthusiastic about virtual patients as a novel training tool which provided an opportunity for learners to practice realistic scenarios in a safe environment. Virtual patients offer the potential to 'bridge the gap' in pharmacist pre-registration sector-related training variation, promote learning through reflection on doing and increase overall preparedness for practice.

Qualitative findings about stigma as a barrier to contraception use: the case of Emergency Hormonal Contraception in Britain and implications for future contraceptive interventions

Background Emergency Hormonal Contraception (EHC) has been underused in Britain and internationally since its introduction. ‘Stigmatisation’ has been identified as one of the barriers to EHC. However, few, if any publications have focussed on the significance of this factor in the British context, the social meanings for women of seeking EHC and the implications for future contraceptive provision and innovation. Method In-depth qualitative material from 27 women across two British studies was analysed. The first, in which 11 young women were interviewed in-depth regarding EHC specifically, was supplemented by material from a multi-stage narrative study of 15 women concerning their life history experiences of using contraception more broadly. Results Stigmatisation of EHC use is a key barrier and derives from associations with irresponsible behaviour. This irresponsibility exists on a continuum with some behaviours and some women more ir/responsible than others. In addition, despite not being an abortifacient, EHC may be closely aligned with abortion meaning users can be perceived as ‘bad women’ in a similar way to abortion seekers. This stigma can deter participants seeking EHC when they may need it. Conclusion Stigma is a powerful barrier to EHC use due to the social significance of responsibility and expectations pertaining to the behaviour of ‘good women.’ Understandings about stigmatisation in the case of EHC should be translated to other aspects of contraceptive service delivery and future innovations, to ensure effective provision of methods and safeguard their uptake.

Pharmacist-Prescribed And Over-The-Counter Hormonal Contraception In Los Angeles County Retail Pharmacies.

Federal and state policies to increase access to birth control have included expanding access to preventive and emergency hormonal contraception at pharmacies for women and girls of all ages without a physician's prescription. We conducted a "mystery shopper" telephone survey to quantify the impact of these policies in Los Angeles County, California. That county consistently has among the highest number of unintended pregnancies and teen births in the US, especially in low-income and minority neighborhoods. Between June and November2017, three in four pharmacies offered over-the-counter emergency hormonal contraception, but only one in ten offered pharmacist-prescribed preventive hormonal contraception. Many of these pharmacies also imposed age restrictions when dispensing hormonal contraception, including in the neighborhoods at highest risk for unintended pregnancies and teen births, even though the Food and Drug Administration removed age restrictions for over-the-counter emergency hormonal contraception in 2013. In addition, many low-income, minority neighborhoods lacked pharmacies when the survey was performed. Policies aimed solely at expanding pharmacy access to birth control might not be sufficient to address disparities in contraceptive use.

Young women’s fertility knowledge: partial knowledge and implications for contraceptive risk-taking

BackgroundThere is a lack of research on young women’s fertility knowledge and awareness. This has implications for contraceptive risk-taking, including the use of emergency hormonal contraception (EHC). By drawing on...

Assessment of contraceptive curricula in US pharmacy programs

IntroductionPharmacists prescribe contraception in some states following expansions in scope of practice. Adequate education on contraception in pharmacy curricula is crucial to effectively deliver these services. MethodsA 26-item survey assessing contraception curricula regarding was administered by email to instructors and administrators at 139 pharmacy schools in the United States. The survey assessed teaching methods, hours taught, topic content, and opinion of adequacy of contraceptive education provided by the program. ResultsThe survey achieved a response rate of 40% (n = 56). All programs that responded offer emergency contraception and hormonal contraception content, 96% offer non-hormonal over-the-counter contraception content, and 91% offer long-acting reversible hormonal contraception content. Average number of hours taught were as follows: non-hormonal over-the-counter contraception 2.0 hours, emergency contraception 0.9 hours, hormonal contraception 3.0 hours, long-acting reversible hormonal contraception 0.8 hours, and non-reversible hormonal contraception 0.5 hours. Patient cases were most used to supplement didactic content in all topics. Standardized patient interviews were used less frequently for both hormonal contraception (25%) and emergency contraception (7%). About 68% of programs agreed or strongly agreed that the contraceptive education provided by the program was adequate. A majority (70%) indicated interest in a standardized contraceptive curriculum. ConclusionsContraceptive education is broadly covered in didactic curricula within pharmacy education. Further assessment and development of curricula standards may be warranted to assess quality and adequacy of contraceptive education in pharmacy.

Primary Health Care and Community Pharmacy in Ireland: a lot of visions but little progress.

Ireland is small country with a population of 4.8M which spent 6.9% of its gross domestic product on healthcare in 2018. Health services are provided through a twin track approach – all public services are largely free to those eligible (32.44% in 2019) and private patients pay for most services. Most of the expenditure on medicines is paid by the government while visits to General Practitioners (GPs) are an out-of-pocket expense for private patients under 70 years of age, and private health insurance provides cover for most hospital services. Healthcare professionals in the primary care sector contract to provide public services with the Health Services Executive (HSE) which is responsible for the day-to-day running of the service. Primary care teams began to be formed in 2001 to try to link and integrate the provision of care but since these are led by GPs neither community pharmacists nor dentists joined these teams. The focus of policy remained the primary care team until a proposal to create a public health service to provide universal health coverage called Sláintecare was agreed in 2017. However, implementation of Sláintecare has been slow and piecemeal. The government regularly devises policies to control prescribing and the HSE, together with other regulators has implemented generic substitution and preferred drugs and limited access to expensive drugs through schemes for particular patient groups. A programme called Healthy Ireland has taken on the health promotion policies but pharmacists have been excluded from most programmes although some campaigns have included them. Community pharmacy organisations have tried to develop pharmacy services and while a few which are targeted at specified patient groups, such as opioid substitution, emergency administration of certain drugs, emergency hormonal contraception and seasonal influenza vaccination have been remunerated for public patients by the HSE, other services have not. GP organisations defend their members’ scope of practice and seek to influence policy makers to channel schemes and services through general practice. There is no professional body to represent pharmacists that is independent of any trade union responsibilities and this has weakened the profession’s advocacy. Pharmacists are one of the most trusted group of professionals in Ireland and have maintained their practices throughout periods of recession and declining income from government. Whether pharmacists can argue that the optimisation of a patient’s medicines depends upon their contribution and will benefit the health service remains an open question.

A Comparative Study of the Cost and Uptake of Community Pharmacy "Stop Smoking and Emergency Contraception" Services from the Perspective of the National Health Service.

Objective:The objective was to explore if the community pharmacy (CP) stop smoking service (SSS) and emergency hormonal contraception patient group direction (EHC PGD) meet the needs of the English population and are cost-effective.Methods:This research was completed over 2 years. Public health resources provided details of CPs and provision of SSS and EHC PGD. Questionnaires were sent to smoking cessation/sexual health leads in local authorities to obtain information not available elsewhere. Questionnaires inquired about CP payment for provision of SSS and EHC PGD, overhead costs, successful outcomes, and validation methods. Quit rates at 4-weeks, 52-weeks, and lifetime determined SSS effectiveness. The effectiveness of EHC PGD was based on the probability of unintended pregnancy with/without levonorgestrel. Incremental cost-effectiveness ratio and cost of quality-adjusted life years (QALYs) gained were calculated. Descriptive statistics were determined. A priori of less than 0.05 (P < 0.05) was significant.Findings:SSS provision and uptake did not match local needs (smoking prevalence) even though increased CP SSS provision correlated with increased SSS success. Similarly, the need (based on teenage pregnancy rates) for EHC PGD did not correlate with the rate of CP provision but only with the uptake. Nevertheless, the provision of SSS and EHC PGD from CPs was cost-effective from an NHS perspective. Various assumptions were tested, but in all cases fell well below NICE QALY recommendations for cost-effectiveness.Conclusion:Provision of SSS and EHC PGD from CP does not meet the needs of the population even though the delivery of these services is cost-effective.

Refusing to supply emergency hormonal contraception undermines our profession — no pharmacist should do it

Refusing to supply emergency hormonal contraception undermines our profession — no pharmacist should do it

La anticoncepción hormonal de emergencia: Mitos y Realidades

La anticoncepción hormonal de emergencia ha sido objeto de debate por lo mitos que han surgido en torno a su uso, sin embargo, existe evidencia científica basada en diversas investigaciones biomédicas que demuestran que los dos principales mitos: que se trata de un “tratamiento abortivo” y que su uso en la población aumenta las infecciones de transmisión sexual, son falsos. &#x0D; Palabras clave: aborto, anticoncepción hormonal de emergencia, infecciones de transmisión sexual.

Pharmacist Compliance With Therapeutic Guidelines on Diagnosis and Treatment Provision

Misuse and overselling of over-the-counter pharmaceuticals poses a major burden on both private and public health expenditures. To seek evidence on whether over-the-counter medication dispensing behavior complies or conflicts with the protocols indicated in practice standards and guidelines of a national professional pharmacy organization. This quality improvement study was undertaken in 205 pharmacies in the wider Brisbane, Australia, area. Two standardized patient (SP) scenarios were developed to evaluate noncompliant behavior. Data collection for scenario 1 was conducted between November 23 and December 9, 2016. Data collection for scenario 2 was conducted between September 1 and 28, 2017. A 2-sample test of proportions and a probit regression model were used to evaluate the likelihood of noncompliant treatments and overtreatments in each case scenario. Statistical analysis was performed from January 30 to June 21, 2018, and revised in May 2019. Outcomes were the observed likelihood of noncompliant treatments and overtreatments. Noncompliance is defined as treatments not complying with practice standards and guidelines set by the professional pharmacy society. Noncompliant treatments include undertreatment (patient did not receive necessary treatment) and overtreatments (patient was supplied with more than sufficient treatments) in both scenarios. In scenario 1, 9 trained female SPs visited 89 pharmacies to request emergency hormonal contraception from pharmacy staff. In 45 cases, SPs reported having unprotected intercourse within the last 24 hours (case 1A), and in 44 cases, SPs reported having unprotected intercourse more than 72 hours ago (case 1B), which is past the efficacy threshold of over-the-counter emergency hormonal contraception. In scenario 2, 11 SPs (5 male and 6 female) visited 150 pharmacies (154 visits in total) to request treatment for family members or a partner with symptoms indicating bacterial conjunctivitis (case 2A; n = 73) or viral conjunctivitis (case 2B; n = 81). In scenario 1-dispensing emergency hormonal contraception when physician referral is recommended-21 of 44 pharmacists (47.7%) in case 1B violated the recommendation by selling the over-the-counter medication. With the inclusion of both no physician referral and emergency hormonal contraception sold, this rate increased to 79.5% (35 of 44 pharmacists). In scenario 2-1 case each of bacterial and viral conjunctivitis-overtreatment occurred in 55 of 154 cases (35.7%). In both scenarios, 140 of 243 pharmacies (57.6%) followed dispensing behavior compliant with the protocol, while 76 of 243 pharmacies (31.3%) involved some form of overtreatment or overselling of medication. Some evidence of an association between sex of SP and pharmacist was also found. Although the market for dispensing over-the-counter medication in Australia is regulated, relatively high rates of overtreatment and some cases of undertreatment were observed in this study. Given the unintended adverse effects, including overuse of antibiotics and corticosteroids, these observations suggest the advisability of regulatory intervention ensuring compliance with professional protocols.

Moral distress among community pharmacists: causes and achievable remedies.

This study aims to explore the incidence of moral distress experienced by UK community pharmacists through the deployment of a previously developed and validated survey instrument to a national sample. An e-mail inviting pharmacists to complete an on-line questionnaire developed to measure moral distress was successfully delivered via the mailing list of a nationwide support organisation for the pharmacy profession. Completed questionnaires were subjected to statistical analysis to determine to what extent common practice scenarios generated moral distress in community pharmacists. Time constraints represent the greatest source of moral distress for United Kingdom (UK) community pharmacists, scoring highest for both frequency and intensity of distress. The supply of emergency hormonal contraception (EHC) in opposition to religious beliefs scored lowest. Possible underlying causes of moral distress are discussed in the light of our results, and potential mechanisms for reducing the incidence of moral distress for this professional group are considered. The reduction in the frequency and occurrence of moral distress is best achieved by the creation of morally habitable workplaces, where possible triggers can be identified and avoided. Structured undergraduate ethics education and accessible postgraduate training and resources could provide a meaningful opportunity to support pharmacists in exercising their moral competency or moral agency. Moral distress provides a reliable indicator of constraints in the form of policies, legislation and regulations, and the structural and relational aspects of the working environment in which pharmacists practise. This provides invaluable information in the search for strategies to reduce the recurrence of this phenomenon.

The use of emergency hormonal contraception in South Africa: current and future perspectives

Emergency hormonal contraceptives play an important role in preventing unplanned pregnancies in South Africa. In this review, we discuss the levonorgestrel emergency contraceptive, the combined estrogen and progestin regimen (also known as the Yuzpe method) and the use of Ulipristal acetate. The levonorgestrel and the combined estrogen, progestin regimen are available in South Africa. The specific mechanisms of action of each of these emergency hormonal contraceptives will be discussed as well as their efficacy, the side effects associated with each of these preparations and the drug interactions. Levonorgestrel can be used as a single dose (1.5 mg) instead of two doses (0.75 mg) 12 hours apart. Levonorgestrel is very effective, with fewer adverse effects than the combined estrogen and progestogen administration. Levonorgestrel and the Yuzpe method have demonstrated good efficacy when utilised within 72 hours after unprotected intercourse or contraceptive failure. These emergency hormonal contraceptives should not be used as regular contraception. It is essential that all health professionals and educators inform women of reproductive age about the risks and common side effects of emergency hormonal contraceptives.