Prescribe Emergency Contraception Research Articles

Forensic Nurses' Understanding of Emergency Contraception Mechanisms: Implications for Access to Emergency Contraception.

An estimated 25,000 pregnancies result from sexual assault in the United States annually. Numerous professional healthcare organizations endorse offering emergency contraception (EC) as an integrated aspect of post-sexual-assault care. Lack of knowledge surrounding EC's mechanism of action, including misinterpreting ECs as abortifacients, might restrict patient access to this important healthcare option. We evaluated sexual assault nurse examiners' understanding of the mechanism of action of oral ECs levonorgestrel (LNG) and ulipristal acetate (UPA). A cross-sectional survey of practicing sexual assault nurse examiners was conducted through the International Association of Forensic Nurses. Among 173 respondents, 96.53% reported they prescribed/dispensed EC at the time of medical forensic examinations. LNG was prescribed more frequently than UPA (57.80% vs. 38.2%, respectively). When asked if they agreed or disagreed if LNG and UPA can disrupt an established pregnancy, 83.2% selected disagree/strongly disagree for LNG versus 78.6% for UPA, which were not significantly different. When asked whether the Supreme Court ruling overturning Roe v. Wade would change their EC prescribing, 79.77% reported it will have no change, 6.94% said it would increase, and 12.72% reported they were unsure. Several commented they were concerned whether state laws would prohibit EC and at least one program stopped prescribing EC because of their state laws. Addressing misinformation regarding EC's mechanism of action and increasing access to oral EC options after sexual assault have the potential to reduce the incidence of rape-related pregnancy.

Oral Emergency Contraception Provision in the Veterans Health Administration: a Retrospective Cohort Study

ABSTRACTBackgroundIn the USA, oral emergency contraception (EC) use to prevent unintended pregnancy is increasing. Oral EC methods include levonorgestrel (LNG) and ulipristal acetate (UPA), with increased UPA efficacy over LNG in high BMI users and those beyond 3 days post intercourse. The Veterans Health Administration (VHA) provides oral EC at low or no cost, yet prescription-level Veteran data are lacking.ObjectiveTo describe oral EC provision in VHA, including method type and Veteran user and prescriber characteristics.DesignA retrospective cohort study using VHA administrative data.ParticipantsAll VHA oral EC prescriptions from January 1, 2016, to December 31, 2020.Main MeasuresWe linked Veteran-level sociodemographic and military characteristics and provider-level data with each prescription to identify variables associated with oral EC method.Key ResultsA total of 4280 EC prescriptions (85% LNG) occurred for 3120 unique Veterans over 5 years. While prescriptions remained low annually, the proportion of UPA prescriptions increased from 12 to 19%. Compared to LNG users, UPA users were older (34% vs 25% over age 35 years, p <0.001); more likely to identify as white (57% vs 46%) and non-Hispanic (84% vs 79%) (p <0.001); and more likely to have a BMI ≥ 25 (76% vs 67%, p <0.001). UPA prescriptions originated most frequently from VA Medical Centers (87%) and women’s health clinics (76%) compared to community-based or other clinic types. In multivariable regression models, race, ethnicity, BMI ≥30, and prescriber facility type of a VA Medical Center or a women’s clinic location were predictive of UPA prescription.ConclusionsOral EC provision in VHA remains low, but UPA use is increasing. LNG prescription occurs frequently in high BMI Veterans who would benefit from increased efficacy of UPA. Interventions to expand oral EC access in VHA are essential to ensure Veterans’ ability to avert unwanted pregnancies.

Conscientious Objection to Emergency Contraception

Conscientious Objection to Emergency Contraception

Barriers and facilitators for pharmacists prescribing emergency contraception under statewide protocol

AbstractBackgroundPharmacists can prescribe levonorgestrel and ulipristal acetate emergency contraception (EC) under statewide protocol in California. The objective of this study was to determine barriers and facilitators for pharmacists prescribing EC.MethodsFor this qualitative study, we conducted semi‐structured individual interviews with 18 pharmacists and pharmacy technicians practicing in pharmacies across California. We operationalized the Practical, Robust Implementation and Sustainability Model (PRISM) implementation science framework to develop the interview guide and inform the thematic analysis. The interview questions explored barriers and facilitators to implementation of pharmacist prescribing of EC.ResultsSeveral themes emerged around barriers and facilitators to service implementation in the PRISM domains of Intervention, External Environment, Implementation and Sustainability Infrastructure, and Recipients. Though participants had experience with over‐the‐counter sales of levonorgestrel EC, they had limited experience prescribing EC and with ulipristal acetate. Reported barriers include difficulty incorporating an additional service into workload without payment or additional human resources, lack of patient demand possibly due to absence of public awareness, lack of physician prescribing of EC, management approval required, and being unaware of the protocol. Participating pharmacists reported being motivated to prescribe EC to benefit patients and provide clinical services. Other reported facilitators included support from their local communities, opportunities created by the statewide protocol, training opportunities, pharmacy team‐based care, and providing patient‐centered care.ConclusionsMultilevel contextual barriers and facilitators exist to implementing pharmacist prescribing of EC that could be addressed in a multicomponent implementation intervention. These findings may help guide implementation strategies, thus increasing patient access to EC.

Direct Pharmacist Prescribing of Emergency Contraception: Findings of an Academic Detailing Intervention Pilot Study

Purpose. This exploratory study tested the effectiveness of an academic detailing (AD) intervention for improving pharmacist emergency contraception (EC) practices compared to a handout intervention in a state where pharmacists can prescribe EC using a statewide protocol. AD is a peer educational outreach designed to encourage evidence-based practices that improve patient outcomes and healthcare costs.Methods. In this pilot randomized controlled trial, four community pharmacies in San Diego County, California, received an AD intervention or a control handout intervention regarding pharmacist prescribing of EC. The AD intervention group received a one-hour training from an expert pharmacist regarding EC prescribing and an informational EC handout, while the handout intervention group received only the handout. Participants completed a survey assessing EC practices, knowledge, and attitudes before and after the interventions. Phone interviews were performed one month following the interventions.Results. Participants in the AD intervention group demonstrated greater knowledge of clinical considerations for prescribing ulipristal acetate (UPA) EC and California statewide protocols for pharmacist prescribing of EC compared to the handout intervention. Participants in the AD intervention were also more likely to have begun prescribing EC following the intervention compared to those in the handout intervention, which was observed in both quantitative and qualitative results.Conclusions. Increased prescribing rates in the AD intervention group highlight the utility of AD for implementation of pharmacist services. Training that focuses on the clinical considerations for the EC products and statewide protocol for pharmacists’ prescribing of EC could lead to increased community access to EC in pharmacies and more accurate counseling by pharmacists.

Does anticipatory prescribing of emergency contraception reduce the rate of unintended pregnancy?

Evidence-Based Practice: December 2021 - Volume 24 - Issue 12 - p 12-13 doi: 10.1097/EBP.0000000000001321

Medications at the Emergency Department After Recent Rape.

Rape is associated with myriad negative physical and mental health effects, yet little is known about medical prescribing following rape-related emergency room visits. The goal of this study was to examine factors associated with medications prescribed the same day as a sexual assault medical forensic examination (SAMFE). A total of 939 medical records (93.9% female) of a medical university in the Southeastern United States between July 1, 2014, and May 15, 2019, were paired with Sexual Assault Nurse Exam records. Demographic and assault characteristics were examined as correlates of medications prescribed at the emergency department within the same day of a SAMFE. All individuals were offered medications within the national guidelines. Intimate partner violence (IPV) was negatively associated with antibiotic prescriptions and with emergency contraception prescriptions. Genital injury and male gender of victim were positively associated with antiviral prescriptions. Non-genital injury was positively associated with both over-the-counter and prescription pain medication prescriptions. Report of strangulation was positively associated with accepting over-the-counter but not prescription pain medication. IPV and strangulation were positively associated with psychotropic prescriptions. Although specific medications were offered to individuals during the SAMFE, demographic and assault characteristics were associated with medication acceptability.

Epidemiological, Clinical Aspects and Treatment of Victims of Sexual Abuse in the Gynecology and Obstetrics Department of Pikine National Hospital in 183 Cases

Introduction: Sexual abuse or sexual assault is part of violence against women, as is physical violence, female genital mutilation and forced marriage. According to the Criminal Code, this is any sexual offense committed with violence, coercion, threat or surprise on the person of others. It is a criminal act punishable by the laws in force in almost every country in the world. Study Objectives: 1) draw up an epidemiological profile of female victims of sexual abuse; 2) develop the treatment protocol. Methodology: This is a 7-year descriptive retrospective study from January 1, 2010 to December 31, 2016 at the Center Hospitalier National de Pikine (Dakar). Included in this study were all of the patients admitted during our investigation period who were the victims of suspected or certain sexual abuse, with or without requisition. For each case, the following parameters were studied: the epidemiological characteristics (age, gestation, parity and place of residence), the circumstances of the attack (time and place), the characteristics of the aggressor (age, link with the victim, number of aggressor), the type of sexual contact, the possible lesions found during the physical examination (genital and extra-genital), the mode of admission, the delay of the consultation, the attitude after the sexual abuse, the gynecological and obstetrical status of the victim, the repercussions and psychological follow-up, the paraclinical assessment, the treatments administered. Data were collected using a survey form and analyzed with SPSS software. Results: During the study period, 183 victims of sexual abuse were received and treated at the level of our structure out of a total of 39,760 patients, representing a frequency of 0.46%. The age of the victims varied between 2 and 36 years with an average of 13 years. The 11 to 15 age group was the most represented. Students were the most represented among victims of sexual abuse (87.4%). Workers represented 9.3% of the victims. Infants made up 3.3% of the victims; the average age of the alleged attackers was 31 when they were known to their victim. Half of the victims (50.3%) were in the pre-pubertal stage. Among those who were in genital activity (91 cases or 49.7%), 16 cases of pregnancy were reported; which represented 8.7% of cases. Only 20.2% of victims had genital trauma. Prescription of emergency contraception was carried out for 47% of the victims who were in genital activity. After the clinical examination, 17% of the victims had received antibiotic prophylaxis. Conclusion: Sexual abuse is currently a real socio-cultural drama. Preventing them involves raising public awareness. Their management must be early and adapted in order to prevent sexually transmitted infections and psychological consequences.

Emergency Contraception.

Despite significant declines over the past 2 decades, the United States continues to experience birth rates among teenagers that are significantly higher than other high-income nations. Use of emergency contraception (EC) within 120 hours after unprotected or underprotected intercourse can reduce the risk of pregnancy. Emergency contraceptive methods include oral medications labeled and dedicated for use as EC by the US Food and Drug Administration (ulipristal and levonorgestrel), the "off-label" use of combined oral contraceptives, and insertion of a copper intrauterine device. Indications for the use of EC include intercourse without use of contraception; condom breakage or slippage; missed or late doses of contraceptives, including the oral contraceptive pill, contraceptive patch, contraceptive ring, and injectable contraception; vomiting after use of oral contraceptives; and sexual assault. Our aim in this updated policy statement is to (1) educate pediatricians and other physicians on available emergency contraceptive methods; (2) provide current data on the safety, efficacy, and use of EC in teenagers; and (3) encourage routine counseling and advance EC prescription as 1 public health strategy to reduce teenaged pregnancy.

Emergency contraception: Links between providers' counseling choices, prescribing behaviors, and sociopolitical context

Healthcare decisions depend on the characteristics of patients and providers. However, how these decisions are influenced by provider interpretations of biological processes and the sociopolitical context in which they work remains unclear. To answer these questions, we explore providers' prescribing of emergency contraception (EC), methods that can prevent pregnancy after sex has already occurred. Despite the consensus mainstream medical definition that pregnancy begins after a fertilized egg implants in the uterus, an alternative perspective holds that pregnancy instead begins when a sperm fertilizes an egg. How providers define pregnancy may affect their willingness to prescribe EC. However, the ability of providers to recommend treatments consistent with their understandings of medical processes may depend on the sociopolitical context in which the patient-provider interaction occurs. We test whether EC prescribing practices vary by providers' definition of pregnancy and the interaction of this definition with the sociopolitical context in which they practice. Data from U.S. medical providers were collected as part of a survey on EC knowledge and practices (N = 1308). We merged voting results from the county in which the provider practices to data on provider EC prescribing and pregnancy counseling practices. Because recent Republican party platforms have explicitly endorsed a definition of pregnancy that begins at fertilization and party advocacy frequently uses this definition, we use the county vote share for the Republican presidential candidate as a contextual measure of views that pregnancy begins at fertilization. We find a significant interaction such that providers who counsel that pregnancy begins at fertilization are significantly less likely to prescribe EC if they practice in counties with higher Republican vote shares. Our results highlight that patient access to EC may depend on both place of residence and provider views and that providers' EC prescribing may depend jointly on their understanding of pregnancy and sociopolitical context.

Exploring emergency contraception prescribing by pharmacists in California,

ObjectiveTo understand knowledge, current practices, barriers and facilitators for pharmacists prescribing emergency contraception (EC). Study DesignWe conducted a cross-sectional survey among California community pharmacists. We distributed the online survey, consisting of 34 close-ended questions, to members of the California Pharmacists Association via its email listserve. ResultsWe collected a survey response rate of 7%. Although 95% of respondents were aware of the statewide protocol allowing pharmacists to prescribe EC, only 36% of respondents reported prescribing EC in the previous year. Prescribing practices within the past year differed by type of pharmacy. We found no correlation between EC knowledge and prescribing practices. The most frequently reported facilitators of EC prescribing by pharmacists were the statewide protocol, a continuing education training program, and patient need or demand for EC. The most reported barriers to prescribing EC were lack of payment for pharmacist patient care services by insurers, increased responsibility or liability concerns, and time constraints. When asked about their intention to prescribe in the upcoming year, responses differed based on whether or not their pharmacies currently stocked EC. ConclusionThis exploratory study identifies key facilitators, such as the statewide protocol, and key barriers, such as lack of payment by insurance companies for pharmacist services. ImplicationsThe findings of this study could guide future multi-component implementation strategies such as academic detailing that specifically address concerns about increased responsibility, liability and time constraints. In addition, payment for pharmacist services could be addressed at a policy level since this was a barrier to pharmacist EC prescribing.

44. Conscientious Objection By Primary Care Trainee And Faculty Physicians In An Appalachian Health Care System

Refusal to provide medically appropriate care due to strongly held religious or moral beliefs, often called “conscientious objection,” is controversial. The refusal impacts reproductive health and care for gender minorities. This can be particularly restrictive for adolescents and young adults who may have limited access to care, and where the balance of power in the physician-patient relationship may be more pronounced. This study aimed to characterize primary care physicians’ objections to medically appropriate care in a single academic medical center and identify if these objections were associated with religiosity or level of training. A 17-question survey, partially based on preexisting instruments, was distributed to the resident and faculty physicians practicing in primary care at an academic institution in Appalachia providing care to a rural and medically underserved population. An investigator-designed religiosity score was calculated using six questions about religious beliefs and practices. Descriptive statistics were calculated to characterize the sample; χ2 and Fisher exact tests assessed for differences in religious objections to specific types of medical care by religious beliefs and training level. A total of 119 physicians participated in the survey (50% trainees). Half were female and the majority identified their training as internal medicine (45%) or pediatrics (23%). The majority identified as being Catholic, Christian, or Protestant, (29%, 22%, 11%, respectively), while 18% indicated having no religious affiliation. Most (66%) identified as white. Using the calculated religiosity score, 42% were “highly religious,” 37% were “moderately religious,” and 21% were “minimally religious.” Compared to 0% of the “minimally” or “moderately” religious participants, 17% of those who were “highly religious” had an objection to prescribing emergency contraception to adults (p<.01) and adolescents (with and without parental knowledge p<.01, respectively). One in five of “highly religious” participants objected to prescribing cross sex hormones to transgender adults (p=0.01) and transgender adolescents (p<.01) compared to 0-2% objection from “minimally” and “moderately” religious participants. Being classified as “highly religious” was also associated with objecting to all presented scenarios for abortion (including <20 weeks gestation, following sexual assault, and in a minor with parental notification) (all p<0.0001). Significantly more trainees than faculty physicians were undecided about telling patients upon establishing care if they had religious or moral objections to medically indicated treatments (24% versus 5%, p=0.03), and to not feel obligated to explain their objections (58% versus 30%, p=0.01). Most physicians felt they had an obligation to present all options for treatment (96%) and to refer to a colleague willing to provide treatments to which they objected (95%). This study suggests a strong link between personal religiosity and conscientious objection in clinical practice. Nearly all study participants felt there was an ethical obligation to present all options and refer to another willing provider; this proportion was slightly larger than previous studies. The prevalence of conscientious objection continues to be of concern, particularly in rural and medically underserved areas where adolescents, young adults, and others with limited access may be denied medically appropriate care due to lack of willing providers.

Prevalence, Attitudes, and Factors Motivating Conscientious Objection toward Reproductive Health among Medical Students.

We have evaluated the prevalence of and the motivating factors behind the refusal to provide reproductive health services and the ethical knowledge of the subject among medical students from the Escola Bahiana de Medicina e Saúde Pública, in the state of Bahia, Brazil. The present cross-sectional study involved 120 medical students. A questionnaire was utilized. The dependent variables were students' objections (or not) regarding three clinical reproductive health cases: abortion provided by law, contraceptive guidance to an adolescent without parental consent, and prescription of emergency contraception. The independent variables were age, gender, religion, ethical value, degree of religiosity, and attendance at worship services. Ethical knowledge comprised an obligation to state the reasons for the objection, report possible alternatives, and referral to another professional. Data were analyzed with χ2 tests and t-tests with a significance level of 5%. Abortion, contraception to adolescents, and emergency contraception were refused by 35.8%, 17.5%, and 5.8% of the students, respectively. High religiosity (p < 0.001) and higher attendance at worship services (p = 0.034) were predictors of refusing abortion. Refusal to provide contraception to adolescents was significantly higher among women than men (p = 0.037). Furthermore, 25% would not explain the reason for the refusal, 15% would not describe all the procedures used, and 25% would not refer the patient to another professional. Abortion provided by law was the most objectionable situation. The motivating factors for this refusal were high commitment and religiosity. A reasonable portion of the students did not demonstrate ethical knowledge about the subject.

Military Family Physicians' Practices and Perceptions About Reproductive Health Services for Deploying Women.

Incomplete or inadequate provision of contraceptive services to servicewomen can have a profound impact on military health, readiness, and financial outcomes. This study examined the reproductive health practices and perceptions among family medicine physicians caring for servicewomen. We conducted an anonymous survey of 568 registered attendees at the March, 2018 Uniformed Services Academy of Family Physicians annual meeting. The response rate was 52.8% and 69% of responders met inclusion criteria. Our sample of family medicine physicians was 58.3% male and 85.3% Caucasian. In all, 18.3% were current residents, 42.9% graduated between 2008 and 2017, and 38.7% graduated before 2008. A previous deployment was reported by 55.1%.Among physicians with a deployment history, 20.8% reported difficulty prescribing contraception during deployment because they were unable to obtain a patient's desired method, 2.6% reported servicewomen not accessing contraception because of fear and stigma associated with sexual activity in the deployed setting, and 22.1% reported problems with both factors.Among physicians performing pre-deployment and other readiness visits for active duty servicewomen, 17.4% reported not discussing contraception at these encounters because of competing priorities and 1.5% because of ethical/religious concerns. Physicians who could offer more rapid access to subdermal implants (within 2 weeks) were more likely to discuss contraception (87.0% versus 64.7%, p = 0.005).When discussing the use of contraception in the deployed environment, 15.8% of physicians would not prescribe oral contraceptives, 12.3% would not prescribe intrauterine methods, and 14.3% would not prescribe subdermal implants. Physicians who previously deployed were more likely to report they would offer oral contraceptives (91% versus 75.0%, OR 3.4 [95% CI 1.44-8.48], p = 0.002) for women in the deployed setting compared to those who have not deployed. More timely (<2 weeks) access to subdermal implant insertion was associated with a greater rate of offering subdermal implants (91.9% versus 79.6%, p = 0.02).When discussing contraceptive options with all women, 27.3% of physicians do not prescribe emergency contraception because of training, ethical, and/or religious reasons. Some reported they would neither prescribe nor refer women for the following methods: emergency contraception (4.5%), intrauterine contraception (9.3%), and subdermal implants (7.3%). The results of this study support the need to develop a consistent, standardized, and evidence-based pre-deployment process and expanded resources in deployed environments for services related to the provision of reproductive health. Optimal strategies may aim to reduce barriers to care and enable the highest quality of health care through provider education, resource allocation, revised appointment times and content, and diversity among provider experience. Further research is needed to determine the influence of physician practice patterns on patient reproductive health outcomes and interventions to modify these practices to improve patient outcomes and military readiness.

The politics of place: Presidential voting patterns and providers' prescription of emergency contraception

ObjectiveThe most effective forms of emergency contraception (EC) require a prescription or a medical procedure; therefore, provider willingness to offer EC remains critical to patient access. This study seeks to assess whether political alignment of a provider's county is associated with provider attitudes and behaviors regarding EC. Study designWe analyzed survey data collected from 1313 healthcare providers from February 2013 to April 2014 at 14 academic medical centers in the United States. Using logistic regression, we estimated associations between the county political alignment of a provider's practice and his or her EC-related beliefs and practices: 1) if the provider is aware of the most effective EC methods; 2) if knowing that a hypothetical EC method prevented implantation would make a provider less likely to prescribe that method because of personal ethical or religious reasons; and 3) if the provider prescribes any form of EC in his or her practice. ResultsIn multivariate models, a one percentage-point increase in county Republican vote share was associated with a 2.9% decrease in the odds of a provider prescribing EC, after accounting for provider knowledge and attitudes about EC. ConclusionsEC provides a critical last chance to prevent pregnancy after unprotected sex, yet women living in Republican-leaning counties may face difficulty obtaining EC from healthcare providers. Programs seeking to improve access to EC should focus on areas likely to have fewer providers willing to prescribe EC, which may be those that are more Republican-leaning. ImplicationsThe most effective forms of emergency contraception require a prescription or a medical procedure; therefore, provider willingness to offer EC remains critical to patient access. Women living in Republican-leaning counties may face difficulty obtaining emergency contraception from healthcare providers.

Emergency contraception in adolescents. A grey area in Italian legislation

Objective: To explore Italian legislation and the social climate regarding the issue of emergency contraception (EC) in adolescents.Results: In recent years, in Italy, we have seen changes in the law and in attitudes towards EC. Since 2016, EC has been approved for sale as a non-prescription drug to women over the age of 18. However, the requirement for a prescription is still in force for women under 18. This raises questions such as the minor’s ability to consent to family planning services to prevent pregnancy, and whether physicians require parental consent before providing an EC prescription to minors. This article explores these issues within the social and legislative context of adolescent reproductive health care, demonstrating a need for EC among Italian adolescents.Conclusion: Making EC difficult for minors to access seems to respond to a political stance that clashes with existing social needs and with medical evidence that shows that EC is safe and reliable for use in adolescents, and that the increased use of EC has no negative effects on regular, ongoing contraceptive use or encourages risky sexual behaviour. Future interventions by Italian policy-makers should target these themes in order to make EC easily available to adolescents throughout the country.

Seeking ways in improving promotion and provision of emergency contraception in Addis Ababa Hospitals

AbstractObjective: To assess attitudes of physicians working in Addis Ababa government hospitals towards routine counseling andadvance prescription of emergency contraception (EC).Methods: A cross sectional descriptive study on attitudes of physicians towards routine counseling and advance prescription ofEC was performed on 445 physicians working in Addis Ababa public hospitals. A standardized questionnaire which assessedknowledge, attitudes and practices (KAP) on EC provision and routine counseling and advance prescription of EC were administeredamong participants.Results: Out of the total 445 physicians, there was an overall response rate of 86.1%. Only 55.3% participants received a verygood and good knowledge score. Physicians of gynecological and obstetrics department were more knowledgeable than others(p&lt; .0001.). Attitudes of physicians were favorable (64%) towards EC. Being a member of gynecological and obstetrics departmentshowed a very good knowledge score, and past counseling and prescribing EC had favorable attitudes. The majority 72.4%(240) have never prescribed EC. Physicians who ever counseled and prescribed EC before the survey were more likely to have avery good knowledge score (181 p &lt; 0.0001), favorable attitudes (176 p&lt; .001) and past prescribing (124 p &lt; 0.15) than others.The majority of the respondents 316 (83.6%) agreed on the role of routine counseling and advance prescription supply ofEC, in provision, promotion and information dissemination, and among them 68.8%, were willing to prescribe EC in the future.More than 90% had some concerns like it might encourage repeated use. Eighty four percent mentioned mass media,printed materials, women organization and telephone including text messages and involvement of male partners as better optionsfor EC advocacy, information dissemination, and provision.Conclusion: Attitudes of physicians on EC was favorable but knowledge and practices of EC were very low. Strategy to increaseits access through routine counseling and advance prescription supply to all women is taken not only positively but alsomajority of them are willing to offer EC in advance by prescription and addressed the need of information on EC for providersand clients. Improving KAP on EC is crucial and physicians need to be provided with accurate and up to date informationthrough comprehensive training and updates on EC.Keywords: Emergency contraception, KAP, physicians, contraception.

Contraception Initiation in the Emergency Department: A Pilot Study on Providers' Knowledge, Attitudes, and Practices.

Almost half of all pregnancies in the United States are unintended; these pregnancies are associated with adverse outcomes. Many reproductive-age females seek care in the emergency department (ED), are at risk of pregnancy, and are amenable to contraceptive services in this setting. Through a pilot study, we sought to assess ED providers' current practices; attitudes; and knowledge of emergency contraception (EC) and nonemergency contraception (non-EC), as well as barriers with respect to contraception initiation. ED physicians and associate providers in Georgia were e-mailed a link to an anonymous Internet questionnaire using state professional databases and contacts. The questionnaire included Likert scales with multiple-choice questions to assess study objectives. Descriptive statistics were generated as well as univariate analyses using χ(2) and Fisher exact tests. A total of 1232 providers were e-mailed, with 119 questionnaires completed. Participants were predominantly physicians (80%), men (59%), and individuals younger than 45 years (59%). Common practices were referrals (96%), EC prescriptions (77%), and non-EC prescriptions (40%). Common barriers were perceived as low likelihood for follow-up (63%), risk of complications (58%), and adverse effects (51%). More than 70% of participants correctly identified the highly effective contraceptive methods, 3% identified the correct maximum EC initiation time, and 42% correctly recognized pregnancy as a higher risk than hormonal contraception use for pulmonary embolism. Most ED providers in this pilot study referred patients for contraception; however, there was no universal contraceptive counseling and management. Many ED providers in this study had an incorrect understanding of the efficacy, risks, and eligibility associated with contraceptive methods. This lack of understanding may affect patient access and be a barrier to patient care.

Emergency Contraception: Two Steps Forward, One Step Back.

Emergency contraceptives can prevent pregnancy, when used after unprotected sex around the time of ovulation. In the past 15 years, access to emergency contraception (EC) in the United States has increased and more women use it. Emerging data may tailor EC prescribing based on patient weight and starting other contraception. There are several EC options-oral levonorgestrel and oral ulipristal acetate and the copper intrauterine device. Ideally, women should have EC access at low or no cost. Yet, several barriers-limited patient and provider knowledge about EC, cost, EC stocking practices, and state and federal laws exempting providers from supplying EC-make it difficult to integrate this time-sensitive treatment into women's reproductive health care.

Brief Behavioral Intervention to Improve Adolescent Sexual Health: A Feasibility Study in the Emergency Department.

Although emergency department (ED) visits offer an opportunity to deliver brief behavioral interventions to improve health, provision of ED-based interventions targeting adolescent sexual health is uncommon. The objectives for this study were to evaluate the feasibility and preliminary effects of a novel sexual health service intervention for adolescents. In this cross-sectional feasibility study, sexually active patients aged 14 to 19 years presenting to a Midwestern pediatric ED were recruited to receive an intervention to improve sexual health. The intervention, based on motivational interviewing (MI), included agenda setting, exploration of behaviors, a decisional balance exercise, tailored feedback, and provision of personalized health services (including condoms, prescription for emergency contraception, urine testing for Chlamydia trachomatis and Neisseria gonorrheae, and referral to the hospital-affiliated adolescent clinic). Data were collected before and after intervention administration and at a 3-month follow-up telephone interview. Surveys assessed sexual risk behaviors, satisfaction with the intervention, health care use, and demographics. Feasibility criteria were (1) subject-rated interventionist fidelity to MI principles (Likert scale 1 [strongly agree] to 4 [strongly disagree]), (2) subject satisfaction (Likert scale 1 [not at all] to 5 [very]), and (3) session duration (minutes, recorded by the interventionist). A secondary outcome was the proportion of subjects who completed at least 1 health service. Services provided at the adolescent clinic were determined by an electronic medical record review. Comparisons of responses between sex subgroups were analyzed using Χ test. From August to November 2012, 69 adolescents were approached, 66 (96%) completed the screening survey, and 24 (37%) reported previous sexual activity. Of those, 20 (83%) agreed to participate. The mean (SD) age was 16.2 (1.4) years; 60% were female. Most (78%) reported that the interventionist maintained high fidelity to MI principles and most (80%) were very satisfied with the intervention. Mean (SD) intervention length was 15.7 (2.2) minutes. Most subjects (65%) accepted 1 or more health services, including 42% who completed clinic follow-up. In the ED or the referral clinic, the following services were provided to the subjects: condoms (n = 11), emergency contraception prescription (n = 5), C. trachomatis/N. gonorrheae testing (n = 4), hormonal birth control provision (n = 2), and human immunodeficiency virus testing (n = 3). Fifteen subjects (75%) were reached for the 3-month follow-up, and condom use was maintained by 67% of those reporting sexual activity. This study demonstrated the feasibility and potential utility of an MI-based service navigation intervention to connect youth with point-of-care services as well as resources for ongoing sexual health needs.