Prescribe Emergency Contraception Research Articles

Acceptance and use of emergency contraception with standardized counseling intervention: results of a randomized controlled trial

Objective The objective of this work was to evaluate the acceptance, use and recall of an optional advance prescription for emergency contraception (EC). Materials and methods This study used as randomized controlled trial evaluating contraceptive counseling intervention with women aged 16–44 years who were at risk for unintended pregnancy ( N=737). Intervention participants ( n=365) received contraceptive counseling with optional advance EC prescription. Control women ( n=372) received no contraceptive or EC counseling. Among intervention participants, initial acceptance and use of EC in first 2 months were evaluated. Among all participants, differences were evaluated between recall of EC discussion and use of EC. Results Among 365 intervention women, 336 received EC counseling and 51% of these 336 accepted advance EC prescription. At 2 months, among the women who had accepted EC, 6% had filled and used their prescription and 8% had filled but not used their prescription. At 12 months, intervention women were significantly more likely than controls to recall talking about EC (33% vs. 5%) and obtaining a prescription (38% vs. 6%), but there were no differences in the use of EC (6% vs. 6%). Conclusion When the option is available for EC counseling, approximately half of women accepted advance prescription for EC. However, few women who received information and/or an advance prescription remembered discussing EC, filled the prescription or used EC over 12 months.

Access to emergency contraception

The introduction of emergency contraception (EC) has encountered barriers derived from the erroneous perception of EC as an abortificient and conservative attitudes. In several countries, “prolife” groups have initiated lawsuits against national regulatory bodies for approving EC. Other barriers are limited availability and high price of dedicated products, lack of information among providers about EC and the requirement of medical prescription for EC. The availability of EC has increased in the last years due to efforts of multiple stakeholders. Facilitating factors include the acceptability of EC by users and providers; dissemination of information about EC; advocacy among policymakers; training of providers; registration of dedicated products; over the counter sales and inclusion of EC in the national norms. By 2005, 109 countries have registered around 50 dedicated products that are available in public services, pharmacies, NGOs or through social marketing and 45 countries have included EC in their national norms.

An intervention to increase primary care physicians' emergency contraception knowledge, attitudes and prescribing practices at a teaching practice

Little is known about physician prescription of emergency contraception (EC). Our objective was to determine whether an educational and reminder intervention would improve EC knowledge, attitudes and prescribing behavior among primary care residents and faculty.

Emergency contraception: Knowledge and perceptions in a university population

The purpose of this study was to examine knowledge, attitudes, and behaviors regarding emergency contraception (EC) in university men and women aged 18-21. Data sources included responses to a 25-item questionnaire and an 8-item demographic survey completed anonymously at a public site on campus. Ninety-seven university students participated in the study. Participants were asked to respond to questions relating to knowledge, attitudes, and behaviors regarding EC, perceived worthiness, objections, sources of information about EC, preferred birth-control method and usage, and perceptions of their personal risk of unintended pregnancy. Many respondents considered unintended pregnancy to be a major problem and considered EC a worthy option in the event of method failure or unprotected intercourse. While most participants were aware that there was a postcoital method of contraception, confusion existed between EC and RU-486 (the abortion pill). Almost half (49.5%) believed that EC was the same as RU-486. There was an association between advanced prescription for EC and its likelihood of use. Most women would be significantly more likely to use EC if they had a prescription on hand. Of the women who were less likely to choose EC, 100% indicated they would feel embarrassed or judged when asking for it. Only 34% of those women who have had a gynecological exam in the past 12 months had discussed EC with their provider. Advanced practice nurses need to incorporate EC into preventive health counseling for both men and women. Providing women with an advanced prescription increases the likelihood that women will use EC.

Using the Theory of Reasoned Action to Explain Physician Intention to Prescribe Emergency Contraception

Using the Theory of Reasoned Action to Explain Physician Intention to Prescribe Emergency Contraception

Using the Theory of Reasoned Action to Explain Physician Intention to Prescribe Emergency Contraception

CONTEXT:: Although research has examined providers' knowledge, attitudes and prescribing behaviors with regard to emergency contraception, none has used a theory‐based approach to understanding the interplay of these factors.METHODS:: A cross‐sectional survey of 96 faculty physicians from one Southern and three Midwestern universities was conducted in 2004 to assess factors associated with intention to prescribe emergency contraception. The theory of reasoned action guided the study hypotheses and survey design. Correlation and regression analyses were used to examine the data.RESULTS:: Only 42% of respondents strongly intended to prescribe emergency contraception for teenagers, but 65–77% intended to do so for all other specified groups (women who ask for the method, who have had a method problem, who have experienced rape or incest, and who have had unprotected sex). Consistent with the theory of reasoned action, high intention to prescribe emergency contraception was associated with positive attitudes toward doing so and with the perception that specific colleagues or professional groups support prescribing it; however, the perception of support by colleagues or professional groups in general did not predict intention. Also consistent with the theory, physicians' knowledge about emergency contraception and their demographic characteristics were not significant.CONCLUSIONS:: Interventions to encourage physicians to provide emergency contraception should take into account their attitudes toward the method and the components of those attitudes.

New Mexico Pharmacists' Knowledge, Attitudes, and Beliefs Toward Prescribing Oral Emergency Contraception

To describe New Mexico pharmacists' knowledge, attitudes, and beliefs toward the prescribing of oral emergency contraception (EC) in their practices. Cross-sectional study. New Mexico in January through March 2004. POTENTIAL PARTICIPANTS: New Mexico pharmacists. Questionnaire containing 74 items. Mean scores were calculated for individual knowledge items, overall knowledge scores, and attitude/belief items. Knowledge and attitude/belief scores were compared across demographic variables using t tests, ANOVA, and chi-square analyses. Of 1392 deliverable questionnaires, 555 (40%) were returned and 523 (38%) were usable; 136 contained written comments. Pharmacists had overall knowledge scores of 71.2% +/- 11.3%. Pharmacists who had participated in a state-approved EC prescribing training program and had time in their practice setting to prescribe EC had significantly higher knowledge scores. Mean scores indicated that pharmacists have positive attitudes and beliefs toward prescribing EC. Overall, 40% of respondents indicated that they would like to become certified to prescribe EC. Pharmacists who agreed that they would like to be certified to prescribe EC were significantly more likely to be male, non-Hispanic, non-Christian, to have liberal or moderate political views, and to indicate that they had employer/manager approval, time, and privacy in their practice setting to prescribe EC. New Mexico pharmacists have positive attitudes/beliefs toward EC prescribing; however, their knowledge in this area is average. Although religious, moral, and political views influence pharmacists' willingness to prescribe EC, factors such as education and practice environment must be addressed if more pharmacists are to accept this EC prescriptive authority.

Canadian pediatric residents’ experience and level of comfort with adolescent gynecological health care

To examine residents’ comfort and confidence with adolescent gynecological skills, senior Canadian pediatric residents were surveyed. The majority of residents had not prescribed emergency contraception or provided options counseling to adolescents during their residency, and were uncomfortable with gynecological skills (68%, 75%, and 58%, respectively). Senior Canadian pediatric residents are uncomfortable and feel inadequately prepared in providing routine gynecological care to adolescents.

Dispensing with Liberty: Conscientious Refusal and the "Morning-After Pill"

Citing grounds of conscience, pharmacists are increasingly refusing to fill prescriptions for emergency contraception, or the "morning-after pill." Whether correctly or not, these pharmacists believe that emergency contraception either constitutes the destruction of post-conception human life, or poses a significant risk of such destruction. We argue that the liberty of conscientious refusal grounds a strong moral claim, one that cannot be defeated solely by consideration of the interests of those seeking medication. We examine, and find lacking, five arguments for requiring pharmacists to fill prescriptions. However, we argue that in their professional context, pharmacists benefit from liberty restrictions on those seeking medication. What would otherwise amount to very strong claims can be defeated if they rest on some prior restriction of the liberty of others. We conclude that the issue of what policy should require pharmacists to do must be settled by way of a theory of second best. Asking "What is second best?" rather than "What is best?" offers a way to navigate the liberty restrictions that may be fixed obstacles to optimality.

The Emergency Contraception Online Learning Module

Kaiser Permanente (KP) has been on the forefront of educating providers and members about emergency contraception (EC) since 1996, even before a dedicated product was available. EC is up to 89% effective and is exceedingly safe for all women at risk for an unintended pregnancy. Despite awareness efforts, EC has remained underutilized. Recognizing this fact, recommendations were made by a California-wide EC Task Force to increase prophylactic prescribing by all providers who care for women of childbearing age, especially those who are exposed to teratogenic medications and chronic conditions that negatively impact pregnancy. KP Northern California Regional Women's Health—in cooperation with Multimedia, Pharmacy and Analytical Services (PAS)—and Physician Education—developed the Emergency Contraception [Online] Learning Module. The module is approved for one CME and consists of an 18-minute video: Emergency Contraception, Not Just an Ob/Gyn Issue and a 19-slide PowerPoint presentation entitled: Emergency Contraception, You Can Make a Difference, a pretest, a posttest, and a brief evaluation of the teaching tool. The EC Learning module can be accessed by going through the Northern California Women's Health KP Intranet site: http://insidekp.kp.org/california/womenshealth. The EC Learning Module can be accessed by going through the Northern California Women's Health KP Intranet site: http://insidekp.kp.org/california/womenshealth. On the front page is a link to the hosting site: PAS (Figure 1). The focus of the module is on the evidence that supports prophylactic prescribing of EC by all primary and specialty care providers who care for women and also discusses safety, efficacy, and prescribing issues. Several case studies are included. Figure 1 Emergency Contraception link on KP Northern California Women's Health Intranet site. Women's Health has received mostly positive feedback about the EC Learning Module through online evaluations and e-mail communications. As of August 2004, more than 250 providers have participated in this online CME program. Out of the 250 responding to the evaluation, 63% were “very satisfied,” and an additional 32% reported “satisfied.” When asked if they would be likely to view another online Women's Health video module, 93% reported they would and 90% reported they would be likely to use the materials presented this way as a reference. Providers from all KP Regions have accessed the EC Learning Module, the greatest percentage have come from both Northern and Southern California. So many providers and pharmacists from Southern California have accessed the site too that SCPMG Physician Education chose to accredit the program. Two hundred pharmacists from KP Orange County plan to use the module to satisfy state requirements for direct prescribing via collaborative treatment agreements with the Ob/Gyn physicians. This strategy will result in faster screening and dispensing of EC for Orange County KP members. PAS streamlined the CME certification system to allow for providers and pharmacists to download their own CME certificate. CME records are also maintained with respective regional physician education departments. We invite you to take a look at the module for important information about EC and how it pertains to your practice. The EC Learning Module has been accredited by Northern California Physician Education until October 29, 2006. Women's Health believes the success of the EC [Online] Learning Module stems from effective marketing and cooperation from all departments that participated in its development. Look for more Women's Health online CME education projects in the future.

Cervical cancer screening continues to limit provision of contraception

Purpose Balancing needs for contraception and cervical cancer screening is challenging for clinicians. We assessed US obstetrician/gynecologists' practices regarding requirement of Pap testing before prescribing oral contraceptive or emergency contraceptive pills. Methods Questionnaires structured as clinical vignettes describing women desiring contraception with different risks of cervical dysplasia were mailed to a national sample of 355 obstetrician/gynecologists. Results A minority (3%) of the 185 obstetrician/gynecologists who responded would refill 12 months of oral contraceptives without requiring Pap testing. However, most would provide a limited supply of oral contraceptives until Pap testing could be performed. A substantial proportion (11–16%) would refuse to prescribe emergency contraception to women who they felt required Pap testing. Younger physicians, those practicing in academic settings and those who follow American Cancer Society guidelines were more willing to prescribe contraceptives without Pap testing. Conclusions Cervical cancer screening continues to limit prescription of routine and emergency contraception by many US obstetrician/gynecologists.

Emergency Contraception in Emergency Departments in Oregon, 2003

We sought to learn about access to emergency contraception (EC) in Oregon emergency departments, both for women who are rape patients and for women who have had consensual unprotected sexual intercourse ("nonrape patients"). We interviewed emergency department staff in 54 of Oregon's 57 licensed emergency departments in February-March 2003 (response rate = 94.7%). Only 61.1% of Oregon emergency departments routinely offered EC to rape patients. Catholic hospitals were as likely as non-Catholic hospitals to routinely offer EC to rape patients. The hospitals most likely to routinely offer EC to rape patients had a written protocol for the care of rape patients that included offering EC (P = .02) and access to staff with specialized sexual assault training (P=.002). For nonrape patients, 46.3% of emergency departments discouraged the prescribing of EC. Catholic hospitals were significantly less likely than non-Catholic hospitals to provide access to EC for nonrape patients (P=.05). Oregon emergency departments do not routinely offer EC to women who have been raped or to women who have had consensual unprotected sexual intercourse.

Enquête prospective sur la délivrance de la contraception d'urgence dans les centres de planification et d'éducation familiale du Val-de-Marne

To describe emergency contraception provision, including the efficacy of the method, in family planning centers in suburban Paris two years after the method became available without a prescription. A prospective study involving two questionnaires was conducted between September 2001 and July 2002 in 27 family planning centers in the Val-de-Marne region. The first questionnaire was completed at the time emergency contraception was dispensed and the second one upon a follow-up visit. Efficacy was calculated for both perfect use (only one act of unprotected intercourse in the current menstrual cycle, emergency contraception treatment initiated within 72 hours) and typical use (including multiple acts of unprotected intercourse in the cycle and/or treatment initiated after 72 hours). A total of 519 requests for emergency contraception was recorded, resulting in the provision of 518 treatments. The women requesting emergency contraception were young (96% under the age of 25) and cited unprotected intercourse and problems with condom use as the main reasons for the request. Information regarding the outcome of emergency contraception treatment was available in 77% of the cases, and a failure rate of 1.9% was observed with perfect use and 2.7% with typical use. This prospective study of emergency contraception prescription in family planning centers confirms data on the efficacy and safety of the method observed in similar environments. The failure rate associated with typical use is higher than that observed with perfect use.

Are Women Able to Fill Their Emergency Contraception Prescription?

Are Women Able to Fill Their Emergency Contraception Prescription?

Pediatric residents’ knowledge, attitudes and opinions about emergency contraception

To examine the knowledge, attitudes and opinions of pediatric residents regarding the use of emergency contraception in adolescents and compare these findings to a similar study conducted by Golden, et al. in 2001. In this study, it was found that the practicing pediatricians in NY Chapter 2 District II of the American Academy of Pediatrics were being confronted with the decision to prescribe emergency contraception but felt uncomfortable to prescribe it due to inexperience with its use and inadequate training.

The Limits of Conscientious Objection — May Pharmacists Refuse to Fill Prescriptions for Emergency Contraception?

Several reports have detailed cases in which pharmacists have refused to fill prescriptions for emergency contraception. Should pharmacists have the right to refuse access to these medications? This Sounding Board article discusses arguments for and against the right to refuse and proposes a balanced solution to the problem.

The visit before the morning after: barriers to preprescribing emergency contraception.

Research suggests that while advance prescription of emergency contraception (EC) increases women's access, this prescribing model is rarely used. The present study sought to explore attitudes towards EC among patients and physicians, with the goal of understanding potential barriers to advance prescription. Qualitative, semistructured interviews were conducted with patients and clinicians in a New York City family practice clinic. Using qualitative interviews, we found that attitudes towards EC among patients and clinicians are complex. Both groups of participants reported favorable attitudes towards EC. There was general agreement that physicians should take a proactive role in educating patients about the method. A notable minority in each group described substantial reservations, however, especially regarding the potential for EC abuse. Such attitudes emerged mainly in the context of discussions about advance prescription. Advance prescription was viewed as greatly facilitating access to EC, but some patients and clinicians feared that ready access would encourage irresponsible sex. Some participants condoned the occasional, accidental, or emergency use of EC; however, habitual use, or the plan not to plan for sex, was viewed as morally indefensible. Findings suggest that even when attitudes towards EC are generally favorable, some physicians and patients have substantial reservations about advance prescription. Education and dialogue are needed to overcome these reservations.

Emergency contraception: prescribing practices of general internists compared with other primary care physicians

Primary care physicians of all specialties should be familiar with prescribing emergency contraception (EC). We conducted a mail survey of 282 randomly sampled physicians in general internal medicine (31%), family medicine (34%) and obstetrics-gynecology (35%). Experience with prescribing EC significantly differed by specialty (63% of general internists, 76% of family physicians, and 94% of obstetrician-gynecologists, p < 0.0001). Controlling for year of graduation, gender, religion and practice location, family physicians [adjusted odds ratio (OR): 2.5, 95% confidence interval (CI): 1.2–5.2] and obstetrician-gynecologists (adjusted OR: 11.2, 95% CI: 4.0–31.3) were still significantly more likely to have ever prescribed EC than general internists. Efforts to increase awareness and knowledge of EC should be aimed at general internists since they provide primary care for many reproductive age women.

Observational study on the use of emergency contraception in Spain: results of a national survey

The Consensus Statement on Emergency Contraception recommends the collection of data within each country in order to facilitate the use of emergency contraception; this has led us to design a prospective observational study with a view to identifying the reality in Spain regarding emergency contraception. We have conducted a national observational study including 4390 cases of requests for the prescription of emergency contraception in the entire Spanish territory, collected by means of a questionnaire completed by the person prescribing the emergency contraception between April and December 2002. The mean age of the women requesting emergency contraception was 23 years, with 35.1% of these being adolescents and 71% of them under the age of 24 years. Of the applicants, 40% reported that they were students and 31.8% were working. The educational level of studies was medium or higher. Emergency contraception had previously been used by 19.8% of the women and, of these, 75% used it on a single occasion. The main reason put forward for requesting emergency contraception was condom breakage (68.7%), followed by the failure to use any contraceptive measures whatsoever (15.4%). The Spanish women requesting emergency contraception are young students and resort to this method on one occasion.

Pharmacy Provision of Emergency Contraception: The Ontario Emergency Contraception Pilot Project

Objectives: To develop and evaluate a program to provide emergency contraception (EC) directly in pharmacies that would recruit and train pharmacists and physician partners, and inform women about the availability of EC in pharmacies.Methods: Pharmacists and physicians working in the Scarborough, Rexdale, and North York regions of Toronto were recruited to receive a training program on EC. The pharmacists in each pharmacy were linked with a designated physician who retrospectively authorized prescriptions provided under the protocol. Client eligibility for EC was determined using a self-administered questionnaire that was reviewed by the pharmacist. A poster and radio campaign advertised the service, and a telephone hotline informed users of their nearest participating pharmacy. Data on the client’s age, reasons for requesting EC, time elapsed from intercourse until presentation, and requests for follow-up referral were analyzed using descriptive methodology. User satisfaction was determined through a mail-back questionnaire.Results: A total of 146 pharmacists practising in 40 pharmacies were linked with 34 physicians. In the I year of the project, 6931 prescriptions for EC were provided. Fifty-four percent of the women accessed EC within 24 hours of intercourse. The majority of women were very satisfied with the service, and 21.1% indicated that had they not obtained EC in this way, they would not have obtained it elsewhere. More information about birth control was desired by 10.2% of the women.Conclusion: Direct pharmacist provision of EC is an effective pregnancy-prevention strategy that is well accepted by the women who access it.