Pharmacists play a key role in providing emergency contraceptive pills

Pharmacists are front line health care providers around the world. For many people they are the first point of contact with the health system. Emergency contraceptive pills are available without a prescription directly from pharmacists in most European countries, making pharmacists key EC providers in these settings.1

 

HRA-Paharmacie-Situations-368 (1280x853)

The OTC availability of emergency contraceptive pills is critical to increase access and minimise delay of intake. This is especially significant given that emergency contraceptive pills are more effective the sooner they are taken after unprotected intercourse.

When a woman must visit a doctor or other appropriate healthcare provider before she can get an ECP, she often has to make two trips:

• One to a clinic to obtain a prescription

• A second to a pharmacist to fill the prescription

This presents a significant barrier for many women, especially those who do not have transport, or who live in rural areas, without easy access to doctors or pharmacies. Having to make two trips before she can obtain an emergency contraceptive pill causes a delay in intake. In addition, the need for a prescription makes access to ECPs on weekends and at night (when many contraceptive mishaps occur) more difficult.

 

Pharmacists offer advantages in terms of location, convenience and opening times.2 OTC availability of ECPs means that women only have to make one trip. This means women can get oral emergency contraception within 24 hours of unprotected intercourse, when treatment is known to be most effective.2 Women may also like the anonymity of the pharmacy as they can feel embarrassed about needing emergency contraception.3

An International Pharmaceutical Federation (FIP) paper on the pharmacists’ role in improving maternal, newborn, and child health highlights the benefits of pharmacy ECP involvement:4

• When women obtain ECP from a pharmacy instead of a physician or clinic, there are cost-savings for both private and public payers4

• Pharmacists promote dialogue on contraceptive alternatives and influence the beliefs and the outcomes through effective counselling on ECPs. The supply of emergency contraception from pharmacies can be accompanied by patient education from pharmacists, who have expertise on this topic4

• Pharmacists provide information to patients at the time of ECP dispensing, which allows women to understand proper use of this medicine. Pharmacists ensure consistency of information about ECPs, in particular for women less than 16 years of age4

Pharmacy access to ECPs has not led to any negative consequences

When EC is available through pharmacies without a prescription, the use of the medication increases compared to when it is available from doctors, clinics or hospitals.4 Increased access to EC through pharmacies does not have a negative impact on the use of other forms of contraception.4

Studies show that women and adolescents with greater access to EC are more likely to adopt an ongoing contraceptive method after EC use 9. Notably, it has been shown that greater level of use through non-prescription availability:

Does not lead to increased rates of STIs6

Does not increase sexual risk-taking behaviour in adolescents7,8

Does not lead to increased frequency of unprotected sex5

Does not lead to decreased use of other contraceptive methods5

Does not lead to decreased use of contraception, including the most effective methods such as hormonal methods, and including condoms5,8

• Women’s EC experience is actually a motivating factor leading to more consistent use of regular contraception5

14.Web contraceptive use change

 Good Pharmacy Practice can include :

• Asking the right questions; avoiding unnecessary, personal or intrusive questioning
• Providing quality advice in a sensitive way, without lecturing
• Providing an environment where women feel comfortable and not judged

 

The quality of the pharmacy interaction is an important determinant of proper use, leading to fewer unwanted pregnancies and appropriate use of the product. It is also likely to be an important factor in a woman’s decision to take action in the event of a future UPSI.

 

References
1.International consortium for EC. Available at www.cecinfo.org. Accessed October 2013.
2.Taylor B. Journal of Family Planning and Reproductive Health Care 2003: 29(2): 7.
3.HRA data on file. Hamell research, Pharmacists’ recommending behaviour in emergency contraception. April 2013.
4.International Pharmaceutical Federation (FIP): FIP reference paper on the effective utilization of pharmacists in improving maternal, newborn and child health (MNCH) 2011. Available at http://www.fip.org/www/uploads/database_file.php?id=325&table_id=. Accessed October 2013
5.Polis et al. The Cochrane Library 2013, Issue 7.
6.Walker et al. J Adolesc Health 2004; 35(4): 329-34.
7.Raine TR et al. JAMA 2005; 293: 54–62.
8.Moreau C et al. 2009. Am J Public Health 2009; 99: 441–442.
9.Gainer E et al. Contraception 2003; 68(2): 117-24.
10.Good Pharmacy Practice. Joint FIP/WHO Guidelines on GPP: Standards for quality services 2012. Available at: http://www.fip.org/www/uploads/database_file.php?id=331&table_id=. Accessed October 2013.