1
|
Nelson HD, Cantor A, Jungbauer RM, Eden KB, Darney B, Ahrens K, Burgess A, Atchison C, Goueth R, Fu R. Effectiveness and Harms of Contraceptive Counseling and Provision Interventions for Women : A Systematic Review and Meta-analysis. Ann Intern Med 2022; 175:980-993. [PMID: 35605239 PMCID: PMC10185303 DOI: 10.7326/m21-4380] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The effectiveness and harms of contraceptive counseling and provision interventions are unclear. PURPOSE To evaluate evidence of the effectiveness of contraceptive counseling and provision interventions for women to increase use of contraceptives and reduce unintended pregnancy, as well as evidence of their potential harms. DATA SOURCES English-language searches of Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, SocINDEX, and MEDLINE (1 January 2000 to 3 February 2022) and reference lists of key studies and systematic reviews. STUDY SELECTION Randomized controlled trials of interventions providing enhanced contraceptive counseling, contraceptives, or both versus usual care or an active control. DATA EXTRACTION Dual extraction and quality assessment of studies; results combined using a profile likelihood random-effects model. DATA SYNTHESIS A total of 38 trials (43 articles [25 472 participants]) met inclusion criteria. Contraceptive use was higher with various counseling interventions (risk ratio [RR], 1.39 [95% CI, 1.16 to 1.72]; I 2 = 85.3%; 10 trials), provision of emergency contraception in advance of use (RR, 2.12 [CI, 1.79 to 2.36]; I 2 = 0.0%; 8 trials), and counseling or provision postpartum (RR, 1.15 [CI, 1.01 to 1.52]; I 2 = 6.6%; 5 trials) or at the time of abortion (RR, 1.19 [CI, 1.09 to 1.32]; I 2 = 0.0%; 5 trials) than with usual care or active controls in multiple clinical settings. Pregnancy rates were generally lower with interventions, although most trials were underpowered and did not distinguish pregnancy intention. Interventions did not increase risk for sexually transmitted infections (STIs) (RR, 1.05 [CI, 0.87 to 1.25]; I 2 = 0.0%; 5 trials) or reduce condom use (RR, 1.03 [CI, 0.94 to 1.13]; I 2 = 0.0%; 6 trials). LIMITATION Interventions varied; few trials were adequately designed to determine unintended pregnancy outcomes. CONCLUSION Contraceptive counseling and provision interventions that provide services beyond usual care increase contraceptive use without increasing STIs or reducing condom use. Contraceptive care in clinical practice could be improved by implementing enhanced contraceptive counseling, provision, and follow-up; providing emergency contraception in advance; and delivering contraceptive services immediately postpartum or at the time of abortion. PRIMARY FUNDING SOURCE Resources Legacy Fund. (PROSPERO: CRD42020192981).
Collapse
Affiliation(s)
- Heidi D Nelson
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California (H.D.N.)
| | - Amy Cantor
- Oregon Health & Science University, Portland, Oregon (A.C., R.M.J., K.B.E., C.A., R.G., R.F.)
| | - Rebecca M Jungbauer
- Oregon Health & Science University, Portland, Oregon (A.C., R.M.J., K.B.E., C.A., R.G., R.F.)
| | - Karen B Eden
- Oregon Health & Science University, Portland, Oregon (A.C., R.M.J., K.B.E., C.A., R.G., R.F.)
| | - Blair Darney
- Oregon Health & Science University and Portland State University School of Public Health, Portland, Oregon, and Instituto Nacional de Salud Pública, Centro de Investigación en Salud Poblacional, Cuernavaca, México (B.D.)
| | - Katherine Ahrens
- University of Southern Maine Muskie School of Public Service, Portland, Maine (K.A., A.B.)
| | - Amanda Burgess
- University of Southern Maine Muskie School of Public Service, Portland, Maine (K.A., A.B.)
| | - Chandler Atchison
- Oregon Health & Science University, Portland, Oregon (A.C., R.M.J., K.B.E., C.A., R.G., R.F.)
| | - Rose Goueth
- Oregon Health & Science University, Portland, Oregon (A.C., R.M.J., K.B.E., C.A., R.G., R.F.)
| | - Rongwei Fu
- Oregon Health & Science University, Portland, Oregon (A.C., R.M.J., K.B.E., C.A., R.G., R.F.)
| |
Collapse
|
2
|
Elfeky A, Treweek S, Hannes K, Bruhn H, Fraser C, Gillies K. Using qualitative methods in pilot and feasibility trials to inform recruitment and retention processes in full-scale randomised trials: a qualitative evidence synthesis. BMJ Open 2022; 12:e055521. [PMID: 35437247 PMCID: PMC9016401 DOI: 10.1136/bmjopen-2021-055521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 03/28/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES To systematically review published pretrial qualitative research studies and explore how their findings were used to inform recruitment and retention processes in full-scale trials. DESIGN Qualitative evidence synthesis using thematic analysis. DATA SOURCES AND ELIGIBILITY CRITERIA We conducted a comprehensive search of databases; Dissertation Abstracts International, CINAHL, Embase, MEDLINE, Sociological Abstracts and PsycINFO. We included all reports of pretrial qualitative data on recruitment and retention in clinical trials up to March 2018. DATA EXTRACTION AND SYNTHESIS Two authors independently extracted data using a predefined data extraction form that captured study aims, design, methodological approach and main findings, including barriers and facilitators to recruitment and or retention. The synthesis was undertaken using Thomas and Harden's thematic synthesis method and reported following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines. Confidence was assessed using Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research approach. RESULTS Thirty-five papers (connected to 31 feasibility studies) from three different countries, published between 2010 and 2017 were included. All studies were embedded in pilot or feasibility studies to inform design aspects in preparation for a subsequent full-scale trial. Twelve themes were identified as recruitment barriers and three as recruitment facilitators. Two themes were identified as barriers for retention and none as retention facilitators. The findings from qualitative research in feasibility or pilot trials are often not explicitly linked to proposed changes to the recruitment and retention strategies to be used in the future or planned full-scale trial. CONCLUSIONS Many trial teams do pretrial qualitative work with the aim of improving recruitment and retention in future full-scale trials. Just over half of all reports of such work do not clearly show how their findings will change the recruitment and retention strategy of the future trial. The scope of pretrial work needs to expand beyond looking for problems and also look for what might help and spend more time on retention.
Collapse
Affiliation(s)
- Adel Elfeky
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Karin Hannes
- Research Group SoMeTHin'K, Faculty of Social Sciences, KU Leuven, Leuven, Belgium
| | - Hanne Bruhn
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
3
|
Chofakian CBDN, Viana OA, Divino EDA, Borges ALV. [Contraceptive dynamics before and after the use of emergency contraception: contraceptive discontinuities and bridging]. CAD SAUDE PUBLICA 2021; 37:e00055221. [PMID: 34909927 DOI: 10.1590/0102-311x00055221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/18/2021] [Indexed: 11/22/2022] Open
Abstract
The study's objectives were to estimate the occurrence of bridging, that is, the degree to which women that had not been using contraceptive methods began to use them in the month following the use of emergency contraception, and to estimate the rates of contraceptive discontinuity before and after the use of emergency contraception. Data collection occurred through a retrospective daily history on the use of methods in the 30 days before and after the use of emergency contraception, with 2,051 users of primary health care units in São Paulo, Aracaju (Sergipe), and Cuiabá (Mato Grosso), Brazil. The study's results showed that on average, women began their use of the method 7.6 days (SD = 2.4) after the use of emergency contraception, and that discontinuity occurred 17.1 days (SD = 7.0) after its use. Most of the women used the method continuously 30 days before (44.4%) and 30 days after (65.7%) emergency contraception. Only 8.1% of the women who had not been using the method before emergency contraception used it afterwards (bridging). Age 35 years or older (OR = 1.8; 95%CI: 1.4-2.6) was associated with the use of contraceptive methods after the use of emergency contraception among women who had not been using methods before. Residence in Aracaju (OR = 0.7; 95%CI: 0.4-0.9) showed an inverse association. In conclusion, a negligible portion of women who had not been using contraceptive methods before emergency contraception began using them afterwards (bridging).
Collapse
|
4
|
Navarrete J, Yuksel N, Schindel TJ, Hughes CA. Sexual and reproductive health services provided by community pharmacists: a scoping review. BMJ Open 2021; 11:e047034. [PMID: 34312200 PMCID: PMC8314704 DOI: 10.1136/bmjopen-2020-047034] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Pharmacists are increasingly providing patient-focused services in community pharmacies, including in the area of sexual and reproductive health (SRH). Specific SRH areas have been the focus of research, but a broader perspective is needed to position pharmacists as SRH providers. This review explored research that described and evaluated professional pharmacy services across a broad range of SRH areas. DESIGN Scoping review DATA SOURCES: Medline, EMBASE, CINAHL, Web of Science, Scopus and Cochrane Library (January 2007-July 2020). STUDY SELECTION Studies reporting on the description and evaluation of professional pharmacy SRH services provided by community pharmacists. DATA EXTRACTION Two investigators screened studies for eligibility, and one investigator extracted the data. Data were analysed to primarily describe professional pharmacy services and intervention outcomes. RESULTS Forty-one studies were included. The main SRH areas and professional pharmacy services reported were sexually transmitted and bloodborne infections (63%) and screening (39%), respectively. Findings showed that pharmacists' delivery of SRH services was feasible, able to reach vulnerable and high-risk groups, and interventions were highly accepted and valued by users. However, integration into daily workflow, pharmacist remuneration, cost and reimbursement for patients, and policy regulations were some of the barriers identified to implementing SRH services. Studies were primarily in specific areas such as chlamydia screening or hormonal contraception prescribing, while studies in other areas (ie, medical abortion provision, long-acting reversible contraception prescribing and vaccine delivery in pregnant women) were lacking. CONCLUSION This scoping review highlights the expansion of pharmacists' roles beyond traditional product-focused services in a number of SRH areas. Given the potential feasibility, users' acceptability and reach, pharmacists are ideally situated to enhance SRH care access. Future research describing implementation and evaluation of professional pharmacy services in all SRH areas is needed to promote access to these services through community pharmacies and position pharmacists as SRH providers worldwide.
Collapse
Affiliation(s)
- Javiera Navarrete
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Nese Yuksel
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Theresa J Schindel
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Christine A Hughes
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
5
|
Cameron ST, Glasier A, McDaid L, Radley A, Patterson S, Baraitser P, Stephenson J, Gilson R, Battison C, Cowle K, Vadiveloo T, Johnstone A, Morelli A, Goulao B, Forrest M, McDonald A, Norrie J. Provision of the progestogen-only pill by community pharmacies as bridging contraception for women receiving emergency contraception: the Bridge-it RCT. Health Technol Assess 2021; 25:1-92. [PMID: 33949940 DOI: 10.3310/hta25270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Unless women start effective contraception after using emergency contraception, they remain at risk of unintended pregnancy. Most women in the UK obtain emergency contraception from community pharmacies that are unable to provide ongoing contraception (apart from barrier methods which have high failure rates). This means that women need an appointment with a general practitioner or at a sexual and reproductive health clinic. We conducted a pragmatic cluster randomised cohort crossover trial to determine whether or not pharmacist provision of a bridging supply of a progestogen-only pill plus the invitation to attend a sexual and reproductive health clinic resulted in increased subsequent use of effective contraception (hormonal or intrauterine). METHODS Twenty-nine pharmacies in three UK cities recruited women receiving emergency contraception (levonorgestrel). In the intervention, women received a 3-month supply of the progestogen-only pill (75 µg of desogestrel) plus a card that provided rapid access to a local sexual and reproductive health clinic. In the control arm, pharmacists advised women to attend their usual contraceptive provider. The primary outcome was reported use of an effective contraception (hormonal and intrauterine methods) at 4 months. Process evaluation was also conducted to inform any future implementation. RESULTS The study took place December 2017 and June 2019 and recruited 636 women to the intervention (n = 316) and control groups (n = 320). There were no statistically significant differences in demographic characteristics between the groups. Four-month follow-up data were available for 406 participants: 63% (198/315) of the control group and 65% (208/318) of the intervention group. The proportion of participants reporting use of effective contraception was 20.1% greater (95% confidence interval 5.2% to 35.0%) in the intervention group (58.4%, 95% confidence interval 48.6% to 68.2%) than in the control group (40.5%, 95% confidence interval 29.7% to 51.3%) (adjusted for recruitment period, treatment arm and centre; p = 0.011). The proportion of women using effective contraception remained statistically significantly larger, when adjusted for age, current sexual relationship and history of past use of effective contraception, and was robust to the missing data. There were no serious adverse events. CONCLUSION Provision of a bridging supply of the progestogen-only pill with emergency contraception from a pharmacist and the invitation to a sexual and reproductive health clinic resulted in a significant increase in self-reported subsequent use of effective contraception. This simple intervention has the potential to prevent more unintended pregnancies for women after emergency contraception. TRIAL REGISTRATION Current Controlled Trials ISRCTN70616901. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 27. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Sharon T Cameron
- Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK.,Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
| | - Anna Glasier
- Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
| | - Lisa McDaid
- Institute for Social Science Research, The University of Queensland, Brisbane, QLD, Australia.,Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Andrew Radley
- Directorate of Public Health, NHS Tayside, Dundee, UK.,Division of Cardiovascular Medicines and Diabetes, Ninewells Hospital and Medical School, Dundee, UK
| | - Susan Patterson
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Paula Baraitser
- Department of Sexual Health, King's College Hospital NHS Foundation Trust, London, UK
| | - Judith Stephenson
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, UK
| | - Claire Battison
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Anne Johnstone
- Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
| | - Alessandra Morelli
- Department of Sexual Health, King's College Hospital NHS Foundation Trust, London, UK
| | - Beatriz Goulao
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Mark Forrest
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Alison McDonald
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
6
|
Pharmacy-based initiatives to reduce unintended pregnancies: A scoping review. Res Social Adm Pharm 2021; 17:1673-1684. [PMID: 33582078 DOI: 10.1016/j.sapharm.2021.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/30/2021] [Accepted: 01/31/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Community pharmacy contraception services are thought to improve access, with the potential to reduce the persistent sexual and reproductive health inequities observed globally. OBJECTIVES We aimed to identify the range of pharmacy-based initiatives addressing unintended pregnancy in the primary literature and examine their feasibility, acceptability and effectiveness. METHOD Using the Joanna Briggs Institute Methodology for Scoping Reviews, we searched seven bibliographic databases using combinations of keywords and subject headings for related to contraception and community pharmacy. Studies of any design undertaken in high income countries for reproductive-aged women were eligible provided they evaluated intervention or legislation after the implementation of these initiatives. Included articles were critically appraised and findings summarised narratively. RESULTS We identified 49 articles, 80% of which involved pharmacist supply of emergency contraception (EC), 14% of regular contraception methods, and 6% involved adjuncts of EC dispensing: counselling (2%) and bridging initiatives to link clients with regular contraception (4%). EC initiatives were perceived as feasible and were facilitated by interdisciplinary partnerships but there are persistent barriers to the provision of initiatives congruous with the retail pharmacy setting. Furthermore, consumers may be reluctant to receive contraceptive counselling from pharmacists but often value the convenience and anonymity pharmacy services offer. Overall, interventions improved access to contraceptive products but did not consistently reduce inequities, and the health benefits of pharmacy initiatives are either small (EC) or lacking description in the literature (other contraceptive methods and contraceptive counselling). CONCLUSIONS Pharmacy initiatives may not negate all barriers to access or reduce unintended pregnancy rates, however they are valued by pharmacists and consumers. Evidence gaps including the lack of description of health outcomes of regular contraception provision, contraceptive counselling and the perceived barriers and facilitators of access and provision from end-user perspectives, should be pursued in future research, to establish initiatives' utility and effectiveness.
Collapse
|
7
|
Cameron ST, Glasier A, McDaid L, Radley A, Baraitser P, Stephenson J, Gilson R, Battison C, Cowle K, Forrest M, Goulao B, Johnstone A, Morelli A, Patterson S, McDonald A, Vadiveloo T, Norrie J. Use of effective contraception following provision of the progestogen-only pill for women presenting to community pharmacies for emergency contraception (Bridge-It): a pragmatic cluster-randomised crossover trial. Lancet 2020; 396:1585-1594. [PMID: 33189179 PMCID: PMC7661838 DOI: 10.1016/s0140-6736(20)31785-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/01/2020] [Accepted: 08/13/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Unless women start effective contraception after oral emergency contraception, they remain at risk of unintended pregnancy. Most women in the UK obtain emergency contraception from community pharmacies. We hypothesised that pharmacist provision of the progestogen-only pill as a bridging interim method of contraception with emergency contraception plus an invitation to a sexual and reproductive health clinic, in which all methods of contraception are available, would result in increased subsequent use of effective contraception. METHODS We did a pragmatic cluster-randomised crossover trial in 29 UK pharmacies among women receiving levonorgestrel emergency contraception. Women aged 16 years or older, not already using hormonal contraception, not on medication that could interfere with the progestogen-only pill, and willing to give contact details for follow-up were invited to participate. In the intervention group, women received a 3-month supply of the progestogen-only pill (75 μg desogestrel) plus a rapid access card to a participating sexual and reproductive health clinic. In the control group, pharmacists advised women to attend their usual contraceptive provider. The order in which each pharmacy provided the intervention or control was randomly assigned using a computer software algorithm. The primary outcome was the use of effective contraception (hormonal or intrauterine) at 4 months. This study is registered, ISRCTN70616901 (complete). FINDINGS Between Dec 19, 2017, and June 26, 2019, 636 women were recruited to the intervention group (316 [49·6%], mean age 22·7 years [SD 5·7]) or the control group (320 [50·3%], 22·6 years [5·1]). Three women (one in the intervention group and two in the control group) were excluded after randomisation. 4-month follow-up data were available for 406 (64%) participants, 25 were lost to follow-up, and two participants no longer wanted to participate in the study. The proportion of women using effective contraception was 20·1% greater (95% CI 5·2-35·0) in the intervention group (mean 58·4%, 48·6-68·2), than in the control group (mean 40·5%, 29·7-51·3 [adjusted for recruitment period, treatment group, and centre]; p=0·011).The difference remained significant after adjusting for age, current sexual relationship, and history of effective contraception use, and was robust to the effect of missing data (assuming missingness at random). No serious adverse events occurred. INTERPRETATION Provision of a supply of the progestogen-only pill with emergency contraception from a community pharmacist, along with an invitation to a sexual and reproductive health clinic, results in a clinically meaningful increase in subsequent use of effective contraception. Widely implemented, this practice could prevent unintended pregnancies after use of emergency contraception. FUNDING National Institute for Health Research (Health Technology Assessment Programme project 15/113/01).
Collapse
Affiliation(s)
- Sharon T Cameron
- Department of Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK; Chalmers Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK.
| | - Anna Glasier
- Department of Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
| | - Lisa McDaid
- Institute for Social Science Research, The University of Queensland, Brisbane, QLD, Australia; MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Andrew Radley
- Directorate of Public Health, NHS Tayside, Dundee, UK; Division of Cardiovascular Medicines and Diabetes, Ninewells Hospital and Medical School, Dundee, UK
| | - Paula Baraitser
- Department of Sexual Health, King's College Hospital NHS Foundation Trust, London, UK
| | - Judith Stephenson
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, UK
| | - Claire Battison
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Mark Forrest
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Beatriz Goulao
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Anne Johnstone
- Department of Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
| | - Alessandra Morelli
- Department of Sexual Health, King's College Hospital NHS Foundation Trust, London, UK
| | - Susan Patterson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Alison McDonald
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - John Norrie
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
8
|
Pearce E, Jolly K. Emergency Oral Contraceptive Consultations in Pharmacies in a Rural Setting: An Epidemiological Analysis. J Pharm Pract 2020; 35:256-262. [PMID: 32990131 PMCID: PMC9087313 DOI: 10.1177/0897190020961698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Emergency contraception has been available in pharmacies across England since 2001.There is a paucity of evidence describing those women accessing the service, particularly in rural locations, where pharmacies are integral to improving healthcare accessibility. METHODS Routinely collected data from all pharmacy consultations for emergency contraception in Shropshire, England, were obtained and anonymized for the study period April 1, 2016 to January 31, 2019. Consultations were described by time, age of consultee, rationale for consultation, method dispensed (levonorgestrel or ulipristal acetate), referral for copper intrauterine device fitting, chlamydia screening where appropriate and reason for choosing pharmacy setting. Repeat attenders were also described separately. RESULTS 3499 consultations occurred during the study period; 39% were aged between 16-20 years, and 52% attended following unprotected sexual intercourse. Levonorgestrel was initially most prescribed, however ulipristal acetate overtook it in 2018. Onward referral for copper intrauterine device and age-appropriate chlamydia screening took place in 3% and 4% of the eligible populations respectively. Women overwhelmingly chose the pharmacy setting owing to its convenience. Repeat attenders tended to be younger than single attenders, but otherwise similar. CONCLUSION Pharmacy-based emergency contraception is an important and well-utilized service in this rural location and continued funding and possible service expansion should be considered.
Collapse
Affiliation(s)
- Emma Pearce
- Murray Learning Centre, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Murray Learning Centre, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
9
|
Steed L, Sohanpal R, Todd A, Madurasinghe VW, Rivas C, Edwards EA, Summerbell CD, Taylor SJC, Walton RT. Community pharmacy interventions for health promotion: effects on professional practice and health outcomes. Cochrane Database Syst Rev 2019; 12:CD011207. [PMID: 31808563 PMCID: PMC6896091 DOI: 10.1002/14651858.cd011207.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Community pharmacies are an easily accessible and cost-effective platform for delivering health care worldwide, and the range of services provided has undergone rapid expansion in recent years. Thus, in addition to dispensing medication, pharmacy workers within community pharmacies now give advice on a range of health-promoting behaviours that aim to improve health and to optimise the management of long-term conditions. However, it remains uncertain whether these health-promotion interventions can change the professional practice of pharmacy workers, improve health behaviours and outcomes for pharmacy users and have the potential to address health inequalities. OBJECTIVES To assess the effectiveness and safety of health-promotion interventions to change community pharmacy workers' professional practice and improve outcomes for users of community pharmacies. SEARCH METHODS We searched MEDLINE, Embase, CENTRAL, six other databases and two trials registers to 6 February 2018. We also conducted reference checking, citation searches and contacted study authors to identify any additional studies. SELECTION CRITERIA We included randomised trials of health-promotion interventions in community pharmacies targeted at, or delivered by, pharmacy workers that aimed to improve the health-related behaviour of people attending the pharmacy compared to no treatment, or usual treatment received in the community pharmacy. We excluded interventions where there was no interaction between pharmacy workers and pharmacy users, and those that focused on medication use only. DATA COLLECTION AND ANALYSIS We used standard procedures recommended by Cochrane and the Effective Practice and Organisation of Care review group for both data collection and analysis. We compared intervention to no intervention or to usual treatment using standardised mean differences (SMD) and 95% confidence intervals (95% CI) (higher scores represent better outcomes for pharmacy user health-related behaviour and quality of life, and lower scores represent better outcomes for clinical outcomes, costs and adverse events). Interpretation of effect sizes (SMD) was in line with Cochrane recommendations. MAIN RESULTS We included 57 randomised trials with 16,220 participants, described in 83 reports. Forty-nine studies were conducted in high-income countries, and eight in middle-income countries. We found no studies that had been conducted in low-income countries. Most interventions were educational, or incorporated skills training. Interventions were directed at pharmacy workers (n = 8), pharmacy users (n = 13), or both (n = 36). The clinical areas most frequently studied were diabetes, hypertension, asthma, and modification of cardiovascular risk. Duration of follow-up of interventions was often unclear. Only five studies gave details about the theoretical basis for the intervention, and studies did not provide sufficient data to comment on health inequalities. The most common sources of bias were lack of protection against contamination - mainly in individually randomised studies - and inadequate blinding of participants. The certainty of the evidence for all outcomes was moderate. We downgraded the certainty because of the heterogeneity across studies and evidence of potential publication bias. Professional practice outcomes We conducted a narrative analysis for pharmacy worker behaviour due to high heterogeneity in the results. Health-promotion interventions probably improve pharmacy workers' behaviour (2944 participants; 9 studies; moderate-certainty evidence) when compared to no intervention. These studies typically assessed behaviour using a simulated patient (mystery shopper) methodology. Pharmacy user outcomes Health-promotion interventions probably lead to a slight improvement in health-related behaviours of pharmacy users when compared to usual treatment (SMD 0.43, 95% CI 0.14 to 0.72; I2 = 89%; 10 trials; 2138 participants; moderate-certainty evidence). These interventions probably also lead to a slight improvement in intermediate clinical outcomes, such as levels of cholesterol or glycated haemoglobin, for pharmacy users (SMD -0.43, 95% CI -0.65 to -0.21; I2 = 90%; 20 trials; 3971 participants; moderate-certainty evidence). We identified no studies that evaluated the impact of health-promotion interventions on event-based clinical outcomes, such as stroke or myocardial infarction, or the psychological well-being of pharmacy users. Health-promotion interventions probably lead to a slight improvement in quality of life for pharmacy users (SMD 0.29, 95% CI 0.08 to 0.50; I2= 82%; 10 trials, 2687 participants; moderate-certainty evidence). Adverse events No studies reported adverse events for either pharmacy workers or pharmacy users. Costs We found that health-promotion interventions are likely to be cost-effective, based on moderate-certainty evidence from five of seven studies that reported an economic evaluation. AUTHORS' CONCLUSIONS Health-promotion interventions in the community pharmacy context probably improve pharmacy workers' behaviour and probably have a slight beneficial effect on health-related behaviour, intermediate clinical outcomes, and quality of life for pharmacy users. Such interventions are likely to be cost-effective and the effects are seen across a range of clinical conditions and health-related behaviours. Nevertheless the magnitude of the effects varies between conditions, and more effective interventions might be developed if greater consideration were given to the theoretical basis of the intervention and mechanisms for effecting behaviour change.
Collapse
Affiliation(s)
- Liz Steed
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Ratna Sohanpal
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Adam Todd
- Newcastle UniversitySchool of PharmacyQueen Victoria RoadNewcastle upon TyneUKNE1 7RU
| | - Vichithranie W Madurasinghe
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Carol Rivas
- University College LondonDepartment of Social Science, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Elizabeth A Edwards
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Carolyn D Summerbell
- Durham UniversityDepartment of Sport and Exercise Sciences42 Old ElvetDurhamUKDH13HN
| | - Stephanie JC Taylor
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
- Queen Mary University of LondonAsthma UK Centre for Applied ResearchLondonUK
| | - RT Walton
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
- Queen Mary University of LondonAsthma UK Centre for Applied ResearchLondonUK
| | | |
Collapse
|
10
|
Cameron ST, Baraitser P, Glasier A, McDaid L, Norrie J, Radley A, Stephenson JM, Trussell J, Battison C, Cameron S, Cowle K, Forrest M, Gilson R, Goulao B, Johnstone A, McDonald A, Morelli A, Patterson S, Sally D, Stewart N. Pragmatic cluster randomised cohort cross-over trial to determine the effectiveness of bridging from emergency to regular contraception: the Bridge-It study protocol. BMJ Open 2019; 9:e029978. [PMID: 31672711 PMCID: PMC6830607 DOI: 10.1136/bmjopen-2019-029978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Oral emergency contraception (EC) can prevent unintended pregnancy but it is important to start a regular method of contraception. Women in the UK usually access EC from a pharmacy but then need a subsequent appointment with a general practitioner or a sexual and reproductive health (SRH) service to access regular contraception. Unintended pregnancies can occur during this time. METHODS AND ANALYSIS Bridge-It is a pragmatic cluster randomised cohort cross-over trial designed to determine whether pharmacist provision of a bridging supply of a progestogen-only pill (POP) plus rapid access to a local SRH clinic, results in increased uptake of effective contraception and prevents more unintended pregnancies than provision of EC alone. Bridge-It involves 31 pharmacies in three UK regions (London, Lothian and Tayside) aiming to recruit 626-737 women. Pharmacies will give EC (levonorgestrel) according to normal practice and recruit women to both intervention and the control phases of the study. In the intervention phase, pharmacists will provide the POP (desogestrel) and offer rapid access to an SRH clinic. In the control phase, pharmacists will advise women to attend a contraceptive provider for contraception (standard care).Women will be asked 4 months later about contraceptive use. Data linkage to abortion registries will provide abortion rates over 12 months. The sample size is calculated on the primary outcome of effective contraception use at 4 months (yes/no) with 90% power and a 5% level of significance. Abortion rates will be an exploratory secondary analysis. Process evaluation includes interviews with pharmacists, SRH clinicians and women. Cost-effectiveness analysis will use a healthcare system perspective and be expressed as incremental cost-effectiveness ratio. ETHICS AND DISSEMINATION Ethical approval was received from South East Scotland REC June 2017. Results will be published in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER ISRCTN70616901.
Collapse
Affiliation(s)
- Sharon Tracey Cameron
- Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
- Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
| | - Paula Baraitser
- Department of Sexual Health, King's College Hospital NHS Foundation Trust, London, UK
| | - Anna Glasier
- Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
| | - Lisa McDaid
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Andrew Radley
- Directorate of Public Health, NHS Tayside, Dundee, UK
- Division of Cardiovascular Medicines and Diabetes, Ninewells Hospital and Medical School, Dundee, UK
| | - Judith M Stephenson
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - James Trussell
- Office of Population Research, Princeton University, Princeton, New Jersey, USA
| | - Claire Battison
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Sarah Cameron
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Mark Forrest
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, UK
| | - Beatriz Goulao
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Anne Johnstone
- Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
| | - Alison McDonald
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Alessandra Morelli
- Department of Sexual Health, King's College Hospital NHS Foundation Trust, London, UK
| | - Susan Patterson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Deirdre Sally
- Institute for Global Health, University College London, London, UK
| | - Nicola Stewart
- Institute for Global Health, University College London, London, UK
| |
Collapse
|
11
|
Michie L, Cameron ST. Emergency contraception and impact on abortion rates. Best Pract Res Clin Obstet Gynaecol 2019; 63:111-119. [PMID: 31362908 DOI: 10.1016/j.bpobgyn.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/21/2019] [Accepted: 06/27/2019] [Indexed: 12/12/2022]
Abstract
Emergency contraception (EC) is a drug or a device that is taken after sexual intercourse to prevent unintended pregnancy. The most effective EC is the copper-bearing intrauterine device (Cu-IUD), but oral EC methods are more commonly used and include a single dose of either levonorgestrel (1.5 mg) or ulipristal acetate (30 mg). Although all EC methods are extremely safe, access to EC is often limited due to prevailing misconceptions over how EC works. Although EC can prevent unintended pregnancy for an individual woman, it has failed to make an impact on abortion rates at a population level. This may be because it is not used after every episode of unprotected sex and because existing oral EC methods are only effective if used before ovulation. Future strategies around EC should focus on maximising uptake of Cu-IUD, facilitating initiation of effective regular contraception after EC and developing a more effective oral EC.
Collapse
Affiliation(s)
- L Michie
- The Gatehouse, NHS Ayrshire and Arran, Ayrshire Central Hospital, United Kingdom.
| | - S T Cameron
- Chalmers Sexual and Reproductive Health Centre, NHS Lothian, 2 A Chalmers Street, Edinburgh, EH3 9ES, United Kingdom; Obstetrics and Gynaecology, University of Edinburgh, United Kingdom.
| |
Collapse
|
12
|
Boog K, Chen ZE, Cameron S. Sexual and reproductive healthcare providers' opinions on expansion of pharmacy-led provision of contraception. BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:bmjsrh-2018-200252. [PMID: 31154320 DOI: 10.1136/bmjsrh-2018-200252] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/18/2019] [Accepted: 05/16/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Reduced funding to contraceptive services in the UK is resulting in restricted access for women. Pharmacists are already embedded in sexual and reproductive health (SRH) care in the UK and could provide an alternative way for women to access contraception. The aim of this study was to determine the views of UK contraception providers about community pharmacist-led contraception provision. METHODS An anonymous questionnaire was distributed to healthcare professionals at two UK SRH events, asking respondents about: (1) the use of patient group directions (PGDs) for pharmacist provision of oral contraception (OC); (2) the sale of OC as a pharmacy medicine or general sales list medicine; (3) the perceived impact of pharmacy provision of OC on broader SRH outcomes; and (4) if other contraceptive methods should be provided in pharmacies. RESULTS Of 240 questionnaires distributed, 174 (72.5%) were returned. Respondents largely supported pharmacy-led provision of all non-uterine methods of contraception, excluding the contraceptive implant. Provision of the progestogen-only pill by PGD was most strongly supported (78% supported initiation). Respondents felt that the use of bridging (temporary) contraception would improve (103/144, 71.5%), use of effective contraception would increase (81/141, 57.4%), and unintended pregnancies would decline (71/130, 54.6%); but that use of long-acting reversible contraception would decrease (86/143, 60.1%). Perceived barriers included pharmacists' capacity and competency to provide a full contraception consultation, safeguarding concerns, and women having to pay for contraception. CONCLUSIONS UK SRH providers were largely supportive of community pharmacy-led provision of contraception, with training and referral pathways being required to support contraception delivery by pharmacists.
Collapse
Affiliation(s)
- Katie Boog
- Fife Sexual Health Service, Whytemans Brae Hospital, Kirkcaldy, United Kingdom
| | - Zhong Eric Chen
- Chalmers Centre, Edinburgh, UK
- University of Edinburgh, Edinburgh, UK
| | - Sharon Cameron
- Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
- University of Edinburgh Division of Health Sciences, Edinburgh, UK
| |
Collapse
|
13
|
Mooney-Somers J, Lau A, Bateson D, Richters J, Stewart M, Black K, Nothnagle M. Enhancing use of emergency contraceptive pills: A systematic review of women’s attitudes, beliefs, knowledge, and experiences in Australia. Health Care Women Int 2018; 40:174-195. [DOI: 10.1080/07399332.2018.1526286] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Julie Mooney-Somers
- Sydney Health Ethics, Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Amber Lau
- School of Public Health, Brown University, Providence, Rhode Island, USA
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona, USA
| | - Deborah Bateson
- Family Planning New South Wales, Sydney, Australia
- Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, Australia
| | - Juliet Richters
- Kirby Institute for Infection and Immunity in Society, University of New South Wales, New South Wales, Australia
| | - Mary Stewart
- Family Planning New South Wales, Sydney, Australia
| | - Kirsten Black
- Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, Australia
| | - Melissa Nothnagle
- Natividad Family Medicine Residency, University of California San Francisco, Salinas, California, USA
| |
Collapse
|
14
|
Chofakian CBDN, Moreau C, Borges ALV, Santos OAD. Contraceptive patterns after use of emergency contraception among female undergraduate students in Brazil. EUR J CONTRACEP REPR 2018; 23:335-343. [PMID: 30353752 DOI: 10.1080/13625187.2018.1526897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of our study was to describe contraceptive patterns 30 days after use of emergency contraception (EC) among female undergraduate students in São Paulo, Brazil. METHODS This study was part of a larger project conducted in 2015 among 1679 female students aged 18-24 enrolled at the University of São Paulo. Analysis was restricted to the 916 students who reported lifetime use of EC. Logistic regression models were used to examine factors related to the use of contraception within the 30 day period following the last use of EC, changes in contraceptive behaviour before and after EC use, and gaps in contraceptive use within 30 days after EC use. RESULTS Most women (75.4%) used contraception after accessing EC; 92.9% who used contraception prior to EC exposure resumed use of contraception afterwards, compared with 40.7% who did not use contraception prior to EC exposure. Only 6.3% of women switched to a less effective contraceptive method after EC use. Few women (7.5%) reported post-EC gaps in contraception. CONCLUSIONS The results of this study suggest that EC may serve as a potential precursor to regular contraception among undergraduates in Brazil, with few women reporting contraceptive gaps after EC use. These patterns may contribute to reducing the risk of unintended pregnancy in this population.
Collapse
Affiliation(s)
| | - Caroline Moreau
- b Department of Population, Family, and Reproductive Health , Bloomberg School of Public Health, Johns Hopkins University , Baltimore , MD , USA.,c Gender, Sexual and Reproductive Health, CESP Centre for Research in Epidemiology and Population Health , Villejuif , France
| | - Ana Luiza Vilela Borges
- d Department of Public Health Nursing , University of São Paulo School of Nursing , São Paulo , Brazil
| | - Osmara Alves Dos Santos
- d Department of Public Health Nursing , University of São Paulo School of Nursing , São Paulo , Brazil
| |
Collapse
|
15
|
French RS, Geary R, Jones K, Glasier A, Mercer CH, Datta J, Macdowall W, Palmer M, Johnson AM, Wellings K. Where do women and men in Britain obtain contraception? Findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). BMJ SEXUAL & REPRODUCTIVE HEALTH 2018; 44:16-26. [PMID: 29103003 PMCID: PMC6283328 DOI: 10.1136/jfprhc-2017-101728] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 06/13/2017] [Accepted: 08/16/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION To estimate the prevalence of use of different sources of contraceptive supplies in Britain and its variation by key demographic and behavioural characteristics. METHODS Cross-sectional probability sample survey of women and men aged 16-74 years, resident in Britain, interviewed between 2010 and 2012. Analyses reported here were of 4571 women and 3142 men aged 16-44 years who reported having vaginal sex in the past year. Those relying exclusively on sterilisation (including hysterectomy) were excluded. Sources of contraceptive supplies were categorised as: general practice, community clinic, retail and other. Prevalence of use of these sources was estimated, and associated factors examined. RESULTS Some 87.0% of women and 73.8% of men accessed at least one source of contraceptive supplies in the previous year. Most women (59.1%) used general practice and most men (54.6%) used retail outlets. Community clinics were less commonly used, by 23.0% of women and 21.3% of men, but these users were younger and at greater sexual health risk. These associations were also observed among the 27.3% of women and 30.6% of men who used more than one source category (general practice, community clinic or retail) for contraceptive supplies. CONCLUSIONS People in Britain use a variety of sources to obtain contraceptive supplies and some sources are more commonly used by those more vulnerable to poorer sexual health. Our findings suggest that national policy changes to increase access to contraceptive methods have had an effect on the diversity of services used.
Collapse
Affiliation(s)
- Rebecca S French
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca Geary
- Research Department of Infection and Population Health, University College London, London, UK
| | - Kyle Jones
- Research Department of Infection and Population Health, University College London, London, UK
| | - Anna Glasier
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Catherine H Mercer
- Research Department of Infection and Population Health, University College London, London, UK
| | - Jessica Datta
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Wendy Macdowall
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Melissa Palmer
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Anne M Johnson
- Research Department of Infection and Population Health, University College London, London, UK
| | - Kaye Wellings
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
16
|
Wong K, Hum S, McCarthy L, Dunn S. Beyond Plan B: A Qualitative Study of Canadian Pharmacists' Emergency Contraception Counselling Practices. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:1021-1027. [DOI: 10.1016/j.jogc.2017.04.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/28/2017] [Accepted: 04/29/2017] [Indexed: 12/30/2022]
|
17
|
Cameron ST, Li HWR, Gemzell-Danielsson K. Current controversies with oral emergency contraception. BJOG 2017; 124:1948-1956. [DOI: 10.1111/1471-0528.14773] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2017] [Indexed: 12/30/2022]
Affiliation(s)
- ST Cameron
- Chalmers Sexual and Reproductive Health Centre; Edinburgh UK
| | - HWR Li
- Department of Obstetrics and Gynaecology; University of Hong Kong; Queen Mary Hospital; Hong Kong Hong Kong
- Shenzhen Key Laboratory of Fertility Regulation; Reproductive Medicine Centre; The University of Hong Kong-Shenzhen Hospital; Shenzhen China
| | - K Gemzell-Danielsson
- Shenzhen Key Laboratory of Fertility Regulation; Reproductive Medicine Centre; The University of Hong Kong-Shenzhen Hospital; Shenzhen China
- Department of Women's and Children's Health; Division of Obstetrics and Gynaecology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| |
Collapse
|
18
|
Murphy LE, Chen ZE, Warner V, Cameron ST. Quick starting hormonal contraception after using oral emergency contraception: a systematic review. THE JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2017; 43:319-326. [PMID: 28663249 DOI: 10.1136/jfprhc-2017-101740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/28/2017] [Accepted: 05/29/2017] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Unprotected intercourse after oral emergency contraception (EC) significantly increases pregnancy risk. This underlies the importance of promptly starting effective, ongoing contraception - known as 'quick starting'. However, theoretical concern exists that quick starting might interact with EC or hormonal contraception (HC) potentially causing adverse side effects. METHOD A systematic review was conducted, evaluating quick starting HC after oral EC [levonorgestrel 1.5 mg (LNG) or ulipristal acetate 30 mg (UPA)]. PubMed, EMBASE, The Cochrane Library, ICTRP, ClinicalTrials.gov and relevant reference lists were searched in February 2016. A lack of comparable studies prevented meta-analysis. RESULTS Three randomised controlled trials were identified. Two biomedical studies suggested HC action was unaffected by quick starting after UPA; one study examined ovarian quiescence (OR 1.27; 95% CI 0.51-3.18) while taking combined oral contraception (COC). Another assessed cervical mucus impenetrability (OR 0.76; 95% CI 0.27-2.13) while taking progestogen-only pills (POP). Quick starting POP reduced the ability of UPA to delay ovulation (OR 0.04; 95% CI 0.01-0.37). Side effects (OR 1.22; 95% CI 0.48-3.12) and unscheduled bleeding (OR 0.53; 95% CI 0.16-1.81) were unaffected by quick starting COC after UPA. Another study reported higher self-reported contraceptive use at 8 weeks among women quick starting POP after LNG, compared with women given LNG alone (OR 6.73; 95% CI 2.14-21.20).
Collapse
Affiliation(s)
- Lauren Ee Murphy
- Department of Reproductive and Developmental Sciences, University of Edinburgh, Edinburgh, UK.,Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | | | | | - Sharon T Cameron
- Department of Reproductive and Developmental Sciences, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
19
|
Hickey MT, Shedlin MG. Emergency contraceptive pill users' risk perceptions for sexually transmitted infections and future unintended pregnancy. J Am Assoc Nurse Pract 2017. [PMID: 28639423 DOI: 10.1002/2327-6924.12485] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The availability of emergency contraception pills (ECP) over the counter (OTC) has the potential to reduce the incidence of unintended pregnancy; however, the increased risk for sexually transmitted infection (STI) acquisition, related to unprotected intercourse, has not been adequately addressed. The purpose of this study is to gain insight into risk perceptions for STIs and subsequent unintended pregnancy in women who have purchased ECP OTC. METHODS Twenty-one women, aged 18-24, attending a private university in an urban setting, who purchased and used ECP OTC participated in 1-h, individual interviews. CONCLUSIONS Narrative, descriptive findings indicated that these women did not consider themselves at risk for STI or unintended pregnancy, despite having used ECP OTC. Pregnancy prevention was paramount for these women, which overshadowed concerns regarding STIs. IMPLICATIONS FOR PRACTICE Women at risk for unintended consequences of sexual activity are not fully cognizant of those potential outcomes and do not take measures to prevent their occurrence. The availability of ECP OTC offers protection against unintended pregnancy; however, opportunities for health promotion and prevention counseling may be lost.
Collapse
Affiliation(s)
- Mary T Hickey
- School of Nursing, Hunter College, City University of New York, New York, New York
| | | |
Collapse
|
20
|
Provision of contraception after emergency contraception from the pharmacy: evaluating the acceptability of pharmacy for providing sexual and reproductive health services. Public Health 2016; 135:97-103. [DOI: 10.1016/j.puhe.2015.11.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 11/07/2015] [Accepted: 11/27/2015] [Indexed: 11/24/2022]
|
21
|
Envall N, Groes Kofoed N, Kopp-Kallner H. Use of effective contraception 6 months after emergency contraception with a copper intrauterine device or ulipristal acetate - a prospective observational cohort study. Acta Obstet Gynecol Scand 2016; 95:887-93. [DOI: 10.1111/aogs.12916] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/19/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Niklas Envall
- Swedish Association for Sexuality Education; Stockholm Sweden
- Department of Women's and Children's Health; Division of Obstetrics and Gynecology; Karolinska Institute; Stockholm Sweden
| | - Nina Groes Kofoed
- Department of Obstetrics and Gynecology; Danderyd Hospital; Stockholm Sweden
| | - Helena Kopp-Kallner
- Department of Women's and Children's Health; Division of Obstetrics and Gynecology; Karolinska Institute; Stockholm Sweden
- Department of Obstetrics and Gynecology; Danderyd Hospital; Stockholm Sweden
- Department of Clinical Sciences at Danderyd Hospital; Division of Obstetrics and Gynecology; Karolinska Institute; Stockholm Sweden
| |
Collapse
|
22
|
Heller R, Cameron ST. Evaluating the attractiveness of the availability of injectable progestogen contraceptives at the community pharmacy setting in the United Kingdom. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 24:247-52. [PMID: 26875480 DOI: 10.1111/ijpp.12249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 01/03/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Pharmacists have extended opening hours and are located in communities. Many offer sexual and reproductive health services such as emergency contraception. The opportunity to receive injectable contraception from community pharmacists would improve availability of this method and might increase uptake and continuation. A self-administered survey of women attending a large urban sexual and reproductive health clinic was undertaken to determine the acceptability of receiving contraceptive injections from a community pharmacist. METHODS Women aged 16-50 years attending an NHS walk-in sexual and reproductive health clinic were invited to complete questionnaires while they were waiting to attend an appointment with a clinician. Questionnaires asked women if they were current, previous or never users of the progestogen only injectable, their method of contraception and whether availability of the injectable from a local pharmacist would influence their decision to use this method. RESULTS Two hundred and forty questionnaires were distributed and 220 completed (92%). A total of 9% of respondents were past users of the injectable (n = 21), 4% were current users (n = 8) and the remaining 87% were never users. Of those 191 current non-users, 33% (n = 64) indicated that they would consider using this method if it was available at the pharmacy. The main perceived advantages of attending the pharmacy were quicker appointments (52%) and easier access (47%). CONCLUSION Provision of the injectable contraceptive from a pharmacist might make this method attractive to almost one in three women who are not currently using it. This could be a strategy to improve uptake and continuation of this method.
Collapse
Affiliation(s)
- Rebecca Heller
- Chalmers Sexual & Reproductive Health Centre, Edinburgh, UK
| | | |
Collapse
|
23
|
A Qualitative Study of Prescription Contraception Use: The Perspectives of Users, General Practitioners and Pharmacists. PLoS One 2015; 10:e0144074. [PMID: 26633191 PMCID: PMC4669182 DOI: 10.1371/journal.pone.0144074] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 11/12/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The oral contraceptive pill (OCP) remains the most popular form of prescription contraception in many countries, despite adherence difficulties for many. Uptake of long acting reversible contraceptives (LARCs), which are less reliant on user adherence, remains low. The aim of this study was to explore the experiences of, and attitudes towards, prescription contraception amongst samples of contraception users, general practitioners (GPs) and pharmacists. METHODOLOGY AND FINDINGS We conducted a qualitative study using semi-structured interviews with 18 contraception users, 18 GPs and 9 pharmacists. The study took place in Galway, Republic of Ireland between June and September 2014. Thematic analysis was used to analyse the data. Overall, contraception users were more familiar with the OCP, and all the women interviewed began their prescription contraception journey using this method. All participants identified episodes of poor adherence throughout the reproductive life course. The identified barriers for use of LARCs were lack of information, misconceptions, lack of access and high cost. In contrast, GPs believed that adherence to the OCP was good and stated they were more likely to prescribe the OCP than other methods, as they were most familiar with this option. Barriers to prescribing LARCSs were time, cost to practice, training and deskilling. Pharmacists also believed that adherence to the OCP was generally good and that their role was limited to dispensing medication and providing information when asked. DISCUSSION AND CONCLUSION There are contrasting perspectives between contraception service providers and contraceptive users. Training for healthcare providers is required to support informed contraceptive choice and adherence. It is necessary to address the practice barriers of cost and lack of time, to promote better communication around adherence issues and prescription contraception options. There is a need for more easily-accessible public health information to promote awareness on all methods of prescription contraception.
Collapse
|
24
|
Glasier A. Starting hormonal contraception after using emergency contraception: what should we recommend? Hum Reprod 2015; 30:2708-10. [PMID: 26405264 DOI: 10.1093/humrep/dev242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 08/27/2015] [Indexed: 12/30/2022] Open
Affiliation(s)
- Anna Glasier
- Department of Obstetrics and Gynaecology, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Midlothian EH16 4TJ, UK
| |
Collapse
|
25
|
Cameron ST, Berger C, Michie L, Klipping C, Gemzell-Danielsson K. The effects on ovarian activity of ulipristal acetate when 'quickstarting' a combined oral contraceptive pill: a prospective, randomized, double-blind parallel-arm, placebo-controlled study. Hum Reprod 2015; 30:1566-72. [PMID: 25994664 DOI: 10.1093/humrep/dev115] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 04/28/2015] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What is the effect on ovarian activity of a preceding intake of ulipristal acetate (UPA) when starting a combined oral contraceptive (COC) in the mid- to late-follicular phase of the cycle? SUMMARY ANSWER This study shows that UPA does not affect the ability of the COC to induce ovarian quiescence. WHAT IS KNOWN ALREADY UPA is a progesterone receptor modulator that is available for emergency contraception (EC). In theory, UPA could alter the effectiveness of hormonal contraception started immediately following it and vice versa. Current guidelines regarding quick starting a COC following UPA are based on expert opinion only. STUDY DESIGN, SIZE, DURATION A double-blind, randomized, placebo-controlled trial was conducted at three separate sites, Edinburgh (Scotland), Stockholm (Sweden) and Groningen (the Netherlands), over a 5-month period in 2012. Healthy female volunteers were randomized to take either UPA or an identically packaged placebo, at mid-cycle (once a lead ovarian follicle was determined to be >13 mm on transvaginal ultrasound imaging). Participants were randomized by a computer-generated randomization schedule, allocated by sequential, sealed envelopes. All women then started 21 days of the same COC the following day. The study was designed to show non-inferiority of UPA compared with placebo in terms of the proportion of women attaining ovarian quiescence, as measured by the Hoogland scoring system, while taking COC. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 76 women were recruited over the three sites, Edinburgh (n = 18), Stockholm (n = 13), Groningen (n = 45) and received either UPA (n = 39) or placebo (n = 37). MAIN RESULTS AND THE ROLE OF CHANCE There were no significant differences in demographic characteristics of women in the UPA and placebo groups. Among the 76 participants treated, 47 (61.8%) reached quiescence and 25 (32.9%) ovulated. There were no significant differences between the groups in the odds ratio (OR) of reaching ovarian quiescence or not; OR 0.97 (95% CI: 0.39-2.46). All women who reached quiescence had done so after taking COCs for 14 days. LIMITATIONS, REASONS FOR CAUTION The main limitations of the study were that measurements of follicle size and blood tests were performed every 2-3 days and so it was not possible to determine the actual day that follicle rupture occurred for the women who ovulated. Furthermore, the ultrasonography was conducted by a number of investigators at the sites which may introduce error in the form of inter-observer variability in measurements of follicle growth. Finally, the findings of the study cannot be extrapolated to other combined hormonal methods of contraception such as the patch or ring, nor to progestogen- only methods of contraception. WIDER IMPLICATIONS OF THE FINDINGS This study provides evidence to suggest that UPA does not affect the ability of the COC to induce ovarian quiescence. However, this study design cannot determine whether the COC affects the ability of UPA to delay ovulation. STUDY FUNDING/COMPETING INTERESTS Funding was provided by HRA Pharma Paris, France. C.K., S.T.C. and K.G.D. have received funds for conducting research studies and lectures for HRA Pharma. C.K. is director of a contract research organization (Dinox). The remaining authors declare no conflicts of interests. TRIAL REGISTRATION NUMBER Clinicaltrials.gov: NCT01569113.
Collapse
Affiliation(s)
- S T Cameron
- Chalmers Sexual Health Clinic, 2a Chalmers Street, Edinburgh EH3 9ES, UK Obstetrics and Gynaecology, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh EH16 4SU, UK
| | - C Berger
- Karolinska University Hospital Solna, Stockholm SE-171 76, Sweden
| | - L Michie
- Chalmers Sexual Health Clinic, 2a Chalmers Street, Edinburgh EH3 9ES, UK
| | - C Klipping
- Dinox, Hanzeplein 1, Entrance 53, Groningen 9713 GZ, The Netherlands
| | | |
Collapse
|
26
|
|
27
|
Emergency contraception. Widely available and effective but disappointing as a public health intervention: a review. Hum Reprod 2015; 30:751-60. [PMID: 25678571 PMCID: PMC4447791 DOI: 10.1093/humrep/dev019] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 01/12/2015] [Accepted: 01/19/2015] [Indexed: 12/30/2022] Open
Abstract
Emergency contraception (EC) prevents pregnancy after unprotected sex or contraceptive failure. Use of EC has increased markedly in countries where a product is available over the counter, yet barriers to availability and use remain. Although effective in clinical trials, it has not yet been possible to show a public health benefit of EC in terms of reduction of unintended pregnancy rates. Selective progesterone receptor modulators developed as emergency contraceptives offer better effectiveness than levonorgestrel, but still EC is less effective than use of ongoing regular contraception. Methods which inhibit ovulation whenever they are taken or which act after ovulation to prevent implantation and strategies to increase the uptake of effective ongoing contraception after EC use would prevent more pregnancies.
Collapse
Affiliation(s)
- ESHRE CapriWorkshop Group
- Correspondence address. P.G. Crosignani, Scientific Direction, IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, Via M. Fanti, 6, 20122 Milano, Italy, E-mail:
| | | |
Collapse
|
28
|
Cleland K, Raymond EG, Westley E, Trussell J. Emergency contraception review: evidence-based recommendations for clinicians. Clin Obstet Gynecol 2014; 57:741-50. [PMID: 25254919 PMCID: PMC4216625 DOI: 10.1097/grf.0000000000000056] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Several options for emergency contraception are available in the United States. This article describes each method, including efficacy, mode of action, safety, side effect profile, and availability. The most effective emergency contraceptive is the copper intrauterine device (IUD), followed by ulipristal acetate and levonorgestrel pills. Levonorgestrel is available for sale without restrictions, whereas ulipristal acetate is available with prescription only, and the copper IUD must be inserted by a clinician. Although EC pills have not been shown to reduce pregnancy or abortion rates at the population level, they are an important option for individual women seeking to prevent pregnancy after sex.
Collapse
Affiliation(s)
- Kelly Cleland
- Office of Population Research, Princeton University, Princeton, NJ
| | | | | | - James Trussell
- Office of Population Research, Princeton University, Princeton, NJ
- The Hull York Medical School, University of Hull, Hull England
| |
Collapse
|