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Pharmacy-based interventions for initiating effective contraception following the use of emergency contraception: a pilot study

  • L. Michie
    Correspondence
    Corresponding author at: Chalmers Sexual Health Centre, 2A Chalmers Street, Edinburgh, EH3 9ES, United Kingdom. Tel.: +44 131 536 1070; fax: +44 131 536 1609.
    Affiliations
    Department of Reproductive and Developmental Sciences, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 5SU, United Kingdom

    Chalmers Sexual Health Centre, 2A Chalmers Street, Edinburgh, EH3 9ES, United Kingdom
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  • S.T. Cameron
    Affiliations
    Department of Reproductive and Developmental Sciences, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 5SU, United Kingdom

    Chalmers Sexual Health Centre, 2A Chalmers Street, Edinburgh, EH3 9ES, United Kingdom
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  • A. Glasier
    Affiliations
    Department of Reproductive and Developmental Sciences, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 5SU, United Kingdom

    London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
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  • N. Larke
    Affiliations
    London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
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  • A. Muir
    Affiliations
    Department of Public Health and Health Policy, NHS Lothian, Waverley Gate, 2-4 Waterloo Place, Edinburgh, EH1 3EG
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  • A. Lorimer
    Affiliations
    Pharmacy Department, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh, EH10 5HF
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      Abstract

      Objectives

      In Scotland most women get emergency contraception (EC) from pharmacies. Pharmacists currently cannot provide effective ongoing contraception after EC. In this pilot study, we aimed to determine the feasibility of a larger study designed to ascertain if pharmacy-based interventions can increase the uptake of effective contraception after EC.

      Study design

      This is a pilot study of women presenting for levonorgestrel EC to community pharmacies in Edinburgh, UK, in 2012. Pharmacies were cluster randomized to provide either standard care or one of two interventions: (a) one packet of progestogen-only pills (POPs), giving women 1 month to arrange ongoing contraception; (b) invitation to present the empty EC packet to a family planning clinic (FPC) for contraceptive advice (rapid access).

      Results

      One hundred sixty-eight women were recruited from 11 pharmacies to POP (n=56), rapid access (n=58) and standard care (N=54) groups, respectively. Telephone follow-up was conducted successfully in 102 women (61%) 6–8 weeks later to determine current contraceptive use. In the POP arm, 35/39 (90%) women used the pills provided, and 9/28 women (32%) in the rapid access arm attended the FPC. The proportion of women using effective contraception at follow-up was significantly greater in both POP [56% (22/39), p=<0.001] and rapid access [52% (13/25), p=0.006] groups compared to standard care [16% (5/31)]. The relative probability of a woman using an effective method of contraception versus barrier/no method, after use of EC, was 3.13 [95% confidence interval (CI), 1.90–5.13] in the POP group and 2.57 (95% CI, 1.55–4.27) in the rapid access group.

      Conclusions

      This promising pilot study suggests that simple pharmacy-based interventions may increase the uptake of effective contraception after EC. A larger study is required to provide further validation of these findings.

      Implications statement

      For women obtaining EC from a pharmacy, simple interventions such as supplying 1 month of a POP, or offering rapid access to a FPC, hold promise as strategies to increase the uptake of effective contraception after EC.

      Keywords

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