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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Article info
Publication history
Published online: May 13, 2014
Accepted:
May 1,
2014
Received in revised form:
April 23,
2014
Received:
February 16,
2014
Footnotes
☆Funding: The Edinburgh & Lothians Health Foundation provided funding for this study. In addition, a research grant was provided by HRA Pharma which enabled LM to be funded as a clinical research fellow at The University of Edinburgh. This grant was independent and unrestricted; not specified to fund any particular research projects.
☆☆Conflict of interests: Both STC and AG, currently and in the past, have received research support from and undertaken consultancies for pharmaceutical companies working to develop emergency contraception.
★Clinical Trial Registration Number: NCT01738971
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
