Outdated Counseling in the Pharmacy?; A Qualitative Analysis of Emergency Contraception Access in Wyoming

Abstract

testosterone and Male to Female (MTF) patients on estrogen with or without testosterone blockers (ie. spironolactone). Patients with endocrine disorders that would predispose patients to altered metabolic profiles, including CAH and PCOS, were excluded. Previously recorded measurements of testosterone, estradiol, prolactin, and lipids were reviewed, as well as blood pressure, BMI, electrolytes, liver function tests, hemoglobin/ hematocrit, and hemoglobin A1c. Values reviewed were obtained from prior to the beginning of therapy (baseline), at 1-3 months after the initiation of therapy, at 4-6 months, and at 6 months and beyond. Repeated measures ANOVA models were used to evaluate the change in lab values and other metabolic markers over time.Results: A total of 116 adolescents were included in the study, including 72 FTM patients on testosterone and 44 MTF patients on estrogen. Of the 72 subjects on testosterone therapy, hemoglobin and hematocrit significantly increased at each subsequent visit. There was also a significant increase in BMI and lowering of HDL levels found at each visit. There was an increase in blood pressure, total cholesterol and LDL noted at the 3 month visit; however, these were not statistically significant and were noted to plateau after three months. Changes in AST/ALT, BUN/Cr, Estradiol, Prolactin, Triglycerides and HgbA1c were also not found to be statistically significant. Of note, testosterone doses above 50mg weekly were associated with a greater increase in hematocrit, systolic blood pressure and HDL compared to those receiving only 25mg every week.Of the 44 subjects on estrogen therapy, no statistically significant changes were noted to measured metabolic parameters over time. There was also no statistically significant difference in measured metabolic parameters among the different Methods of administration of estradiol (patch, oral or parenteral). There was also no significant change in potassium levels over time among the 38 subjects on concurrent spironolactone therapy.Conclusions: Testosterone use was associated with increased hematocrit levels; otherwise, cross-gender hormone administration in adolescents was not associated with significant differences in the selected metabolic parameters over time.Acknowledgement: Funding for statistical analysis is from the Medstar

Role of the community pharmacist in emergency contraception counseling and delivery in the United States: current trends and future prospects

“…14 A study published in 2016 that examined availability and access in community pharmacies in Wyoming showed that although 88% of pharmacies stocked EC, only 16% had it in stock and on the shelf. 15 …”

“…Studies have demonstrated gaps in pharmacist knowledge that may result in incorrect information or advice given to patients seeking EC. 15 , 58 , 59 Furthermore, education is needed to allow access to EC in a timely manner. 15 , 60 In one small study, educating pharmacists about the use of the copper IUD for EC increased referral and uptake by women of the copper IUD almost threefold.…”

“… 15 , 58 , 59 Furthermore, education is needed to allow access to EC in a timely manner. 15 , 60 In one small study, educating pharmacists about the use of the copper IUD for EC increased referral and uptake by women of the copper IUD almost threefold. 61 Suggestions to improve knowledge and behavior include standardized protocols at the community pharmacy when patients are seeking EC, updated training (eg, continuing professional education) of pharmacists, and mandatory private consultation areas to enhance the counseling environment.…”

The feasibility of contraceptive injections at the community pharmacy

“…If the deception is successful, providers' normal method of practice can be observed (Madden et al, 1997). Research using 'mystery shoppers' with pharmacists providing EHC has identified gaps in knowledge among dispensing pharmacists, and/or a failure to discuss ongoing contraceptive methods; this has been demonstrated in Australia (Hussainy et al, 2015;Higgins and Hattingh, 2013;Queddeng et al, 2011), the United States (Wilkinson et al, 2012;French and Kaunitz, 2007;Nelson and Jaime, 2009;Bennett et al, 2003;Sampson et al, 2009;Cleland et al, 2016;Gaffaney et al, 2016;Bullock et al, 2015), Canada (Cohen et al, 2004), Thailand (Ratanajamit and Chongsuvivatwong, 2001;Ratanajamit et al, 2002), Kenya (Liambila et al, 2010), Brazil (Tavares and Foster, 2016), and the United Kingdom (Glasier et al, 2010;Brant et al, 2014). Mystery shopper techniques have also identified other gaps in service provision, for example that EHC is more likely to be procured immediately from an urban than a rural pharmacy in California (Sampson et al, 2009), and Kansas (Samson et al, 2013), and by an English speaker more successfully than a Spanish speaker in California (Sampson et al, 2009).…”