Sexual and reproductive healthcare providers’ opinions on expansion of pharmacy-led provision of contraception

Boog, Katie; Chen, Zhong Eric; Cameron, Sharon

doi:10.1136/bmjsrh-2018-200252

Cited by 10 publications

(8 citation statements)

References 19 publications

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“…Unsurprisingly, there was less concern about patients' safety for POP, especially among younger physicians. This finding can be explained due to the different safety profile of POP and is in line with recent research in the UK, where respondents were largely supportive of pharmacy-led provision of HC and initiation of POP was most strongly supported [22]. Our survey revealed a clear refusal of OTC access to HC, which corresponds to the view among pharmacists in Switzerland [19].…”

Section: Practical Implicationssupporting

confidence: 89%

“…In the UK, a majority of delegates at national and regional sexual and reproductive health services were supportive of pharmacists providing HC [ 22 ] and recently the first POP has been reclassified and is available from pharmacies without a prescription [ 11 ]. This is an important first step in the direction of extended access and women empowerment.…”

Section: Discussionmentioning

confidence: 99%

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Physicians’ Opinion Regarding Extended Access to Hormonal Contraception in Switzerland

2021

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(1) Background: Access to hormonal contraceptives (HC) strongly differs between countries and varies from over the counter (OTC) to prescription-only availability. This study aimed to identify opinions among physicians in Switzerland regarding extended access to HC. (2) Methods: Web-based survey among physicians (gynecologists, general practitioners, and pediatricians) in Switzerland. (3) Results: Hundred sixty-three physicians, mainly gynecologists, participated in this survey and 147 (90%) were included for analysis. A total of 68% (n = 100) answered that prescription-only status could be extended under certain conditions but physicians were concerned about patients’ safety (97%, n = 142). Moreover, there was concern about insufficient patient education on HC (93%, n = 136) and that women may forego preventive examinations (80%, n = 118). Participants did not support OTC availability (93%, n = 136). Pharmacists prescribing (including initiation of HC) revealed controversial results, but a combined access model (initial prescription from physician and follow-up prescriptions by pharmacists) found acceptance in 70% (n = 103). (4) Conclusions: Participating physicians stated that prescription-only status for HC could be lifted under certain conditions but also some concerns, e.g., patients’ safety or neglection of preventive examinations, were raised. Future research should focus on specific conditions in which extended access to HC could be agreed on.

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Section: Practical Implicationssupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Physicians’ Opinion Regarding Extended Access to Hormonal Contraception in Switzerland

2021

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“… 22 This bridging method has also received support from members of the Faculty of Sexual and Reproductive Healthcare UK, gathered from surveys. 22 , 34 The progestogen-only pill is safe and has few contraindications to use. 28 In addition, current threats of the pandemic to health-care delivery show the importance of developing alternative methods for supplying contraception.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Summary 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 As...

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“…21,43 Provision of a bridging supply of POP with EC has received support in surveys of EC users and also from members of the Faculty of Sexual and Reproductive Healthcare. 32,44 In addition to increasing uptake of effective contraception, it is likely that widely implementing bridging POP might also reduce rates of repeat EC use (as observed in the Bridge-it study), which would also generate savings (through reduced consultations for EC).…”

Section: Implications For Decision-makersmentioning

confidence: 99%

Provision of the progestogen-only pill by community pharmacies as bridging contraception for women receiving emergency contraception: the Bridge-it RCT

Cameron

Glasier

McDaid

et al. 2021

Health Technol Assess

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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.

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Sexual and reproductive healthcare providers’ opinions on expansion of pharmacy-led provision of contraception

Cited by 10 publications

References 19 publications

Physicians’ Opinion Regarding Extended Access to Hormonal Contraception in Switzerland

Physicians’ Opinion Regarding Extended Access to Hormonal Contraception in Switzerland

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

Provision of the progestogen-only pill by community pharmacies as bridging contraception for women receiving emergency contraception: the Bridge-it RCT

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