Trends in dispensing oral emergency contraceptives and safety issues: a survey of German community pharmacists

Abstract

Background Oral emergency contraceptives containing levonorgestrel or ulipristal acetate are available without prescription and only in pharmacies in Germany since March 2015. Due to this change community pharmacists are responsible for evaluating whether the product is appropriate and to educate women on proper use. Objective To measure the utilization of emergency contraceptives without a prescription and describe potential concerns and safety issues identified by community pharmacists in Germany. Setting The Drug Commission of German Pharmacists' nationwide network of reference pharmacies which includes 860 community pharmacies. Methods Reference community pharmacies were asked to participate in the eleven-questions online survey. Respondents were asked to recall their experiences with oral emergency contraceptives in the past 3 months. Data were collected between January 8 and February 19, 2018. Main outcome measure The survey focused on the utilization of emergency contraceptives without a prescription in Germany, and on the pharmacists' experiences with (potential) problems and concerns regarding safe use. Results In total, 555 community pharmacies (64.5%) participated. Overall 38.2% of community pharmacists stated they dispensed six to ten courses of emergency contraceptives within the past 3 months. In addition, 54.3% of the pharmacists estimated they dispensed emergency contraceptives exclusively without prescription and 35.9% dispensed more than 30% of emergency contraceptives during night-time and emergency services. Moreover, 82.8% of pharmacists stated that emergency contraceptives were requested not by the women concerned but a third person and 44.3% identified uncertainties in woman's self-diagnosis. Three out of four pharmacists had concerns about the effective and safe use of emergency contraceptives. In situations suggesting sexually transmitted diseases, or suspicion for use of force, 59.5% and 55.8% of the pharmacists, respectively, dispensed emergency contraceptives. In cases of acute health impairment or chronic disease, or (potentially) relevant drug/drug interaction, the vast majority (91.0% and 90.5%) did not. Here, most pharmacists referred to gynecologists. Conclusion Pharmacists had safety concerns when dispensing emergency contraceptives. Professional expertise in evaluating the need for oral emergency contraceptives and the proper use is needed.

Predictors of modern contraceptive use among women in Meru and Arusha districts in Northern Tanzania

“…As such, we note that pharmacies are also a major source of methods, being reported by approximately 13% of the women who use modern methods in this study. Pharmacies are opened for longer hours than outpatient departments in most health facilities, thus they become a preferred source of methods for women who are out of stock or need emergency contraceptives [31]. Pharmacies and drug stores can be important potential sites in improving availability and access of methods especially emergency methods, after taking into consideration regulatory and training issues [31][32][33].…”

The Quality of Counselling for Oral Emergency Contraceptive Pills—A Simulated Patient Study in German Community Pharmacies

“…The recommendations, including the checklist published by the BAK, formed the basis of the test scenario that was developed (see Table 1 ) and the evaluation form used (see Table 2 ). The request for the “morning after pill” because of a broken condom that was simulated in the scenario is realistic because this reason was cited most frequently in requests for emergency contraception in pharmacies in a recent German study [ 26 ]. Dispensing the emergency contraception ellaOne ® , the only preparation with the active substance UPA available on the German market [ 60 ], was defined as the appropriate outcome.…”

“…The BAK recommendations stipulate the dispensing of only UPA 72 to 120 h after unprotected sexual intercourse or contraceptive failure, but it is not currently known to what extent pharmacies comply with these recommendations. The three studies available to date in Germany on the counselling and dispensing behaviour for emergency contraception have also not investigated this issue [ 26 , 27 , 28 ]. The study results are also based on self-assessment by pharmacies and may therefore be distorted, for example, due to social desirability [ 29 , 30 ].…”

A Nationwide Mystery Caller Evaluation of Oral Emergency Contraception Practices from German Community Pharmacies: An Observational Study Protocol

“…However, it is quite realistic to assess when a man calls for his wife or girlfriend and wants to take the call for her because she feels uncomfortable, ashamed or might even already be psychologically burdened [69][70][71]. In a German study, more than 82% of the CPs interviewed also considered it a problem that oral EC was not requested by the woman concerned, but by the respective man or a third person [51].…”

“…In a nationwide interview study, 12 female EC users interviewed wished, among other things, for more discretion and more patient-oriented information gathering [50]. In contrast, a non-representative online survey of 555 CPs concluded, among other things, that pharmacy staff refer women to gynaecologists in the case of safety concerns [51]. In contrast, however, no studies on pricing from German CPs to oral EC are known.…”