RESEARCH | Pharmacies Provide More Rapid Access to EC Than Clinical Settings, Study Finds

RESEARCH | Pharmacies Provide More Rapid Access to EC Than Clinical Settings, Study Finds
[March 20, 2008]

Summary of "Provision of Emergency Contraception: A Pilot Study Comparing Access Through Pharmacies and Clinical Settings," Black et al., Contraception, March 2008.

This study sought to compare the provision of emergency contraception through different health care settings, including community pharmacies, family planning clinics and general practices. Researchers also aimed to determine whether client satisfaction, and subsequent contraceptive use and sexual health outcomes vary significantly depending on where the services are provided.

Methods and Findings
Kirsten Black of the Department of Obstetrics and Gynecology at the University of Sydney and colleagues interviewed 50 women who obtained EC from a community pharmacy and 83 women who received EC from clinical services in the South London boroughs of Lambeth and Southwark. The interviews were conducted between January 2004 and April 2005 -- four months after the women received EC -- to examine the short-term impact of each service.

A questionnaire was used to obtain demographic information, the participants' experiences obtaining EC and their subsequent behavior. The primary outcome measures included accessibility of the services, experience of service use and effectiveness of the consultation in subsequent sexual health practices. According to the researchers, the women who obtained EC from a pharmacy were similar in demographic characteristics to those who visited clinical settings. However, women who attended a pharmacy were significantly more likely to have vocational or professional educations.

The questionnaire indicated that 70% of women who went to a pharmacy obtained EC within 24 hours of having unprotected sex, compared with 43.4% of women who went to clinical services. In addition, 83.1% of women who went to a clinic said it was easy to obtain EC, compared with 74% of women who went to pharmacies. About 91% of women who went to a clinic reported feeling comfortable asking for EC, compared with 74% in the other group. When asked if adequate privacy had been provided, 98.9% of the women who went to a clinic said that it had, compared with 44% of women who went to a pharmacy. Ninety-five percent of women who went to a clinic said they had received adequate advice on EC, and 90.4% of women in the same group said future contraceptive choices were discussed. However, only 82% of the pharmacy group said they had received adequate EC advice, and only 28% said future contraceptive choices were discussed.

The questionnaire also asked participants if the EC consultation influenced their subsequent sexual health behavior. Of the women who had sex in the four months after receiving EC, all of the women who went to a clinical service used a contraceptive method at least some of the time, compared with 86.7% of the pharmacy group. The prevalence of repeated EC use was about the same for both groups, with 23.4% of the clinical service group and 20% of the pharmacy group.

Conclusions
Women who obtained the drug from pharmacies had more rapid access than those who went to family planning clinics and general medical practices. The rapid access available at community pharmacies is "potentially of great importance" because of findings from the World Health Organization that the sooner EC is taken after unprotected sex the more effective it is. However, other "aspects of provision and client satisfaction seem to favor attendance at a clinical setting over a pharmacy" for obtaining EC, they write, adding that women who "went to a clinical service described less discomfort and greater privacy." Women attending clinical settings also "felt better informed" about EC, as well as "future contraceptive options," according to the researchers. It is "important to ensure" that improvements in access to EC through pharmacies "are also beneficial in terms of women's subsequent sexual health," the researchers noted. They concluded, "To miss the chance to adequately inform women about their contraceptive choices is potentially detrimental."