L Michie1, S T Cameron2, A Glasier3, N Larke4, A Muir5, A Lorimer6. 1. Department of Reproductive and Developmental Sciences, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 5SU, United Kingdom; Chalmers Sexual Health Centre, 2A Chalmers Street, Edinburgh, EH3 9ES, United Kingdom. Electronic address: michieluc@yahoo.co.uk. 2. Department of Reproductive and Developmental Sciences, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 5SU, United Kingdom; Chalmers Sexual Health Centre, 2A Chalmers Street, Edinburgh, EH3 9ES, United Kingdom. 3. Department of Reproductive and Developmental Sciences, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 5SU, United Kingdom; London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom. 4. London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom. 5. Department of Public Health and Health Policy, NHS Lothian, Waverley Gate, 2-4 Waterloo Place, Edinburgh, EH1 3EG. 6. Pharmacy Department, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh, EH10 5HF.
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.
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.
Authors: Sharon T Cameron; Anna Glasier; Lisa McDaid; Andrew Radley; Susan Patterson; Paula Baraitser; Judith Stephenson; Richard Gilson; Claire Battison; Kathleen Cowle; Thenmalar Vadiveloo; Anne Johnstone; Alessandra Morelli; Beatriz Goulao; Mark Forrest; Alison McDonald; John Norrie Journal: Health Technol Assess Date: 2021-05 Impact factor: 4.014
Authors: Liz Steed; Ratna Sohanpal; Adam Todd; Vichithranie W Madurasinghe; Carol Rivas; Elizabeth A Edwards; Carolyn D Summerbell; Stephanie Jc Taylor; R T Walton Journal: Cochrane Database Syst Rev Date: 2019-12-06
Authors: Sharon Tracey Cameron; Paula Baraitser; Anna Glasier; Lisa McDaid; John Norrie; Andrew Radley; Judith M Stephenson; James Trussell; Claire Battison; Sarah Cameron; Kathleen Cowle; Mark Forrest; Richard Gilson; Beatriz Goulao; Anne Johnstone; Alison McDonald; Alessandra Morelli; Susan Patterson; Deirdre Sally; Nicola Stewart Journal: BMJ Open Date: 2019-10-30 Impact factor: 2.692
Authors: Sharon T Cameron; Anna Glasier; Lisa McDaid; Andrew Radley; Paula Baraitser; Judith Stephenson; Richard Gilson; Claire Battison; Kathleen Cowle; Mark Forrest; Beatriz Goulao; Anne Johnstone; Alessandra Morelli; Susan Patterson; Alison McDonald; Thenmalar Vadiveloo; John Norrie Journal: Lancet Date: 2020-11-14 Impact factor: 202.731
Authors: Rebecca S French; Rebecca Geary; Kyle Jones; Anna Glasier; Catherine H Mercer; Jessica Datta; Wendy Macdowall; Melissa Palmer; Anne M Johnson; Kaye Wellings Journal: BMJ Sex Reprod Health Date: 2017-11-08