Christa Spycher

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    Supply of emergency hormonal contraception without prescription

    in Swiss community pharmacies

     

    Spycher C, Beutler M, Lemke S, Bruppacher R, Hersberger KE,

    PLANes – Lausanne , CH

     

    Introduction: Levonorgestrel for emergency hormonal contraception (EHC) is used by the Familiy Planning Center of the Department of Obstetrics and Gynecology, Inselspital Bern since 1999 (along with guidelines and a specific EHC-protocol). Experiences have been analyzed and were favourable. Levonorgestrel was officially introduced in Switzerland as EHC in November 2002. It is available without prescription (‘pharmacist only’). The same Guidelines and a specific EHC-protocol were implemented to assure safe and rational drug use.

     

    Objectives: Monitor in a pilot study the demand and the pharmacists’ counselling activities and search for improvement potential concerning supply and pharmaceutical care.

     

    Design: Retrospective analysis of the EHC-protocols, collected from pharmacies to elicit request and supply problems as background for the development of a questionnaire.

    Prospective query of all women requesting EHC in 4 community pharmacies with enlarged opening hours and known supply of EHC of more than 20 times a month. A 13 items questionnaire, filled in by the customers immediately after triage in the pharmacy, was linked with the respective EHC-protocol.

     

    Setting: Random sample of 14 community pharmacies in German speaking Switzerland offering access to their EHC-protocols; 4 of them with frequent requests approached their customers for answering the questionnaire.

     

    Results: In 14 pharmacies a total of 205 protocols were documented during the first 6 month after introduction of Levonorgestrel for EHC. Only 44 missing data (3.0% out of 1435 items) demonstrated that triage was based on complete information.

    During 10 weeks the 4 pharmacies approached 177 women requesting EHC, of them 141 (71%) (median age 23 years, range 16 - 47) filled in the questionnaire. 59% used EHC for the first time. The major reasons for EHC request were problems with condoms (69%) and non-compliance with hormonal contraception (13%). Before sexual contact only 55% knew about availability of EHC without prescription through pharmacies. Alternatively women would have contacted a physician (55%) or a hospital (27%), but 11% would have waited without action. In 91% of all requests EHC was supplied. General satisfaction with pharmaceutical care was rated best (on a 4 point scale) by 86% of the women. Deficits concerned counselling about future contraception and risk of sexually transmitted diseases.

     

    Conclusions: EHC through pharmacies could successfully be implemented. The structured counselling protocol was well used and is likely to support good counselling.

    To monitor problems and changes in the quality of pharmaceutical care and in emergency contraception behaviour a larger study should follow this pilot study.