No abstract

Purpose of review Hormonal contraceptives are largely responsible for recent declines in unintended adolescent pregnancies, with oral contraceptives being the most commonly used. Young people face multiple barriers to accessing effective contraception in clinical settings. This article reviews innovations in contraceptive access. Recent findings The three biggest innovations are over-the-counter oral contraceptives (OTC-OCs), pharmacist-prescribing, and web-based telehealth platforms. In many countries, oral contraceptives are available OTC, and FDA trials for OTC-OCs are underway in the United States. Many states have passed legislation allowing pharmacists to prescribe contraceptives after a brief health screening. Web-based telehealth platforms also provide prescription contraceptive access. There is a small but growing body of literature that demonstrates young people's interest in, and capacity to consent to, hormonal contraceptives in nontraditional settings. State-to-state variability in minor consent, pharmacist prescribing, and telehealth laws act as barriers to young people's access to these newer options. Summary Access to hormonal contraception is expanding outside of clinical settings, reducing barriers. Adolescents’ unique needs should be considered in the design, implementation, and evaluation of these new approaches. More data is needed to ensure that adolescents are not excluded from expanded contraceptive access options, as they are disproportionately affected by unintended pregnancy.

Introduction Unintended pregnancy is a public health issue, with young women in their late teens and early 20s at highest risk. Multiple approaches to increasing contraception access have been implemented, including adoption of statewide pharmacist prescribing legislation in multiple states. Indiana does not currently have such legislation in place. The objective of this study was to identify how women at risk for unintended pregnancy in central Indiana perceive pharmacist prescribing of contraception. Study Design Qualitative, one‐on‐one semi‐structured interviews. Methods Purposive, convenience sampling of eligible women 18 to 29‐years‐old who live in Indiana was used. Recruitment occurred via printed flyers placed in public locations that were not focused on health care, free classified online advertisements, and electronic flyers within Facebook social groups relevant to the study population. Interviews were conducted via telephone until thematic saturation was achieved. Participant demographics, baseline characteristics, current and past barriers to obtaining contraception, and perception of a pharmacist contraception prescribing model were collected. Interview transcripts were coded in an iterative manner with qualitative data analysis software (MAXQDA, Version 12) until consensus was achieved. Results Fourteen women completed the study. Four primary themes emerged encompassing accessibility, communication, pharmacist attributes, and payment. Thirteen participants would personally utilize a pharmacist prescribing contraceptive service and all stated that this service would be beneficial for other women. Of those women expressing a preference (n = 7), a female pharmacist would be preferred for service delivery. Participants expressed concerns related to access by minors, skills and training of the pharmacist, and environment within the pharmacy. Conclusions Women in Indiana desire broader access to contraception. Efforts should be made at the individual pharmacist‐provider level and statewide to explore strategies to increase access. Resources should be allocated to the creation of protocols for pharmacist prescribing within Indiana and other states.

Chronic obstructive pulmonary disease (COPD) is a debilitating, irreversible disease with currently available therapies targeting symptom control and exacerbation reduction. A need for alternative disease-modifying therapies remains, specifically those that may have antiinflammatory and immunomodulatory properties that impact the pathophysiologic components of COPD. Statin drugs, the current gold standard for the treatment of dyslipidemia and prevention of cardiovascular disease (CVD), contain properties that affect the inflammatory disease processes seen in COPD. Several retrospective studies have demonstrated that statins may have a benefit in the reduction of morbidity and mortality in patients with COPD. This has led to prospective trials evaluating the impact of statins on various COPD-related outcomes. This article reviews the current body of prospective evidence for use of statins in patients with COPD. A search of the PubMed/Medline database of English-language articles was conducted from 1964 through November 2015; references of relevant articles were also reviewed for qualifying studies. Prospective studies of all types relating to statin use in patients with COPD were included if they had COPD- or respiratory-related outcomes; ultimately, eight studies were identified for this review. Statin effects on exacerbation rates, mortality, and inflammatory markers in patients with COPD are discussed. Strong prospective evidence does not currently exist to suggest that statins provide a clinical benefit in patients with COPD who do not have other CVD risk factors. Benefits from statins that have been illustrated are likely explained by their impact on underlying CVD risk factors rather than the COPD disease process. An opportunity exists for unanswered questions to be addressed in future studies.