A 5-year evaluation of the emergency contraception enhanced community pharmacy service provided in Wales

Mantzourani, Efi; Hodson, Karen; Evans, Andrew; Alzetani, Sarah; Hayward, Rebecca; Deslandes, Rhian; Hughes, Mary; Holyfield, Gareth; Way, Cheryl

doi:10.1136/bmjsrh-2018-200236

Cited by 11 publications

(9 citation statements)

References 24 publications

(22 reference statements)

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“…69 75 77 79 Mantzourani et al noted that 31% of EC consultations included a referral to a sexual health clinic or a general practitioner. 77 Monastersky Maderas and Landau found that pharmacy and clinic partnerships to expand access to injectable contraception resulted in reciprocal referrals. 75 Michie et al concluded that referral by pharmacists to a family planning clinic and pharmacists' provision of progestogen-only contraceptive pill were valuable and could increase the uptake of effective contraception after EC.…”

Section: Contraceptionmentioning

confidence: 99%

Sexual and reproductive health services provided by community pharmacists: a scoping review

et al. 2021

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ObjectivesPharmacists are increasingly providing patient-focused services in community pharmacies, including in the area of sexual and reproductive health (SRH). Specific SRH areas have been the focus of research, but a broader perspective is needed to position pharmacists as SRH providers. This review explored research that described and evaluated professional pharmacy services across a broad range of SRH areas.DesignScoping reviewData sourcesMedline, EMBASE, CINAHL, Web of Science, Scopus and Cochrane Library (January 2007–July 2020).Study selectionStudies reporting on the description and evaluation of professional pharmacy SRH services provided by community pharmacists.Data extractionTwo investigators screened studies for eligibility, and one investigator extracted the data. Data were analysed to primarily describe professional pharmacy services and intervention outcomes.ResultsForty-one studies were included. The main SRH areas and professional pharmacy services reported were sexually transmitted and bloodborne infections (63%) and screening (39%), respectively. Findings showed that pharmacists’ delivery of SRH services was feasible, able to reach vulnerable and high-risk groups, and interventions were highly accepted and valued by users. However, integration into daily workflow, pharmacist remuneration, cost and reimbursement for patients, and policy regulations were some of the barriers identified to implementing SRH services. Studies were primarily in specific areas such as chlamydia screening or hormonal contraception prescribing, while studies in other areas (ie, medical abortion provision, long-acting reversible contraception prescribing and vaccine delivery in pregnant women) were lacking.ConclusionThis scoping review highlights the expansion of pharmacists’ roles beyond traditional product-focused services in a number of SRH areas. Given the potential feasibility, users’ acceptability and reach, pharmacists are ideally situated to enhance SRH care access. Future research describing implementation and evaluation of professional pharmacy services in all SRH areas is needed to promote access to these services through community pharmacies and position pharmacists as SRH providers worldwide.

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Section: Contraceptionmentioning

confidence: 99%

Sexual and reproductive health services provided by community pharmacists: a scoping review

et al. 2021

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“… 6 This finding highlights the potential for providing bridging contraception within retail settings, such as community pharmacies, to reduce repeat emergency contraception use and unintended pregnancies in this group. 35 Importantly, the mean age of women participating in the Bridge-it study was 22 years, highlighting that the intervention reached key age groups; abortion rates in the UK are highest among women aged 20–24 years 30 , 31 and use of emergency contraception highest among women aged 16–24 years. 6 Thus, if the Bridge-it intervention were implemented widely as a service, the use of effective contraception might increase in the relevant age group and among those at greater risk of unintended pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Use of effective contraception following provision of the progestogen-only pill for women presenting to community pharmacies for emergency contraception (Bridge-It): a pragmatic cluster-randomised crossover trial

et al. 2020

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Summary Background Unless women start effective contraception after oral emergency contraception, they remain at risk of unintended pregnancy. Most women in the UK obtain emergency contraception from community pharmacies. We hypothesised that pharmacist provision of the progestogen-only pill as a bridging interim method of contraception with emergency contraception plus an invitation to a sexual and reproductive health clinic, in which all methods of contraception are available, would result in increased subsequent use of effective contraception. Methods We did a pragmatic cluster-randomised crossover trial in 29 UK pharmacies among women receiving levonorgestrel emergency contraception. Women aged 16 years or older, not already using hormonal contraception, not on medication that could interfere with the progestogen-only pill, and willing to give contact details for follow-up were invited to participate. In the intervention group, women received a 3-month supply of the progestogen-only pill (75 μg desogestrel) plus a rapid access card to a participating sexual and reproductive health clinic. In the control group, pharmacists advised women to attend their usual contraceptive provider. The order in which each pharmacy provided the intervention or control was randomly assigned using a computer software algorithm. The primary outcome was the use of effective contraception (hormonal or intrauterine) at 4 months. This study is registered, ISRCTN70616901 (complete). Findings Between Dec 19, 2017, and June 26, 2019, 636 women were recruited to the intervention group (316 [49·6%], mean age 22·7 years [SD 5·7]) or the control group (320 [50·3%], 22·6 years [5·1]). Three women (one in the intervention group and two in the control group) were excluded after randomisation. 4-month follow-up data were available for 406 (64%) participants, 25 were lost to follow-up, and two participants no longer wanted to participate in the study. The proportion of women using effective contraception was 20·1% greater (95% CI 5·2–35·0) in the intervention group (mean 58·4%, 48·6–68·2), than in the control group (mean 40·5%, 29·7–51·3 [adjusted for recruitment period, treatment group, and centre]; p=0·011).The difference remained significant after adjusting for age, current sexual relationship, and history of effective contraception use, and was robust to the effect of missing data (assuming missingness at random). No serious adverse events occurred. Interpretation Provision of a supply of the progestogen-only pill with emergency contraception from a community pharmacist, along with an invitation to a sexual and reproductive health clinic, results in a clinically meaningful increase in subsequent use of effective contraception. Widely implemented, this practice could prevent unintended pregnancies after use of emergency contraception. Funding National Institute for Health Research (Health Technology As...

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“…Secondly, media campaigns to improve awareness of contraception and LARC among young people were introduced in November 2009; however, this only ran for a month, and it was unlikely that the impact lasted as long as the end of our study period in 2013/2014 [ 27 ]. In addition, the Teenage Pregnancy Strategy was introduced in England in 1999, and the policy was implemented for 10 years [ 28 ]; emergency hormonal contraception had been made available free of charge in Scotland from 2008 and in Wales in 2011, which could also contribute to reducing unplanned pregnancies [ 29 , 30 ]. However, our study design shows additional impact of the P4P scheme over underlying trends and in other age groups.…”

Section: Discussionmentioning

confidence: 99%

Impact of a pay-for-performance scheme for long-acting reversible contraceptive (LARC) advice on contraceptive uptake and abortion in British primary care: An interrupted time series study

Cecil

Bottle

et al. 2020

PLoS Med

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Background Long-acting reversible contraception (LARC) is among the most effective contraceptive methods, but uptake remains low even in high-income settings. In 2009/2010, a target-based pay-for-performance (P4P) scheme in Britain was introduced for primary care physicians (PCPs) to offer advice about LARC methods to a specified proportion of women attending for contraceptive care to improve contraceptive choice. We examined the impact and equity of this scheme on LARC uptake and abortions. Methods and findings We examined records of 3,281,667 women aged 13 to 54 years registered with a primary care clinic in Britain (England, Wales, and Scotland) using Clinical Practice Research Datalink (CPRD) from 2004/2005 to 2013/2014. We used interrupted time series (ITS) analysis to examine trends in annual LARC and non-LARC hormonal contraception (NLHC) uptake and abortion rates, stratified by age and deprivation groups, before and after the P4P was introduced in 2009/2010. Between 2004/2005 and 2013/2014, crude LARC uptake rates increased by 32.0% from 29.6 per 1,000 women to 39.0 per 1,000 women, compared with 18.0% decrease in NLHC uptake. LARC uptake among women of all ages increased immediately after the P4P with step change of 5.36 per 1,000 women (all values are per 1,000 women unless stated, 95% CI 5.26–5.45, p < 0.001). Women aged 20 to 24 years had the largest step change (8.40, 8.34–8.47, p < 0.001) and sustained trend increase (3.14, 3.08–3.19, p < 0.001) compared with other age groups. NLHC uptake fell in all women with a step change of −22.8 (−24.5 to −21.2, p < 0.001), largely due to fall in combined hormonal contraception (CHC; −15.0, −15.5 to −14.5, p < 0.001). Abortion rates in all women fell immediately after the P4P with a step change of −2.28 (−2.98 to −1.57, p = 0.002) and sustained decrease in trend of −0.88 (−1.12 to −0.63, p < 0.001). The largest falls occurred in women aged 13 to 19 years (step change −5.04, −7.56 to −2.51, p = 0.011), women aged 20 to 24 years (step change −4.52, −7.48 to −1.57, p = 0.030), and women from the most deprived group (step change −4.40, −6.89 to −1.91, p = 0.018). We estimate that by 2013/2014, the P4P scheme resulted in an additional 4.53 LARC prescriptions per 1,000 women (relative increase of 13.4%) more than would have been expected without the scheme. There was a concurrent absolute reduction of −5.31 abortions per 1,000 women, or −38.3% relative reduction. Despite universal coverage of healthcare, some women might have obtained contraception elsewhere or had abortion procedure that was not recorded on CPRD. Other policies aiming to increase LARC use or reduce unplanned pregnancies around the same time could also explain the findings. ...

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A 5-year evaluation of the emergency contraception enhanced community pharmacy service provided in Wales

Cited by 11 publications

References 24 publications

Sexual and reproductive health services provided by community pharmacists: a scoping review

Sexual and reproductive health services provided by community pharmacists: a scoping review

Use of effective contraception following provision of the progestogen-only pill for women presenting to community pharmacies for emergency contraception (Bridge-It): a pragmatic cluster-randomised crossover trial

Impact of a pay-for-performance scheme for long-acting reversible contraceptive (LARC) advice on contraceptive uptake and abortion in British primary care: An interrupted time series study

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