Transcript Emergency Contraception

What if ?
A condom broke or slipped
off, you had sex when you
didn’t expect to, you didn’t
use any birth control that
weekend, you stopped taking
birth control pills temporarily,
or missed several pills, your
diaphragm slipped out of
place…..
Options
• Do nothing because you don’t know
about EC
• Call a provider and get an
appointment
• Fill an advance prescription
• Take meds your provider gave you at
your last annual exam
• Go to the drugstore and buy meds
Do nothing because you
don’t know about EC
• Kaiser Family Foundation Study, 2004
– 57% of women had heard of
ECPs/morning-after pills
– Only 7% had heard about it from a health
care provider
– Only 6% of women had ever used ECPs
– 50% confused it with the “abortion pill”
Call a provider and get an
appointment
• Study using callers posing as women
who had a condom break and called
1-888-not-2-late for assistance.
– 76% of attempts resulted in an
appointment or telephone Rx within 72
hours.
Fill an advance
prescription
• No studies to determine if this
effective but…………
Rx Availability of EC in
Albuquerque
• All pharmacies in ABQ visited by two
research assistants. One assistant in
her 40s, one in her 20s
• Presented a written Rx for either
Preven or Plan B
– “I would like to know if I could get this
filled and how much it will cost?”
Rx Availability
Plan B visits Preven visits Total visits
On shelf
6 (7%)
13 (15%)
19 (11%)
Within 24
hrs
> 24 hrs
35 (39%)
27 (30%)
62 (35%)
26 (29%)
30 (34%)
56 (31%)
Never
21 (24%)
15 (17%)
36 (20%)
Rx Availability
Day of Week
Fri, Sat, Sun
Mon-Thurs
On shelf
4 (8%)
14 (12%)
Within 24 hrs
6 (12%)
56 (46%)
> 24 hrs
35 (70%)
21 (17%)
Never
5 (10%)
30 (25%)
Helpfulness of Pharmacy
Providers
Over 24
hours
Never
available
Total
Helpful
16 (31%)
2 (6%)
18 (21%)
Somewhat
helpful
16 (31%)
15 (44%)
31 (36%)
Unhelpful
19 (37%)
17 (50%)
36 (42%)
Reasons not available
Plan B
Preven
Total
Lack of need
45 (68%)
43 (69%)
88 (65%)
Corporate
policy
Individual
ethics
Carry other
product
2 (3%)
6 (10%)
8 (6%)
6 (9%)
3 (5%)
9 (7%)
7 (11%)
2 (3%)
9 (7%)
6 (9%)
8 (13%)
14 (11%)
Don’t know
Conclusions
• There is a lack of availability of
dedicated products for EC in
Albuquerque
• The main reason for a pharmacy not
to have such medications is lack of
demand for the products
• Availability on weekends is less than
during the week
Take meds your provider gave
you at your last annual exam
• Raine et al, 2000
– Patients given meds 3x more likely to
use EC than those only counseled
– No increase in risk behaviors
• Glaiser et al, 1997
– Significantly more likely to use meds if
they had been given them vs. told how
they could get them
– No difference in number who used >1x
Provider Practice: Good News
100%
OB/GYNs
80%
FPPs
60%
40%
20%
0%
Ever prescribed ECPs
Prescribed ECPs Last Year
The Henry J. Kaiser Foundation 2001
Provider Practice: Bad News
100%
OB/GYNs
80%
FPPs
60%
40%
20%
0%
Prescribed More Than Five Times
Among Those Who Prescribed
Rountinely Discuss EC
The Henry J. Kaiser Foundation 2001
The Clinical Bottleneck
• Clinicians overwhelmingly think ECPs
are safe and effective, and the
majority have prescribed in the last
year
• Clinicians are waiting for women to
ask for EC
The Clinical Bottleneck
• But women do not know to ask
• Kaiser Family Foundation Study, 2004
– 57% of women had heard of ECPs/morningafter pills
– Only 7% had heard about it from a health care
provider
– Only 6% of women had ever used ECPs
– 50% confused it with the “abortion pill”
Go to the drugstore and buy
meds without a prescription
• Maybe…
–Currently
• If you are in one of 6 states in the US
• If you go to the right pharmacy at the right
time
– Future
• If becomes OTC
Emergency Contraception BTC
• ECPs are available directly from
pharmacists without having first to get
a prescription from a clinician in:
–WA,CA,NM,AK,HI,ME
–British Columbia
–France
–United Kingdom
–South Africa
–Portugal
–Belgium
–Albania
–Denmark
–Sweden
“Behind the Counter”
• Currently about 160 pharmacists in
NM are trained
• Can find out about availability at
– http://ec.princeton.edu
Current Status of OTC-EC in
the U.S.
• Petition filed by 70 organizations in 2/2001.
• Barr Corp. filed for OTC status 4/2003
• FDA advisory panel voted 23-4 in 12/03 to
make Plan B OTC.
• FDA issued “Not approvable” letter, 5/2004
• Barr submitted revised application 7/2004
• President Bush re-elected 11/2004
Strategies to Improve Use of EC
• Routine discussion of EC during
office visits
• Provide advance prescriptions/meds
• Abandon unnecessary requirements
such as pregnancy testing/physical
examination for women seeking EC
• Make products available over the
counter
• Increase demand!
Increasing Demand
• Provider education
– ACOG “call to action” in 4/02 and mailing in
2/02
• Patient education
– State EC working group
– Clinical Prevention Initiative subcommittee on
unintended pregnancy recently formed
– “Back up Your Birth Control” program by
Reproductive Health Technologies project
• Useful websites
– plannedparenthood.com
– Backupyourbirthcontrol.org
– Ec.princeton.edu
• A 27 yo G3 P3,
married patient calls
your office saying
she and her husband
noted the condom
was broken after sex
the night before.
What should she
do??
What I really want you to
know!
• What form of EC is most effective
– IUD>progestin only>combination
• Talk to every reproductive age woman at
risk for pregnancy about EC
• Provide EC in advance
• Support ECP to be available over the
counter.