Emergency contraception — direct from the pharmacist
Collaborative practice means easier access for women
The condom broke on Friday night. The pack of pills stayed at home on a weekend trip. What can a woman do to protect herself against an unplanned pregnancy when her local health care provider’s office is closed?
Work is now under way to expand access in a number of areas in North America so that pharmacists can directly dispense emergency contraceptive pills (ECPs) under collaborative agreements with local providers
Availability from coast to coast
If such efforts are successful, expanded access to the pregnancy prevention method may spread from California and Oregon to Washington, where collaborative therapy already is under way, to Alaska and British Columbia, opening a North American territory of expanded access to ECPs, according to Jane Hutchings, MPH, senior program officer at Program for Appropriate Technology in Health (PATH), a Seattle-based health organization.
PATH is just one of more than 20 members of the Consortium for Emergency Contraception, an international working group whose focus is to make emergency contraception (EC) a standard part of reproductive health care around the globe. (The Consortium has just published Expanding Global Access to Emergency Contraception, which includes updated medical and service delivery guidelines; see ordering information at end of article.)
In the United States, groups in Alaska, California, Oregon, Kentucky, New Jersey, Pennsylvania, Rhode Island, South Dakota, and Texas are working with the "EC Does It" project coordinated by the ProChoice Resource Center, a nonprofit reproductive rights advocacy organization based in Port Chester, NY. (See resource information at end of article.) The project is aimed at creating and sustaining a favorable public policy environment in support of greater access to EC, as well as reforming policies that restrict such access, according to project coordinator Amy Fitzgibbons.
British Columbia moves
As of Dec. 1, 2000, women in British Columbia are able to access ECPs directly from pharmacists under new prescriptive law. More than 800 pharmacists already have trained in EC provision, and about 50 more signed up for education when the announcement was made in late October, states Judith Chrystal, director of communications of the Richmond-based British Columbia Pharmacy Association.
Prescriptive authority allowing pharmacists to independently prescribe a medication is a first in Canada, says Chrystal.
The prescriptive authority is limited; the only prescription product pharmacists can independently prescribe is ECP. The need for ongoing contraception and the possibility of sexually transmitted diseases will be reviewed by the pharmacist with each woman requesting ECPs, and women will be referred to a physician for ongoing care, according to Chrystal.
The prescriptive authority in British Columbia differs from the collaborative practice model used in the Washington state project, states Chrystal. (See the August 1999 issue of Contraceptive Technology Update for an overview of the Washington state project.)
She says British Columbia has four "drug schedules" that group medications into:
• prescription only — physician;
• nonprescription, but must be behind the pharmacy counter;
• available over the counter;
• the new one: prescription only — pharmacist may prescribe.
"The pharmacists do not need a physician’s approval to prescribe ECP," Chrystal says.
The British Columbia public education campaign to increase awareness of ECP and introduce the availability of ECP directly from pharmacists will include distribution of information on the Emergency Contraception Hotline (888) NOT-2-LATE and its companion Web site, not-2-late.com), posters and shelf cards placed in participating pharmacies, mass transit and radio advertising aimed at women ages 18-34, and educational information to physicians, public health nurses, hospital emergency rooms, and women’s health centers.
Alaska pushes forward
Alaska EC proponents have been working on a number of fronts to not only expand EC access through collaborative drug therapy with local pharmacists, but to see that EC is covered under medical insurance and available in local emergency departments statewide. While there is work to do on each front, progress is being made, according to Colleen Murphy, MD, FACOG, an Anchorage physician and leader of the Alaska Emergency Contraception Project.
A protocol to allow collaborative pharmacy drug therapy under an agreement with physicians is being reviewed by the state medical and pharmacy boards. The interest in EC in Alaska has grown with the recognition of the state’s high rate of unintended pregnancies, says Murphy.
"What I think works here, at least on a local level, is just pounding away at the issue of unintended pregnancy because you just can’t deny those statistics," she says.
What began as a proposed pilot project to provide ECPs under collaborative agreements in seven Oregon counties may blossom into a statewide effort if legislation continues apace, reports Mary Jeanne Kuhar, MD, a Bend, OR, physician and Oregon Medical Association member who has been active in the project. (CTU reported on the initial project in its August 1999 issue.)
A bill to allow collaborative therapy has been introduced in the state legislature, says Kuhar. If approved, protocol will have to be drafted and education put in place, she notes. A successful effort will include education of the physicians and pharmacists participating in the protocol, as well as the public, to inform them that the EC option exists and that ECPs are not an "abortion pill," notes Kuhar.
The process might take up to a year, but such work is necessary because the current collaborative drug therapy rules in Oregon are extremely restrictive, says Kuhar.
California pushes access
California, through the Pharmacy Access Partnership, is launching a major effort to expand consumer access to contraceptive commodities such as ECPs, says Jane Boggess, PhD, director of the statewide effort. This collaborative effort is bringing public health officials, reproductive rights advocates as well as pharmacy stakeholders together to attain this goal, she states.
Legislation went into effect in January 2000 that permits pharmacists to administer ECP under collaborative protocol to clients of the authorizing health care facility, says Boggess. There are major differences, however, between Washington state and California in the restrictions governing those protocols, she explains.
In Washington, the State Board of Pharmacy must approve all collaborative protocols, says Boggess. In California, no such approval is required, but the protocols only apply to the clients enrolled in the authorizing health care agency. Thus, in Washington, any consumer in need of ECP can obtain it from a participating pharmacy. In California, only clients of the authorizing health care facility can access ECP from a participating pharmacy, states.
The project is creating between 10 to 15 pharmacy-based demonstration sites in California that will allow women to directly access ECP in pharmacies without a prescription.
"We are currently in the process of developing these local partnerships in San Diego, Los Angeles, Marin, San Francisco, Santa Cruz, San Luis Obispo, Santa Barbara, and San Joaquin counties," states Boggess. "The providers include local health departments, community-based organizations, Planned Parenthood, university health services, and Medicaid managed care plans."
Pharmacists have new role
Statewide certificate program training to promote local collaborative protocols, sponsored by the Sacramento-based California Pharmacists Association, will enable pharmacists to offer a range of reproductive health services and commodities, including ECPs, says Boggess.
Training also will be available to promote new practices among clinical providers that emphasize a much stronger role for pharmacists in the health care consultative team, she adds. "Part of the message delivered in this training will be the importance of consumer access and choice around contraceptive commodities."
(Editor’s note: With the recent approval of mifepristone in the United States, providers need to clear up any confusion between the abortion drug and ECPs. See "Make the distinction: EC prevents pregnancy," in this issue of CTU.)
Resources
For a copy of Expanding Global Access to Emergency Contraception, published by the Consortium for Emergency Contraception, contact:
• Kimberly Evans, c/o PATH, 4 Nickerson St., Seattle, WA 98109. Telephone: (206) 285-3500. Fax: (206) 285-6619. E-mail: [email protected]. Providers also may order Emergency Contraceptive Pills: Medical and Service Delivery Guidelines, also printed in Expanding Global Access, but offered as a freestanding document for use in training and/or distribution to medical providers. Both publications are available free of charge while supplies last.
For information on the ProChoice Resource Center, contact:
• ProChoice Resource Center, 16 Willett Ave., Port Chester, NY 10573-4326. Telephone: (800) 733-1973. Fax: (914) 690-0958. E-mail: [email protected]. For information on the "EC Does It" project, contact Amy Fitzgibbons at (202) 530-2900.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.