Survey Methods
In 2002, Dr. Wendy Bennett, MD, MPH, and the Duvall Project surveyed 315, or 10%, of licensed Pennsylvania pharmacies. Two female researchers posed as community members seeking information about EC, presumably for themselves. The calls opened with a general question:
“A friend told me about something called emergency contraception. I think you can use it after unprotected sex. I wonder if you could tell me something about it?”
The opening question was followed by a number of questions and prompts for more information regarding EC and its side effects.
Findings
Our findings reveal a significant lack of availability of EC throughout the state. While almost half of pharmacists surveyed knew that EC contains higher doses of the hormones found in birth control pills, only 35% said they could fill a prescription for EC that day. Additionally, while one-third were able to state the correct timeframe for EC (72 hours)*, 13% said it was an abortion method, either confusing it with the early abortion pill mifepristone (also know as RU-486), or stating that “it will cause an abortion.”
Access to EC in Pennsylvania Pharmacies
Most of the pharmacists surveyed (79%) knew that EC is a prescription only medication. About half (52%) of the pharmacists recommended Preven, 12% recommended Plan B, and only 11% recommended birth control pills. Unfortunately, one-fifth (21%) of the pharmacists did not provide a product name, and 13% replied they did not know what the caller should ask for when she called her physician.
“Can You Fill a Prescription Today?”
The majority of pharmacists (65%) said they could not fill a prescription for EC that day (Figure 1). The most common reason (79%) was that the product was not in stock (Figure 2). A pharmacist’s answer to the survey question “Can you fill a prescription today?” revealed not only whether the pharmacy stocked any EC products, but also whether the pharmacist possessed enough information about EC to know that certain oral contraceptives can be used as a substitute. It is important to note that all pharmacies presumably carry one of the many brands of oral contraceptives that can be used as emergency contraception and therefore should be able to fill a prescription.
Other reasons pharmacists reported for being unable to fill a prescription, while less common, are problematic. Some indicated that EC conflicted with their personal beliefs (6%) and others that EC conflicted with store policy (7%).
Role of Pharmacist Knowledge
The survey showed a strong association between pharmacist knowledge and pharmacist ability or willingness to distribute EC. Pharmacists who incorrectly identified EC as an abortion method were about one-third less likely to provide EC, while those who knew that EC consists of higher doses of hormones were two times more likely to provide EC. This shows that pharmacists’ knowledge can be a determining factor in EC availability. Increased pharmacist education, then, could increase access to EC.
Pharmacists identified other factors that impede access to EC, including lack of consumer demand and lack of communication from pharmaceutical companies about the product.
Common Misconceptions
Because EC is a time sensitive medication, inaccurate information can be just as detrimental as no information at all. Examples of common misconceptions in the survey included: EC is an abortion method, the pills have to be taken within 24 hours, and that EC is not available in the United States. Additionally, some pharmacists offered incorrect product names (“Previa”), or gave inaccurate information about how EC works (“It basically causes uterine contractions which causes a miscarriage”).
What's Next? Improving Pharmacist Education and Communication
The education of women, clinicians, and pharmacists is essential to increased access. Our survey suggests that many PA pharmacists do not have accurate and sufficient information about emergency contraception, which is related to the low proportion of pharmacists dispensing EC.
We suggest several targeted strategies to reduce pharmacists’ misconceptions and increase the likelihood that EC will be provided at a given pharmacy:
- Development of educational campaigns targeted at community pharmacists and pharmacy students, using such resources as the continuing medical education booklet from the American Pharmaceutical Association.
- Further education of women and clinicians in order to increase the number of EC prescriptions pharmacists receive, offering them incentive to stock and understand EC products.
- Encouraging clinicians to follow the recommendations of the American College of Obstetrics and Gynecology (ACOG) by providing advance prescriptions during routine visits.
- Seeking changes in state laws to promote “collaborative agreements,” which allow specially trained pharmacists to dispense EC to women without a prescription, increasing the chances a woman has of receiving the regimen in a timely manner. Washington, Alaska, California, and New Mexico have increased access to EC through such collaborative agreements.
- Supporting efforts like those of Barr Pharmaceuticals, the makers of Plan B, to make emergency contraception available over the counter nationwide.
Conclusions
Among health professionals, community pharmacists are in a unique position to increase access to emergency contraception. The results of this survey suggest that community pharmacists in Pennsylvania do not currently have sufficient or accurate information about EC, and that their lack of information relates to the low proportion of pharmacists in the state able to dispense emergency contraception.
Increasing pharmacist education, as well as creating greater community demand for EC, will require the cooperation of clinicians, pharmaceuticals companies, and women’s health organizations. Together with pharmacists, these groups can ensure access to emergency contraception for every woman who may need it by offering accurate information and timely provision of this safe and effective option for pregnancy prevention.
Written by intern Kate Duffy in 2003.
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