Cost, embarrassment and reduced trading hours impede EC access

Despite convenience and anonymity, both patients and pharmacists cite “persistent barriers” to the provision of emergency contraception in the retail pharmacy setting

While patients value the convenience and anonymity that community pharmacy contraception services offer, new research has found there are still barriers to access.

A study led by the NHMRC Centre for Research Excellence in Women’s Sexual and Reproductive Health in Primary Care (SPHERE) reviewed 49 articles, 80% of which involved pharmacist supply of emergency contraception (EC), 14% regular contraception methods, 4% bridging initiatives to link clients with regular contraception and 2% counselling.

Studies were conducted across the US, UK, Canada, Australia, Sweden, France, Switzerland, Poland, Lithuania, Norway and Portugal.

Community pharmacists held overall positive views of their role in dispensing EC or regular contraception, bridging initiatives and education/counselling, the researchers found.

Initiatives were perceived opportunities to increase convenience for patients, promote public health, expand pharmacists’ skills and responsibilities. They also increased perceptions of professional importance.

However there were barriers frequently cited by pharmacists to service provision, according to the paper published in Research in Social and Administrative Pharmacy.

These included lacking confidence and knowledge; lack of private consultation areas, time and work burden; irrelevant or unclear protocols; and lack of receptiveness or interest from women and concern they would not use EC correctly.

Pharmacists reported experiencing difficulty initiating discussions about ongoing contraception.

Across the literature, patients viewed community pharmacy contraceptive services positively and were generally satisfied with the information received during contraceptive counselling.

“The main benefits of pharmacy initiatives for patients were convenience and anonymity,” said SPHERE researchers Pip Buckingham, Dr Natalie Amos, Dr Safeera Hussainy and Professor Danielle Mazza.

“Since the deregulation of EC there has been an apparent shift towards greater acceptance of pharmacists as regular EC providers, and increasing positive perceptions of pharmacy supply of regular contraception,” they wrote.

“However poor implementation and logistical challenges affect the quality of care and resultant negative perceptions by service users.”

Women were more likely to have negative attitudes when logistical factors interfered with the intervention. Logistical or systemic barriers reported by patients included reduced weekend trading hours in regional areas/on weekends and cost.

In Australia, EC pills are available over-the-counter from pharmacies without a prescription and cost between $15 and $45, depending on the type and brand.

And while most patients felt they were treated with respect, some reported negative experiences with pharmacists who may appear judgmental about the patient’s need for EC.

They also cited personal barriers such as feelings of embarrassment.

Overall community pharmacy interventions improved access to contraceptive products but did not consistently reduce inequities.

Promotional materials in pharmacies to prompt conversations can be beneficial, said the researchers.

They further suggested increased collaboration and evaluation of scope-of-practice expansion to examine potential public health impacts.

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