Hospital-Based Program for Increasing the Availability of Emerge
Hospital-Based Program for Increasing the Availability of Emerge
Purpose: A hospital-based program simulating nonprescription access to emergency contraception (EC) is described. Methods. A collaborative agreement between the pharmacy and therapeutics committee and the pharmacy department was initiated at a safety-net teaching hospital to provide EC to clinic patients directly from the hospital pharmacy without the need to first see a health care provider. EC was available 24 hours per day to any woman requesting it at the hospital pharmacy, with the collaborative agreement serving as the prescription. During clinic hours, patients were directed to the outpatient pharmacy to request EC. After hours, patients went to the emergency department triage desk and were directed to the inpatient pharmacy. Patients making inquiries about EC were encouraged to see their health care provider as soon as possible for counseling about contraceptive options. No specific program was initiated for publicizing the increased availability of EC, as it was assumed that health care providers and word-of-mouth would inform patients of this option.
Results: The program was initiated in the fourth quarter of 2001. Total doses of EC dispensed increased nearly eightfold over the 1.5-year study period since the inception of this program. Most of this increase (81%) was attributable to the collaborative agreement. Twenty-eight percent of EC was dispensed outside of regular clinic hours. No patient complaints regarding this plan were received, and pharmacy staff did not believe that this program presented a significant additional burden to their workload.
Conclusion: A collaborative agreement simulating nonprescription availability increased the use of EC in a hospital-based clinic setting.
Emergency contraception (EC) is a safe and effective means of reducing the occurrence of pregnancy after unprotected intercourse. Two oral doses of levonorgestrel (the most effective and best tolerated medication for this purpose) taken 12 hours apart reduce the expected rate of pregnancy by 79% if taken within 72 hours of intercourse. A single dose of levonorgestrel, although less well studied, appears equally effective, and its adverse effects are minor. Levonorgestrel acts by preventing ovulation or implantation, thus preventing conception. EC cannot interrupt an established pregnancy and is therefore not an abortifacient. Despite its efficacy and safety, EC is underutilized. Factors contributing to its limited use include physicians' and patients' lack of awareness of its existence and efficacy and its availability in many countries only by prescription.
There is consensus among medical and public health organizations that EC should be made available without a prescription, and more than 60 organizations signed a petition sent to the Food and Drug Administration (FDA) in February 2001 to this effect, including the American Public Health Association, American Medical Association, and American College of Obstetricians and Gynecologists. This recommendation to FDA was based on the safety of EC, the lack of contraindications to its use, the need to administer EC as soon as possible after unprotected intercourse to maximize its efficacy, and the anticipated substantial gains in public health from the prevention of unwanted pregnancies. Many countries have already made EC available without a prescription, including the United Kingdom, South Africa, Portugal, Morocco, Israel, France, Finland, Denmark, and Belgium. Despite this support for non-prescription availability, EC remains restricted to prescription-only status in the United States. The cost, inconvenience, and privacy issues surrounding the need for prior medical evaluation may contribute to the currently limited use of EC.
We describe a program at a county safety-net hospital designed to simulate the nonprescription availability of EC. The purpose of this program was to increase the availability of EC to women by obviating the need for them to first see a health care professional. Additional goals were to make EC available 24 hours per day and to allow women to anonymously receive EC.
Purpose: A hospital-based program simulating nonprescription access to emergency contraception (EC) is described. Methods. A collaborative agreement between the pharmacy and therapeutics committee and the pharmacy department was initiated at a safety-net teaching hospital to provide EC to clinic patients directly from the hospital pharmacy without the need to first see a health care provider. EC was available 24 hours per day to any woman requesting it at the hospital pharmacy, with the collaborative agreement serving as the prescription. During clinic hours, patients were directed to the outpatient pharmacy to request EC. After hours, patients went to the emergency department triage desk and were directed to the inpatient pharmacy. Patients making inquiries about EC were encouraged to see their health care provider as soon as possible for counseling about contraceptive options. No specific program was initiated for publicizing the increased availability of EC, as it was assumed that health care providers and word-of-mouth would inform patients of this option.
Results: The program was initiated in the fourth quarter of 2001. Total doses of EC dispensed increased nearly eightfold over the 1.5-year study period since the inception of this program. Most of this increase (81%) was attributable to the collaborative agreement. Twenty-eight percent of EC was dispensed outside of regular clinic hours. No patient complaints regarding this plan were received, and pharmacy staff did not believe that this program presented a significant additional burden to their workload.
Conclusion: A collaborative agreement simulating nonprescription availability increased the use of EC in a hospital-based clinic setting.
Emergency contraception (EC) is a safe and effective means of reducing the occurrence of pregnancy after unprotected intercourse. Two oral doses of levonorgestrel (the most effective and best tolerated medication for this purpose) taken 12 hours apart reduce the expected rate of pregnancy by 79% if taken within 72 hours of intercourse. A single dose of levonorgestrel, although less well studied, appears equally effective, and its adverse effects are minor. Levonorgestrel acts by preventing ovulation or implantation, thus preventing conception. EC cannot interrupt an established pregnancy and is therefore not an abortifacient. Despite its efficacy and safety, EC is underutilized. Factors contributing to its limited use include physicians' and patients' lack of awareness of its existence and efficacy and its availability in many countries only by prescription.
There is consensus among medical and public health organizations that EC should be made available without a prescription, and more than 60 organizations signed a petition sent to the Food and Drug Administration (FDA) in February 2001 to this effect, including the American Public Health Association, American Medical Association, and American College of Obstetricians and Gynecologists. This recommendation to FDA was based on the safety of EC, the lack of contraindications to its use, the need to administer EC as soon as possible after unprotected intercourse to maximize its efficacy, and the anticipated substantial gains in public health from the prevention of unwanted pregnancies. Many countries have already made EC available without a prescription, including the United Kingdom, South Africa, Portugal, Morocco, Israel, France, Finland, Denmark, and Belgium. Despite this support for non-prescription availability, EC remains restricted to prescription-only status in the United States. The cost, inconvenience, and privacy issues surrounding the need for prior medical evaluation may contribute to the currently limited use of EC.
We describe a program at a county safety-net hospital designed to simulate the nonprescription availability of EC. The purpose of this program was to increase the availability of EC to women by obviating the need for them to first see a health care professional. Additional goals were to make EC available 24 hours per day and to allow women to anonymously receive EC.
Source...