Use of simulated patients to evaluate combined oral contraceptive dispensing practices of community pharmacists.

BACKGROUND: Combined oral contraceptive (COC) use is the most commonly used reversible method of birth control. The incorrect use of COCs is frequent and one of the most common causes of unintended pregnancies. Community pharmacists (CPs) are in a strategic position to improve COC use because they are the last health professional to interact with patients before drug use. OBJECTIVE: To evaluate the COC dispensing practices of CPs in a developing country. METHOD: A cross-sectional study was conducted in community pharmacies of Assis and Ourinhos microregions, Brazil, between June 1, 2012, and October 30, 2012. Four simulated patients (SPs) (with counseled audio recording) visited community pharmacies with a prescription for Ciclo 21(®) (a COC containing ethinyl estradiol 30 mcg + levonorgestrel 15 mcg). The audio recording of every SP visit was listened to independently by 3 researchers to evaluate the COC dispensing practice. The percentage of CPs who performed a screening for safe use of COCs (i.e., taking of patients' medical and family history, and measuring of blood pressure) and provided counseling, as well as the quality of the screening and counseling, were evaluated. RESULTS: Of the 185 CPs contacted, 41 (22.2%) agreed to participate in the study and finished the study protocol. Only 3 CPs asked the SP a question (1 question asked by each professional), and all of the questions were closed-ended, viz., "do you smoke?" (n = 2) and "what is your age?" (n = 1). None of the CPs measured the patient's blood pressure. Six CPs provided counseling when dispensing COCs (drug dosing, 5 CPs; possible adverse effects, 2 CPs), and one CP provided counseling regarding both aspects. CONCLUSION: The CPs evaluated did not dispense COC appropriately and could influence in the occurrence of negatives therapeutic outcomes such as adverse effects and treatment failure.

Do Mexico City pharmacy workers screen women for health risks when they sell oral contraceptive pills over-the-counter?

CONTEXT: In Mexico, oral contraceptives (OCs) are available to women over-the-counter in pharmacies. While past research has suggested that nonmedical providers, such as pharmacy workers, are capable of screening women for contraindications to OCs, little is known about their practices. METHODS: After selecting a 10% random sample of all pharmacies in Mexico City (n = 108), we surveyed the first available pharmacy worker to learn more about pharmacy workers' screening practices when selling OCs over-the-counter to women. RESULTS: While nearly all of the pharmacy workers surveyed had sold OCs without a prescription, only 31% reported asking women any questions before selling pills. Among those who asked questions, the most commonly asked questions were about other medications a woman was taking, about blood pressure and about alcohol intake. Pharmacy workers did not ask these questions consistently to all clients. CONCLUSION: Training pharmacy workers might be one strategy to improve screening of women for pill contraindications. However, pharmacy workers may lack the time and motivation to carry out such screening. An alternative strategy might be to better inform women to self-screen for pill contraindications.

Emergency contraception: pharmacy access in Albuquerque, New Mexico.

OBJECTIVE: Emergency contraception could reduce the approximately 3 million unintended pregnancies that occur annually in the United States. Dedicated emergency contraception products may be particularly useful because instructions are easy to understand and simple to follow. However, they must be available within a few days to women who have had unprotected intercourse. The goal of this study was to investigate whether women presenting to pharmacies in a moderately sized metropolitan area with a prescription for Plan B or Preven could get it filled. METHODS: Two research assistants posed as women needing emergency contraception. They visited 89 pharmacies in Albuquerque, New Mexico, presenting a prescription for either Plan B or Preven. The assistants recorded the availability of the products in the pharmacies. When the product was not in stock, the research assistants asked pharmacy providers why the products were not carried. Fisher exact test was performed to compare categoric data. RESULTS: Plan B and Preven were in stock at only 19 visits (11%). Of the pharmacies that did not stock the products, 53% reported they could obtain Plan B or Preven within 24 hours. The most common reason cited by pharmacy providers for not stocking Plan B or Preven was the lack of prescriptions received for them (65%). CONCLUSION: Plan B and Preven were not in stock at the majority of pharmacies in a moderately sized metropolitan area. Lack of availability at the pharmacy constitutes a major barrier to emergency contraception access.

Cross-border procurement of contraception. estimates from a postpartum survey in El Paso, Texas.

Along the US-Mexico border, US residents have the option of crossing to Mexico in order to purchase hormonal contraception sold over-the-counter at very low prices in pharmacies. We investigated the prevalence of cross-border contraceptive procurement by way of a survey of 3134 women who delivered in a large public hospital in El Paso, Texas, between 1996 and 1997. Pills, injectables, condoms and IUDs were the most commonly used methods by women in the birth interval preceding delivery. Among multiparous women, 41% of pills and 54% of injectables were obtained in Mexico. However, almost all condoms were obtained in the United States. In this largely Hispanic population, the prevalence of cross-border procurement was highest among women who were born and educated in Mexico. Discontinuation of pills and injectables was lower when obtained across the border than in the United States. These findings support the proposition that reducing the medical requirements to acquire pills and injectables and making them available at low cost would augment their use in low-income populations.

Emergency contraception in Mexico City: knowledge, attitudes, and practices among providers and potential clients after a 3-year introduction effort.

Emergency contraception (EC) has the potential to reduce unwanted pregnancy significantly, in Mexico as elsewhere. Recent years have seen tremendous growth in programs and research devoted to expanding access to emergency methods worldwide. In Mexico City, we conducted a pre-intervention/post-intervention research study of one way to introduce EC. Following a baseline survey of family planning providers and clients in 1997, we organized and implemented a three-year program of training for health care providers and a multi-faceted information campaign for the general public, including a national toll-free hotline and website. In 2000, we again surveyed family planning clinic providers and clients, using instruments similar to those employed in the baseline study. EC awareness increased significantly from 13% of clients to 32%, and support jumped from 73% to 83%. Providers at study clinics improved method recognition from 88% to 100%.

Information campaign and advocacy efforts to promote access to emergency contraception in Mexico.

Emergency contraception (EC) has the potential to reduce unwanted pregnancy significantly, in Mexico as elsewhere. Recent years have seen tremendous growth in programs and research devoted to expanding access to emergency methods worldwide. In Mexico we developed a comprehensive model introduction effort that included four components: provider training, public information (through a dedicated hotline and website, free media, paid radio and TV spots, participation in talk shows, and alternative media channels), collaboration with the public sector to include EC in the official family planning norms, and assistance to partner with commercial firms to register a dedicated EC product. Ongoing efforts to combat misperceptions and overcome opposition are crucial to informing the public and ensuring greater access to the method.