Tracey A. Wilkinson

Access to Emergency Contraception After Removal of Age Restrictions.

Same-day access to EC is examined nationally by using mystery callers. Persistent barriers remain despite regulatory changes that started in 2013, which made it OTC. BACKGROUND: Levonorgestrel emergency contraception (EC) is safe and effective for postcoital pregnancy prevention. Starting in 2013, the US Food and Drug Administration removed age restrictions, enabling EC to be sold over the counter to all consumers. We sought to compare the availability and access for female adolescents with the 2012 study, using the same study design. METHODS: Female mystery callers posing as 17-year-old adolescents in need of EC used standardized scripts to telephone 979 pharmacies in 5 US cities. Using 2015 estimated census data and the federal poverty level, we characterized income levels of pharmacy neighborhoods. RESULTS: Of 979 pharmacies, 827 (83%) indicated that EC was available. This proportion did not vary by pharmacy neighborhood income level, nor was significantly different from the 2012 study (P = .78). When examining access, 8.3% of the pharmacies reported it was impossible to obtain EC under any circumstances, which occurred more often in low-income neighborhoods (10.3% vs 6.3%, adjusted odds ratio 1.5; 95% confidence interval 1.20–1.94). This was not significantly different from 2012 (P = .66). Correct information regarding over-the-counter access was conveyed only 51.6% of the time; accuracy did not differ by pharmacys neighborhood income (47.9% vs 55.3%, adjusted odds ratio 0.89; 95% confidence interval 0.71–1.11) and was not significantly different from 2012 (P = .37). CONCLUSIONS: A majority of pharmacies have EC available; however, barriers to and disparities in access for adolescents persist and have not changed since the previous study despite regulatory changes that were designed to improve access to EC.

Evaluating Community Pharmacy Responses About Levonorgestrel Emergency Contraception by Mystery Caller Characteristics

PURPOSE Since restrictions on nonprescription sales were removed in 2013, levonorgestrel emergency contraception (EC) should be available without a prescription at pharmacies for consumers of all genders and ages. Using mystery callers, we assessed variations in availability of and access to EC. METHODS In 2015-2016, three sets of mystery callers (two female physicians, two adolescent females, and two adolescent males) each called all licensed retail pharmacies in five U.S. cities using standardized call scripts. Scripts assessed same-day availability and subsequent access to EC for 17-year-olds. Data on various characteristics of calls were collected and compared by caller type. RESULTS Among the 993 pharmacies called, same-day availability for EC was approximately 80%, with no differences by caller types (p = .34). However, 10.7% of calls made by the adolescent male caller and 8.3% made by the adolescent female caller resulted in incorrectly being told they could not obtain EC based on age, compared to only 1.6% of calls made by the physician (p < .01). Pharmacy staff stated correctly that EC was available over-the-counter more often to adolescent male callers (62.0%) than adolescent females (51.6%) or female physicians (57%) (p < .01). Physicians were more likely to be placed on hold, talk to a pharmacist, or be transferred to a pharmacist (p < .01) than adolescents. CONCLUSIONS Persistent barriers to accessing EC exist for adolescents despite regulatory changes to make EC available over-the-counter, especially for females. Additional work to remove these barriers is needed to assure timely access for those who require effective pregnancy prevention.

Exploring adolescents’ current sources and learning preferences about contraception in a US paediatric emergency department

In the USA, adolescents who seek care in emergency departments have been shown to be a group at increased risk of pregnancy and sexually transmitted infections because of misuse or non-use of contraception.1 Schools are often their traditional source of sexual health education, but school curricula vary greatly, are not always medically accurate, and may focus on abstinence-only education.2 In addition, adolescents are less likely to have primary care providers and thus may miss opportunities to receive contraceptive counselling,the emergency department being their only contact with a clinician.1 Several studies have shown that adolescent females are interested in being educated about contraception in emergency departments.3 4 We assessed male and female adolescents’ current and most trusted sources of contraception education, as well as their interest and preferences for contraception education in the emergency department. We surveyed a convenience sample of English-speaking adolescents aged 14–21 …

Feasibility of using text message reminders to increase fulfilment of emergency contraception prescriptions by adolescents

Emergency contraception (EC) is a safe and effective form of pregnancy prevention after intercourse, but its efficacy decreases with time.1 ,2 Having EC in advance of need enables it to be taken soon after unprotected intercourse, thus maximising its effect. EC is available over-the-counter in the USA without age restrictions, but many clinicians provide EC in advance to their patients as a means of eliminating residual barriers to access.3–5 In a randomised pilot study among sexually active women in an urban adolescent clinic, we examined the feasibility of using text messages as a convenient mechanism to remind adolescents to fulfil their advance EC …