The developing role of pharmacists in patient access to emergency contraception

Unintended pregnancy and subsequent abortion remain major public health issues in many countries, despite evidence that post-coital emergency contraceptives have a good safety profile, are easy to use, and are effective in preventing unwanted pregnancies. Although emergency contraceptives have been prescribed in developed countries for more than 25 years, abortion rates have continued to rise steadily in many jurisdictions. Barriers to the use of emergency contraceptives reduce ready access of women to this birth control option. Because the effectiveness of emergency contraceptives is time dependent, establishing prescribing and dispensing mechanisms that are convenient to women is crucial to their ability to use the therapy in a timely manner. Emergency contraceptives in developed countries are traditionally prescribed by physicians in organized healthcare settings. In these countries, pharmacists are ideally situated to improve patient access to emergency contraceptives, since community pharmacies are widely available in both urban and rural settings and are open extended hours. Innovative initiatives using a variety of regulatory mechanisms now allow pharmacists a greater role in prescribing and distributing emergency contraceptives. In Washington State, USA, pharmacists entering into a collaborative drug therapy agreement with a physician or nurse practitioner can initiate emergency contraceptives based on a prescribing protocol. Several local programs in the United Kingdom have utilized accredited community pharmacists to supply emergency contraceptives using a patient group directive. In British Columbia, Canada, specially-certified pharmacists with independent prescriptive authority utilize an informed consent during the interactive consultation with the potential emergency contraceptive user. In yet other jurisdictions, emergency contraceptives have been transferred to over-the-counter (OTC) status. Relevant public health research questions can now be posed. Future studies will be able to compare the effectiveness of various regulatory mechanisms to expand access, to identify and address potential drawbacks of pharmacist-initiated) emergency contraceptives, and to explore whether pharmacist-initiated prescriptions represent expanded access or simply a transfer of the prescribing of these agents from physicians to pharmacists. Countries with OTC emergency contraceptives will be able to explore the relationship between varying levels of pharmacist interaction with emergency contraceptive users and health outcomes, and to investigate whether the change in prescriptive status has resulted in unintentional barriers to access for populations such as teenagers and those with restricted discretionary income. These findings will provide valuable new information on the impact of initiatives designed to expand access to emergency contraceptives.