Academic journal article American Journal of Pharmaceutical Education

Active-Learning Instruction on Emergency Contraception Counseling

Academic journal article American Journal of Pharmaceutical Education

Active-Learning Instruction on Emergency Contraception Counseling

Article excerpt

INTRODUCTION

Emergency contraception is used to reduce the risk of pregnancy following unprotected intercourse or contraceptive failure. (1) From 2006 to 2008, an estimated 10% of American women used emergency contraception. (2) Levonorgestrel is available by prescription for patients younger than 15 years. For patients aged 15 years and older, the product is available behind the pharmacy counter and can only be obtained by asking the pharmacist. This provides pharmacists with an opportunity to counsel patients on the use of emergency contraception and the importance of using regular birth control. Pharmacists in 9 states have the authority to dispense emergency contraception without a prescription regardless of the patient's age if working with a physician in a collaborative practice agreement. (3) In order to ensure that pharmacists are comfortable with counseling patients regarding emergency contraception it is important to incorporate this information into the pharmacy curriculum.

The mechanism by which emergency contraception works has always been a controversial topic. There have been many articles published discussing the proposed pharmacology. According to the Food and Drug Administration's (FDA's) product labeling, levonorgestrel works primarily by altering tubal transport of ova and/ or sperm, thus inhibiting ovulation and fertilization, and in turn inhibiting implantation. The drug is not effective once implantation has occurred. The 2 levonorgestrel dosing regimens available are a 1.5 mg tablet taken as a onetime dose (Plan B One Step) and a 0.75 mg tablet taken in 2 doses, 12 hours apart (Next Choice). With either product, the medication needs to be taken within 72 hours after unprotected intercourse for maximum efficacy. (4) The most common adverse reactions include nausea, abdominal pain, headache, fatigue, and menstrual changes. (5) Ulipristal (Ella), a prescription-only medication for emergency contraception, was approved in the United States in August 2010. It is administered as a 30 mg tablet taken within 120 hours after unprotected intercourse or contraceptive failure. (4,6) Research studies within the US (7-9) and international (10-12) medical communities have demonstrated that practitioner knowledge of emergency contraception is lacking. Physicians and nurses who received education on emergency contraception were more likely to counsel on the topic in the future. (10) A study conducted among New Mexico pharmacists found that 36% of respondents incorrectly believed emergency contraception was RU486, the "abortion pill" (in contrast to emergency contraception, RU-486 terminates a pregnancy). (13)

Barriers to patient access of emergency contraception have been identified, but in contrast, barriers to a pharmacist's willingness to counsel on emergency contraception are not well known. A survey of pharmacists and technicians showed that patient gender was not a barrier to access. (14) A study outside of the United States found that one of pharmacists' main barriers to the provision of emergency contraception was religious opposition to use of the product. (15) In a 2010 American College of Obstetricians and Gynecologists Practice Bulletin on emergency contraception, experts expressed the need for health care providers to understand barriers, especially for younger women, and their implications on clinical practice. (16) It was of interest to the study investigators to assess potential pharmacy student barriers to the provision of emergency contraception counseling.

A few studies have assessed pharmacy students' knowledge of emergency contraception. Approximately a third of pharmacy students at the University of Arkansas's College of Pharmacy reported that they did not know the mechanism of action of levonorgestrel and only 4% knew the appropriate time frame for effectiveness. Only 26.7% agreed that they felt competent instructing patients on the appropriate use of emergency contraception. …

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