1. What if ? ?
A condom broke or slipped off, you had sex when you didn’t expect to, you didn’t use any birth control that weekend, you stopped taking birth control pills temporarily, or missed several pills, your diaphragm slipped out of place…..

3. Options Do nothing because you don’t know about EC
Call a provider and get an appointment
Fill an advance prescription
Take meds your provider gave you at your last annual exam
Go to the drugstore and buy meds

4. Do nothing because you don’t know about EC
Kaiser Family Foundation Study, 2004
57% of women had heard of ECPs/morning-after pills
Only 7% had heard about it from a health care provider
Only 6% of women had ever used ECPs
50% confused it with the “abortion pill”

5. Call a provider and get an appointment
Study using callers posing as women who had a condom break and called not-2-late for assistance.
76% of attempts resulted in an appointment or telephone Rx within 72 hours.

6. Fill an advance prescription
No studies to determine if this effective but…………

7. Rx Availability of EC in Albuquerque
All pharmacies in ABQ visited by two research assistants. One assistant in her 40s, one in her 20s
Presented a written Rx for either Preven or Plan B
“I would like to know if I could get this filled and how much it will cost?”

8. Rx Availability Plan B visits Preven visits Total visits On shelf
6 (7%)
13 (15%)
19 (11%)
Within 24 hrs
35 (39%)
27 (30%)
62 (35%)
> 24 hrs
26 (29%)
30 (34%)
56 (31%)
Never
21 (24%)
15 (17%)
36 (20%)

9. Rx Availability Day of Week
Fri, Sat, Sun
Mon-Thurs
On shelf
4 (8%)
14 (12%)
Within 24 hrs
6 (12%)
56 (46%)
> 24 hrs
35 (70%)
21 (17%)
Never
5 (10%)
30 (25%)

10. Helpfulness of Pharmacy Providers
Over 24 hours
Never available
Total
Helpful
16 (31%)
2 (6%)
18 (21%)
Somewhat helpful
15 (44%)
31 (36%)
Unhelpful
19 (37%)
17 (50%)
36 (42%)

11. Reasons not available Plan B Preven Total Lack of need 45 (68%)
43 (69%)
88 (65%)
Corporate policy
2 (3%)
6 (10%)
8 (6%)
Individual ethics
6 (9%)
3 (5%)
9 (7%)
Carry other product
7 (11%)
Don’t know
8 (13%)
14 (11%)

12. Conclusions
There is a lack of availability of dedicated products for EC in Albuquerque
The main reason for a pharmacy not to have such medications is lack of demand for the products
Availability on weekends is less than during the week

13. Take meds your provider gave you at your last annual exam
Raine et al, 2000
Patients given meds 3x more likely to use EC than those only counseled
No increase in risk behaviors
Glaiser et al, 1997
Significantly more likely to use meds if they had been given them vs. told how they could get them
No difference in number who used >1x

14. Provider Practice: Good News
The Henry J. Kaiser Foundation 2001

15. Provider Practice: Bad News
The Henry J. Kaiser Foundation 2001

16. The Clinical Bottleneck
Clinicians overwhelmingly think ECPs are safe and effective, and the majority have prescribed in the last year
Clinicians are waiting for women to ask for EC

17. The Clinical Bottleneck
But women do not know to ask
Kaiser Family Foundation Study, 2004
57% of women had heard of ECPs/morning-after pills
Only 7% had heard about it from a health care provider
Only 6% of women had ever used ECPs
50% confused it with the “abortion pill”

18. Go to the drugstore and buy meds without a prescription
Maybe…
Currently
If you are in one of 6 states in the US
If you go to the right pharmacy at the right time
Future
If becomes OTC

19. Emergency Contraception BTC
ECPs are available directly from pharmacists without having first to get a prescription from a clinician in:
WA,CA,NM,AK,HI,ME
British Columbia
France
United Kingdom
South Africa
Portugal
Belgium
Albania
Denmark
Sweden

20. “Behind the Counter” Currently about 160 pharmacists in NM are trained
Can find out about availability at

21. Current Status of OTC-EC in the U.S.
Petition filed by 70 organizations in 2/2001.
Barr Corp. filed for OTC status 4/2003
FDA advisory panel voted 23-4 in 12/03 to make Plan B OTC.
FDA issued “Not approvable” letter, 5/2004
Barr submitted revised application 7/2004
President Bush re-elected 11/2004

22. Strategies to Improve Use of EC
Routine discussion of EC during office visits
Provide advance prescriptions/meds
Abandon unnecessary requirements such as pregnancy testing/physical examination for women seeking EC
Make products available over the counter
Increase demand!

23. Increasing Demand Provider education Patient education Useful websites
ACOG “call to action” in 4/02 and mailing in 2/02
Patient education
State EC working group
Clinical Prevention Initiative subcommittee on unintended pregnancy recently formed
“Back up Your Birth Control” program by Reproductive Health Technologies project
Useful websites
plannedparenthood.com
Backupyourbirthcontrol.org
Ec.princeton.edu

25. A 27 yo G3 P3, married patient calls your office saying she and her husband noted the condom was broken after sex the night before. What should she do??

26. What I really want you to know!
What form of EC is most effective
IUD>progestin only>combination
Talk to every reproductive age woman at risk for pregnancy about EC
Provide EC in advance
Support ECP to be available over the counter.