Michie L, Cameron S T, Glasier A, Larke N, Muir A, Lorimer A
Department of Reproductive and Developmental Sciences, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 5SU, United Kingdom; Chalmers Sexual Health Centre, 2A Chalmers Street, Edinburgh, EH3 9ES, United Kingdom.
Department of Reproductive and Developmental Sciences, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 5SU, United Kingdom; Chalmers Sexual Health Centre, 2A Chalmers Street, Edinburgh, EH3 9ES, United Kingdom.
Contraception. 2014 Oct;90(4):447-53. doi: 10.1016/j.contraception.2014.05.004. Epub 2014 May 14.
In Scotland most women get emergency contraception (EC) from pharmacies. Pharmacists currently cannot provide effective ongoing contraception after EC. In this pilot study, we aimed to determine the feasibility of a larger study designed to ascertain if pharmacy-based interventions can increase the uptake of effective contraception after EC.
This is a pilot study of women presenting for levonorgestrel EC to community pharmacies in Edinburgh, UK, in 2012. Pharmacies were cluster randomized to provide either standard care or one of two interventions: (a) one packet of progestogen-only pills (POPs), giving women 1 month to arrange ongoing contraception; (b) invitation to present the empty EC packet to a family planning clinic (FPC) for contraceptive advice (rapid access).
One hundred sixty-eight women were recruited from 11 pharmacies to POP (n=56), rapid access (n=58) and standard care (N=54) groups, respectively. Telephone follow-up was conducted successfully in 102 women (61%) 6-8 weeks later to determine current contraceptive use. In the POP arm, 35/39 (90%) women used the pills provided, and 9/28 women (32%) in the rapid access arm attended the FPC. The proportion of women using effective contraception at follow-up was significantly greater in both POP [56% (22/39), p=<0.001] and rapid access [52% (13/25), p=0.006] groups compared to standard care [16% (5/31)]. The relative probability of a woman using an effective method of contraception versus barrier/no method, after use of EC, was 3.13 [95% confidence interval (CI), 1.90-5.13] in the POP group and 2.57 (95% CI, 1.55-4.27) in the rapid access group.
This promising pilot study suggests that simple pharmacy-based interventions may increase the uptake of effective contraception after EC. A larger study is required to provide further validation of these findings.
For women obtaining EC from a pharmacy, simple interventions such as supplying 1 month of a POP, or offering rapid access to a FPC, hold promise as strategies to increase the uptake of effective contraception after EC.
在苏格兰，大多数女性从药房获取紧急避孕（EC）药物。目前药剂师在提供紧急避孕药物后无法提供有效的持续避孕措施。在这项试点研究中，我们旨在确定一项更大规模研究的可行性，该研究旨在确定基于药房的干预措施能否增加紧急避孕后有效避孕措施的采用率。
这是一项针对2012年在英国爱丁堡社区药房购买左炔诺孕酮紧急避孕药的女性的试点研究。药房被整群随机分组，分别提供标准护理或两种干预措施之一：（a）一包仅含孕激素的药丸（POPs），让女性有1个月时间安排持续避孕；（b）邀请将空的紧急避孕药物包装带到计划生育诊所（FPC）获取避孕建议（快速通道）。
分别从11家药房招募了168名女性，分为仅含孕激素药丸组（n = 56）、快速通道组（n = 58）和标准护理组（N = 54）。6 - 8周后成功对102名女性（61%）进行了电话随访，以确定当前的避孕措施使用情况。在仅含孕激素药丸组中，35/39（90%）的女性使用了提供的药丸，快速通道组中有9/28名女性（32%）前往了计划生育诊所。与标准护理组[16%（5/31）]相比，仅含孕激素药丸组[56%（22/39），p < 0.001]和快速通道组[52%（13/25），p = 0.006]在随访时使用有效避孕措施的女性比例显著更高。在使用紧急避孕药物后，仅含孕激素药丸组女性采用有效避孕方法相对于屏障避孕法/无避孕措施的相对概率为3.13[95%置信区间（CI），1.90 - 5.13]，快速通道组为2.57（95%CI，1.55 - 4.27）。
这项有前景的试点研究表明，基于药房的简单干预措施可能会增加紧急避孕后有效避孕措施的采用率。需要进行更大规模的研究以进一步验证这些发现。
对于从药房获取紧急避孕药物的女性，诸如提供1个月的仅含孕激素药丸或提供快速通道前往计划生育诊所等简单干预措施，有望成为增加紧急避孕后有效避孕措施采用率的策略。
