Rafie Sally, Stone Rebecca H, Wilkinson Tracey A, Borgelt Laura M, El-Ibiary Shareen Y, Ragland Denise
Department of Pharmacy, UC San Diego Health, San Diego, CA.
Department of Clinical and Administrative Pharmacy, University of Georgia, College of Pharmacy, Athens, GA.
Integr Pharm Res Pract. 2017 Mar 23;6:99-108. doi: 10.2147/IPRP.S99541. eCollection 2017.
Women and couples continue to experience unintended pregnancies at high rates. In the US, 45% of all pregnancies are either mistimed or unwanted. Mishaps with contraceptives, such as condom breakage, missed pills, incorrect timing of patch or vaginal ring application, contraceptive nonuse, forced intercourse, and other circumstances, place women at risk of unintended pregnancy. There is a critical role for emergency contraception (EC) in preventing those pregnancies. There are currently three methods of EC available in the US. Levonorgestrel EC pills have been available with a prescription for over 15 years and over-the-counter since 2013. In 2010, ulipristal acetate EC pills became available with a prescription. Finally, the copper intrauterine device remains the most effective form of EC. Use of EC is increasing over time, due to wider availability and accessibility of EC methods. One strategy to expand access for both prescription and nonprescription EC products is to include pharmacies as a point of access and allow pharmacist prescribing. In eight states, pharmacists are able to prescribe and provide EC directly to women: levonorgestrel EC in eight states and ulipristal acetate in seven states. In addition to access with a prescription written by a pharmacist or other health care provider, levonorgestrel EC is available over-the-counter in pharmacies and grocery stores. Pharmacists play a critical role in access to EC in community pharmacies by ensuring product availability in the inventory, up-to-date knowledge, and comprehensive patient counseling. Looking to the future, there are opportunities to expand access to EC in pharmacies further by implementing legislation expanding the pharmacist scope of practice, ensuring third-party reimbursement for clinical services delivered by pharmacists, and including EC in pharmacy education and training.
女性和夫妇意外怀孕的比例仍然很高。在美国，所有怀孕中有45%的时机不当或属于意外怀孕。避孕药具使用不当，如避孕套破裂、漏服避孕药、贴片或阴道环使用时间错误、未使用避孕药具、强迫性交等情况，使女性面临意外怀孕的风险。紧急避孕在预防这些怀孕方面起着关键作用。目前美国有三种紧急避孕方法。左炔诺孕酮紧急避孕药片凭处方使用已有15年以上，自2013年起可非处方购买。2010年，醋酸乌利司他紧急避孕药片开始凭处方使用。最后，铜宫内节育器仍然是最有效的紧急避孕方式。随着时间的推移，由于紧急避孕方法的可及性和可获得性更广，紧急避孕的使用正在增加。扩大处方和非处方紧急避孕产品可及性的一种策略是将药店作为一个获取点，并允许药剂师开处方。在八个州，药剂师能够直接为女性开处方并提供紧急避孕药物：八个州可提供左炔诺孕酮紧急避孕药，七个州可提供醋酸乌利司他紧急避孕药。除了凭药剂师或其他医疗服务提供者开具的处方获取外，左炔诺孕酮紧急避孕药在药店和杂货店均可非处方购买。药剂师在社区药店获取紧急避孕药物方面发挥着关键作用，他们要确保库存中有产品、掌握最新知识并为患者提供全面咨询。展望未来，通过实施扩大药剂师执业范围的立法、确保药剂师提供的临床服务获得第三方报销以及将紧急避孕纳入药学教育和培训等方式，有机会进一步扩大药店紧急避孕药物的可及性。
