Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC.
CMAJ Open. 2021 Nov 30;9(4):E1097-E1104. doi: 10.9778/cmajo.20200193. Print 2021 Oct-Dec.
Ulipristal acetate 30 mg became available as prescription-only emergency contraception in British Columbia, Canada, in September 2015, as an addition to over-the-counter levonorgestrel emergency contraception. In this study, we determined dispensing and practice use patterns for ulipristal acetate, as well as facilitators of and barriers to emergency contraception for physicians, pharmacists and patients in BC.
In the quantitative component of this mixed-methods study, we examined ulipristal acetate use from September 2015 to December 2018 using a database that captures all outpatient prescription dispensations in BC (PharmaNet) and another capturing market sales numbers for all oral emergency contraception in BC (IQVIA). We analyzed the quantitative data descriptively. We conducted semistructured interviews from August to November 2019, exploring barriers and facilitators affecting the use of ulipristal acetate. We performed iterative qualitative data collection and thematic analysis guided by Michie's Theoretical Domains Framework.
Over the 3-year study period, 318 patients filled 368 prescriptions for ulipristal acetate. Use of this agent increased between 2015 and 2018. However, levonorgestrel use by sales (range 118 897-129 478 units/yr) was substantially higher than use of ulipristal acetate (range 128-389 units/yr). In the 39 interviews we conducted, from the perspectives of 12 patients, 12 community pharmacists, and 15 prescribers, we identified the following themes and respective theoretical domains as barriers to access: low awareness of ulipristal acetate (knowledge), beliefs and experiences related to shame and stigma (beliefs about consequences), and multiple health system barriers (reinforcement).
Use of ulipristal acetate in BC was low compared with use of levonorgestrel emergency contraception; lack of knowledge, beliefs about consequences and health system barriers may be important impediments to expanding use of ulipristal acetate. These findings illuminate potential factors to explain low use of this agent and point to the need for additional strategies to support implementation.
醋酸乌利司他 30 毫克于 2015 年 9 月在加拿大不列颠哥伦比亚省作为处方药，与非处方左炔诺孕酮紧急避孕药一同上市。本研究旨在确定不列颠哥伦比亚省医生、药剂师和患者在开具和使用醋酸乌利司他紧急避孕药方面的模式，以及影响紧急避孕的因素和障碍。
在这项混合方法研究的定量部分中，我们使用一个数据库（PharmaNet）来研究 2015 年 9 月至 2018 年 12 月期间醋酸乌利司他的使用情况，该数据库记录了不列颠哥伦比亚省所有门诊处方药的发放情况，另一个数据库（IQVIA）记录了不列颠哥伦比亚省所有口服紧急避孕药的市场销售数量。我们对定量数据进行了描述性分析。我们在 2019 年 8 月至 11 月期间进行了半结构化访谈，探讨了影响使用醋酸乌利司他的障碍和促进因素。我们使用 Michie 的理论领域框架进行了迭代式定性数据收集和主题分析。
在 3 年的研究期间，318 名患者共开出 368 张醋酸乌利司他的处方。2015 年至 2018 年期间，该药物的使用量有所增加。然而，左炔诺孕酮的销售额（范围 118897-129478 单位/年）远高于醋酸乌利司他（范围 128-389 单位/年）。在我们进行的 39 次访谈中，从 12 名患者、12 名社区药剂师和 15 名处方医生的角度，我们确定了以下主题和相应的理论领域，作为获取障碍：对醋酸乌利司他的认识不足（知识）、与羞耻和耻辱有关的信念和经验（对后果的信念）以及多个卫生系统障碍（强化）。
与左炔诺孕酮紧急避孕药相比，不列颠哥伦比亚省使用醋酸乌利司他的情况较少；缺乏知识、对后果的信念和卫生系统障碍可能是扩大醋酸乌利司他使用的重要障碍。这些发现阐明了潜在因素，可以解释该药物使用不足的原因，并指出需要采取额外的策略来支持实施。
