Lungfiel Gwenda, Mandlmeier Franca, Kunow Christian, Langer Bernhard
Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany.
J Pharm Policy Pract. 2023 May 26;16(1):68. doi: 10.1186/s40545-023-00565-w.
In Germany, oral emergency contraception (EC) with the active ingredients levonorgestrel (LNG) and ulipristal acetate (UPA) is available as over-the-counter (OTC) medicine only from community pharmacies (CPs). Because of the window of effect, which is limited to only a few days, CPs have a great responsibility to provide rapid and unimpeded access, while also ensuring "adequate" counseling. The aim was-for the first time in Europe and thus also in Germany for the methodology used in this study-to investigate immediate availability, pricing, and aspects of counseling.
Covert mystery calls were conducted in a random sample of CPs stratified by districts in the German capital Berlin. Each of the 263 CPs included was called once at random by one of two trained female student mystery callers. They simulated a product-based scenario for the UPA original ellaOne, citing a contraceptive failure one day ago as the reason.
Of 257 successfully called CPs, UPA preparations were immediately available in 98.4% (253/257) and LNG preparations in 86.8% (184/212) of CPs. Prices for UPA preparations varied from €15.95 to €42.95 (∆ 169%; median €35.00 [interquartile range (IQR) €5.91]) and for LNG preparations from €10.60 to €32.49 (Δ 207%; median €22.00 [IQR €5.76]). Information about the correct different window of effect of UPA and LNG preparations was provided in 69.8% (127/182) of CPs. UPA preparations were recommended in 63.1% (111/176) and LNG preparations in 17.2% (30/174) of CPs. Information was provided on how to take them as soon as possible in 30.8% (44/143) of CPs and on how to use them after vomiting in 46.0% (64/139).
Berlin CPs support access through high immediate availability, especially to UPA preparations. However, access is hampered by high absolute price ranges of both UPA and LNG preparations, which could ideally be minimized by a comparison app. It is positive that CPs promote the benefits of UPA preparations by recommending them noticeably more often than LNG preparations. However, there are deficiencies in giving advice, so there is a need to raise awareness among pharmacy staff to ensure "adequate" counseling in advance over the phone.
在德国，含有左炔诺孕酮（LNG）和醋酸乌利司他（UPA）活性成分的口服紧急避孕药（EC）仅作为非处方药在社区药房（CP）出售。由于其有效的时间窗口仅限于几天，社区药房有重大责任提供快速且无障碍的获取途径，同时还要确保“充分”的咨询服务。本研究的目的是——在欧洲尚属首次，在德国亦是如此，针对本研究中所采用的方法——调查即时可得性、价格以及咨询方面的情况。
在德国首都柏林按地区分层随机抽取社区药房进行秘密暗访电话调查。263家纳入的社区药房每家由两名经过培训的女学生暗访电话调查员之一随机拨打一次。她们模拟了一个基于产品的场景，以一天前避孕失败为由询问UPA原研药ellaOne的情况。
在257家成功拨通电话的社区药房中，98.4%（253/257）的药房有UPA制剂可供即时获取，86.8%（184/212）的药房有LNG制剂可供即时获取。UPA制剂的价格从15.95欧元到42.95欧元不等（相差169%；中位数35.00欧元[四分位间距（IQR）5.91欧元]），LNG制剂的价格从10.60欧元到32.49欧元不等（相差207%；中位数22.00欧元[IQR 5.76欧元]）。69.8%（127/182）的社区药房提供了关于UPA和LNG制剂正确不同有效时间窗口的信息。63.1%（111/176）的社区药房推荐了UPA制剂，17.2%（30/174）的社区药房推荐了LNG制剂。30.8%（44/143）的社区药房提供了如何尽快服用这些药物的信息，46.0%（64/139）的社区药房提供了呕吐后如何使用这些药物的信息。
柏林的社区药房通过高即时可得性支持药物获取，尤其是UPA制剂。然而，UPA和LNG制剂的绝对价格范围较高阻碍了获取，理想情况下可通过一款比较应用程序将其降至最低。社区药房明显更频繁地推荐UPA制剂而非LNG制剂，这一点值得肯定。然而，在提供建议方面存在不足，因此有必要提高药房工作人员的意识，以确保提前通过电话提供“充分”的咨询服务。
