Ziebland S, Graham A, McPherson A
University Department of Public Health and Primary Care, Institute of Health Sciences, Oxford, UK.
Fam Pract. 1998 Oct;15(5):449-56. doi: 10.1093/fampra/15.5.449.
We aimed to describe GPs' responses to a clinical scenario of a request for a repeat prescription for hormonal emergency contraception (EC), their views about over-the-counter availability and beliefs about absolute contraindications.
We conducted semi-structured tape-recorded telephone interviews with 76 GPs randomly selected from the medical registers of three health authorities which were chosen for high, medium and low prescribing rates for EC.
There was a wide variation in the number of times that GPs would be happy to prescribe EC to the same woman in a year. The content of the consultations appeared patchy. While 59 (77.6%) of the GPs said that they would discuss future contraception with the woman, only 16 (21.1%) said they would talk about possible side effects and 28 (36.3%) would discuss the timing of the next menstrual period and the possibility of method failure. Fifty-two of the practices had a family-planning-trained practice nurse, yet only four (7.7%) had arrangements whereby the nurse could provide EC. Unqualified enthusiasm for deregulation was rare. Concerns included that women would lose out on the benefits of the consultation; worries about the safety of the method; that some women might 'abuse' it by using it frequently; and that certain characteristics of the pharmacy might make it an unsuitable setting for provision of EC.
This qualitative telephone survey revealed concerns about repeated use of EC and caution about the prospects of deregulation. Respondents were worried that pharmacists might not be able to address all of the features of the consultation that may be valued, yet in this sample nor do most GPs. Family-planning-trained practice nurses are an under-utilized resource and could act as a halfway house between provision by GPs and deregulation.
我们旨在描述全科医生对激素紧急避孕（EC）重复处方请求这一临床情景的反应、他们对非处方可得性的看法以及对绝对禁忌证的认识。
我们对从三个卫生当局的医疗登记册中随机选取的76名全科医生进行了半结构化的电话录音访谈，这三个卫生当局因其EC处方率高、中、低而被选中。
全科医生每年愿意给同一名女性开具EC的次数差异很大。咨询内容似乎参差不齐。虽然59名（77.6%）全科医生表示他们会与该女性讨论未来的避孕方法，但只有16名（21.1%）表示会谈论可能的副作用，28名（36.3%）会讨论下次月经的时间以及方法失败的可能性。52家诊所配备了经过计划生育培训的执业护士，但只有4家（7.7%）有安排让护士提供EC。对放松管制毫无保留的热情很少见。担忧包括女性会失去咨询的益处；担心该方法的安全性；一些女性可能会频繁使用而“滥用”它；以及药店的某些特点可能使其成为提供EC的不合适场所。
这项定性电话调查揭示了对重复使用EC的担忧以及对放松管制前景的谨慎态度。受访者担心药剂师可能无法处理咨询中所有可能被重视的方面，然而在这个样本中大多数全科医生也做不到。经过计划生育培训的执业护士是一种未得到充分利用的资源，可以在全科医生提供服务和放松管制之间起到过渡作用。
