More women know about emergency contraception, but can they get it?

New Mexico, Hawaii latest states to offer pharmacist provision of EC

The word is getting out about emergency contraception (EC). A just-released national survey reports that two-thirds of women ages 18-44 are aware that there is something a woman can do to prevent pregnancy in the few days following sexual intercourse.1 However, barriers still exist to EC access. The survey results indicate only 6% of women report ever using the pregnancy prevention method.

Reproductive health advocates in New Mexico and Hawaii have moved forward in eliminating some of the physical obstacles to EC by amending legislation to allow pharmacists to offer direct provision of the method. Now women in those two states will be able to go directly to participating pharmacists for EC rather than waiting to call a clinician.

Five states now allow pharmacist provision of EC; Washington state led the way in 1998, followed by California and Alaska in 2002. (Review Contraceptive Technology Update coverage of these events in the following issues: August 1999, p. 85; January 2001, p. 1; and March 2002, p. 25.)

"New Mexico now has some of the broadest privileges to be granted to pharmacists to provide emergency contraception," says Linda Dominguez, CNP, assistant medical director of Planned Parenthood of New Mexico in Albuquerque.

The New Mexico program is indeed different from other states’ approaches to EC provision, agrees Diana Koster, MD, vice president of medical affairs and medical director of Planned Parenthood of New Mexico.

"It’s not a collaborative practice," she states. "It’s prescriptive authority for pharmacists."

Effective May 15, 2003, all requirements were met to allow pharmacists with training to prescribe EC, reports Dale Tinker, executive director of the Albuquerque-based New Mexico Pharmaceutical Association. The association has worked with the Albuquerque-based New Mexico Department of Health and the San Francisco-based Pharmacy Access Partnership, which helped spearhead similar legislation in its state, in developing the New Mexico program.

Hawaii governor Linda Lingle signed legislation on June 24 to allow collaborative practice provision of EC, and the state board of pharmacy has initiated discussion to begin implementation of the program, says Annelle Amaral, director of public affairs for Planned Parenthood of Hawaii in Honolulu. The bill was before the legislature for two years and passed in the second year, she notes.

Paving new ground

To enact the New Mexico law, proponents had to go to the state legislature to modify the pharmacy practice act, Koster explains. The act was modified for independent practice under protocols approved by the boards of pharmacy, medical examiners, and nursing, she states. The prescriptive authority is extended for two purposes: vaccines and EC. (Review the statute, rules, protocols, and EC forms at the New Mexico Pharmaceutical Association web site; go to www.nm-pharmacy.com/pharmacist_rx_protocol.htm.)

"We have a statewide protocol [for EC] for everybody in the state; it is the public health department’s protocol, with some modifications," states Koster. "So everybody in the state essentially — all of Planned Parenthood, all public health, and all pharmacists — will be doing EC the same way."

Hawaii has opted for the collaborative practice route rather than extending independent prescriptive privileges to pharmacists, states Amaral. Proponents patterned legislation and protocols on the Washington state experience and had several public briefings and discussions with Washington state officials in developing the Hawaii protocol, she explains.

Training is key

New Mexico pharmacists must successfully complete an EC training course prior to providing the drug therapy. The training includes current standards for prescribing EC drug therapy, as well as information on identifying indications for EC use; interviewing patients to establish the need for EC; counseling patients regarding safety, efficacy, and potential adverse effects; evaluating medical profiles for drug interaction; referring patients for follow-up care with a primary health care provider; providing informed consent; and managing records of adverse events, including identification, appropriate response, documentation, and reporting.

More than 70 pharmacists have received the complete EC training, and about 40 have completed part of the training, says Tinker. About 40 pharmacy technicians also have taken the training so they can better support the efforts of pharmacists, he notes.

Training of pharmacists began prior to enactment of the legislation, explains Koster. The New Mexico legislature operates alternating years of a short session, so it took until 2003 for the legislation to receive final approval, she notes.

More than 80 Albuquerque-based University of New Mexico College of Pharmacy students have received the training, since EC provision will now be part of the PharmD curriculum, says Tinker. Since EC provision now is part of the College of Pharmacy educational program, EC now will be seen as standard of practice for pharmacists in New Mexico, notes Koster.

An EC visit represents an opportunity not only to solve the immediate crisis, but also to do some better planning for the future in terms of a more effective method or re-education about the right way to use a method, she states. Pharmacists have been very interested in the contraceptive-counseling component of the training, she reports.

In Hawaii, the need for pharmacist training in EC provision is great; just 6% of pharmacists report they have received EC training within the past five years, reports Amaral. In a survey conducted by the Honolulu-based Healthy Mothers, Healthy Babies Coalition of Hawaii, 94% of the pharmacists surveyed had not received recent certified EC training from the Chicago-based American College of Pharmacy Education. About two-thirds of the pharmacists indicated an interest in receiving EC training. At press time, plans were in motion for the Honolulu-based Hawaii Pharmacists Association to host a statewide pharmacist training session, she says.

Getting the word out

Due to funding issues, the New Mexico pharmaceutical association has no way to notify the public about pharmacist provision of EC, except to encourage pharmacist prescribers to get listed on the Emergency Contraception Hotline, (888) NOT-2-LATE, and its companion web site, www.not-2-late.com. However, this may be set to change, says Koster; one foundation has pledged funding for a public awareness campaign, and proponents are seeking further monies to get out the word about EC.

Such awareness is important, says Koster, because many people continue to confuse EC with mifepristone, the abortion drug.

In a 2001 national survey, more than four in 10 (43%) of women who had heard of mifepristone said — incorrectly — that it is the same thing as EC.2

Planned Parenthood of Hawaii is working with a consortium of people representing the Board of Pharmacy, the Board of Medical Examiners, the University of Hawaii School of Medicine, the Department of Health, Kaiser-Permanente, Hawaii Medical Service Association, and others to develop a statewide coordinated EC public education plan, says Amaral.

With pharmacists now joining clinicians in providing EC, more barriers to accessing the method will fall, say proponents. While clinicians can continue to provide advance supplies of EC to patients, the addition of pharmacists adds another link to the EC access chain.

"New Mexico is a geographically large state with many medically underserved areas and a high rate of unintended pregnancy," reports Dominguez. "Pharmacists will be an important link in the effort to provide this critical service."

References

1. Henry J. Kaiser Family Foundation/SELF magazine. National Survey of Women on their Sexual Health. New York City; June 2003.

2. Henry J. Kaiser Family Foundation. National Survey of Women’s Health Care Providers and the Public: Views and Practices on Medical Abortion. Menlo Park, CA; September 2001.