Emergency contraception gains momentum in U.S.

Barriers to emergency contraception continue to fall in the United States, as policy changes, new educational material, and heightened patient and provider awareness are reinforcing acceptance of the method.

The Planned Parenthood Federation of America in New York City has voted to modify its practices to allow over-the-telephone prescription of emergency contraceptive pills (ECPs) to women not previously seen by a Planned Parenthood physician. This service can be provided once a Planned Parenthood clinician obtains a medical history and informed consent over the telephone prior to the prescription. At Contraceptive Technology Update press time, the New York headquarters was in the midst of preparing practice update mailouts to its 142 affiliates, which represent 900 clinics across the country.

Each affiliate will have to convert the practice standard to local policy, then run training sessions on the change before the new policy takes effect, says Michael Burnhill, MD, vice president of medical affairs for the national organization. He predicts those affiliates that already have shown strong interest in prescribing ECPs will move rapidly to put the new practice standard into effect.

Ready to put emergency contraception into practice at your facility but unsure where to begin? The Emergency Contraception Pilot Project, a program of Kaiser-Permanente of San Diego, is putting the finishing touches on an "Emergency Contraception Toolbox" that will include everything a clinic needs to implement the service, says Debbie Postlethwaite, MPH, RNP, project team leader.

The toolbox, which should be ready for sale this summer, will contain protocols for screening and dispensing, a medical record documentation form, and a provider reference manual. Educational materials will include bilingual brochures, wallet cards, a poster, an information telephone script, bilingual ECP instructions, and a slide presentation with a presenter outline.

An exact cost has yet to be determined, but Postlethwaite predicts it will fall in the $35 to $50 range, including packaging and mailing costs within the United States. The toolbox also will contain learning objectives, a post-test, and a mechanism for earning continu ing education credits.

Video will be available

A highlight of the toolbox will be a 15 to 20 minute video, Once a Secret, Now an Option!, which can be used for patient and provider/staff education. The storyline follows the experiences of a married couple that becomes concerned after having unprotected sex. The married couple scenario illustrates the fact that emergency contraception needs can arise, even for those who are monogamous and regular contraceptive users.

The video uses the couple's experiences to offer information on such issues as unintended pregnancy, as well as emergency contraception's safety and efficacy, mode of action, and side effects. The segment on the health facility visit depicts interactions with each staff member, so patients will know what to expect and providers will learn proper practice techniques.

More EC information out

For providers looking for a clearer under standing of the laws surrounding emergency contraception and its prescribing, dispensing, repackaging, and advertising, the Center for Reproductive Law and Policy in New York City has prepared a nine-page monograph on the subject. (See resource listing, p. 79, for ordering information.)

The publication addresses the legalities of such issues as physician and nonphysician health care provider ECP prescriptions, direct dispensing of ECPs, pharmacist repackaging of oral contraceptives in bulk for ECP use, and civil liabilities for failing to prescribe ECPs. A copy of the Federal Register notice of the U.S. Food and Drug Adminis tration's ECP announcement also is attached.

If facilities are providing emergency contraception, they can join the Emergency Contra ception Hotline provider directory to ensure the public is informed. The directory will put facilities' names in both the toll-free hotline (888-NOT-2-LATE) listing, as well as on the World Wide Web EC Hotline site.

Providers who attended the recent Contracep tive Technology conferences in Washington, DC, and San Francisco took advantage of sign-up sheets to join the national listing. A total of 57 forms were received at the two seminars, says Deanna Lewis, who manages the provider database.

(Editor's note: Provider and public acceptance continue to grow for a pioneer emergency contraception project in Washington state. For details, see story at right.)