New programs broaden contraceptive access

Women in two Western states are finding the doors are swinging open to wider contraceptive access, thanks to two innovative programs.

Planned Parenthood of the Columbia/Willamette (PPCW) in Portland, OR, is using its Internet site, www.ppcw.org, to provide birth control pills, the Ortho Evra contraceptive patch (Ortho-McNeil Pharmaceutical, Raritan, NJ), and the NuvaRing contraceptive vaginal ring (Organon, West Orange, NJ) to women across the state. The pilot Contraception Online program, the first of its kind among Planned Parenthood of America affiliates, is allowing women to undergo an on-line assessment and place orders for these three forms of birth control without having to visit a provider’s office. The methods can be mailed by overnight express mail or standard mail, picked up at a local pharmacy, or obtained at one of PPCW’s eight health centers. About 80 requests had been filled or were being processed within the first few weeks of the program, reports David Greenberg, the affiliate’s president and chief operating officer.

A second program, based in Washington state, is the basis of the Direct Access study, which is determining the feasibility of screening and prescribing oral contraceptives (OCs), the patch, and the ring through specially trained pharmacists, rather than through visits to a doctor or clinic. More than 150 Washington state women have enrolled in the study, conducted by the Seattle-based University of Washington School of Pharmacy and the Department of Obstetrics and Gynecology, reports Jacqueline Gardner, MPH, PhD, professor in the School of Pharmacy and the study’s principal investigator.

Oregon women who wish to use the Contraception Online service can obtain birth control after they review on-line information about hormonal methods of contraception; read and accept a medical consent form and Health Insurance Portability and Accountability Act privacy form; and complete a detailed medical history questionnaire. Once the forms have been submitted, a registered nurse or nurse practitioner contacts the patient by phone to review the information and answer questions. If the patient meets the necessary health requirements, she may opt to obtain a two-month supply of contraception by mail, pick up her prescription at her local pharmacy, or visit a PPCW health center. The affiliate charges a $35 fee to cover the medical assessment.

In order to get refills after two months, patients must submit a blood pressure reading obtained from a licensed medical provider at a local physician’s office, public health department, pharmacy, or a PPCW center. The blood pressure reading can be faxed or mailed to the PPCW on-line services center.

What led the Oregon affiliate to pursue this avenue of family planning delivery? The success of its emergency contraceptive (EC) service was the impetus, says Greenberg. Since the program was launched in 2002, 588 women have received an ECP prescription. The affiliate also uses the Internet to schedule appointments; since 2002, 5,740 people have made appointments on-line at PPCW clinics.

Establishing the new service was not difficult, since the affiliate already had a nurse practitioner and an assistant already assigned to the emergency contraception on-line program and a telephone nurse advice line, says Greenberg. Computer programmers designed the module for the new program. The affiliate will add part-time nurse practitioner hours as demand for the on-line service increases, he notes.

The on-line program is touching a number of needs, Greenberg explains. It provides an avenue of service for women who live far away from health care providers and offers women with active lifestyles an opportunity to take care of their contraceptive needs in a convenient manner.

Other Planned Parenthood affiliates already have expressed interest in the program; however, some see obstacles within their state laws in providing this delivery of service, says Greenberg.

"I think that if this service really becomes as successful as I think it could become, then our public policy folks need to begin to work in those states to get those laws changed, " he notes.

Look at WA program

What led researchers to design the Washington state Direct Access program? Providing contraception is a natural progression for the state’s pharmacists, explains Gardner; they have been prescribing emergency contraception for seven years through collaborative drug therapy agreements.

Funded by the Bethesda-based National Institutes of Health, the Washington study will monitor whether women can answer self-test questions to see if they can safely use OCs, the ring, or the patch with the help of specially trained pharmacists. Pharmacists at eight Bartell Drug Stores and Fred Meyer stores in King and Pierce counties are participating in the study. All have entered collaborative drug therapy agreements with physician prescribers and have received training in contraceptive provision.

Women in the study must be between ages 18 and 45, weigh less than 200 pounds, and be able to pay for the birth control method and the pharmacist consultation, which costs about $50. Women may go through the pharmacy process or opt to become comparators, whereby they receive family planning care from another medical provider. Pharmacists can provide an initial three-month prescription, followed by a nine-month prescription if blood pressure is normal at the time of a return visit to the pharmacy at the end of the first three months. Pharmacists also encourage women to visit a primary care practitioner or family planning clinic for cervical exams and infection screenings.

The study currently allows the pharmacists to prescribe OCs, the patch, and the ring. If safety is documented after preliminary analysis, injectable contraceptive methods will be added to the study, according to the Direct Access web site, www.directaccessstudy.info.

All women in the study will be contacted by telephone at one, three, six, and 12 months for a 10-minute telephone interview. The study is expected to be completed in April 2006, says Gardner.