Help patients obtain emergency contraception

How can you can eliminate barriers to women who seek emergency contraception (EC) from your facility? First, use a role-play staff session to see how staff respond when they receive a request for EC over the telephone.

"I think that even if the health care providers know about [EC], the receptionists and the front-end people don’t," says Melanie Gold, DO, assistant professor of pediatrics at the University of Pittsburgh’s school of medicine.

Second, educate your patients about how to ask for EC over the telephone, says Gold. That education could be done by giving patients a telephone script that states, "Hi, my name is . . . . I need emergency contraception as soon as possible. Please let me speak to a nurse or doctor." You can include the script in your EC pamphlets so patients know how to ask for care when they call the clinic, she suggests.

Advance counseling on common side effects such as nausea and vomiting helps patients to know what to expect and might lead to greater tolerance, according to Contraceptive Technology.1

Patients, particularly adolescents, might fear that such side effects will be so severe that others will suspect they have taken EC, says Gold. Patients also might be concerned about the long-term effects of EC, she notes. Teens might be especially concerned about the effect of EC on their future fertility, so it is important to assure them of the drug’s safety.

When is emergency contraception available at your facility? McCosh Health Center at Princeton (NJ) University offers EC "pretty much around the clock," notes Brian Zack, MD, university physician and medical director of sexual health services. The center operates an inpatient service for university students that is open 24 hours a day except for summers and Christmas break.

During regular hours, students come into the urgent care clinic, where they are seen by a triage nurse and assigned to one of the nurse practitioners or physicians who are available to provide EC, notes Zack. The clinic stocks Plan B and dispenses it with some basic counseling and written information. For those who seek EC at night or on weekends, the registered nurses on duty call the back-up physician for orders to provide EC, and pills are dispensed on the spot.

Directors at Health Interested Teens Own Pro gram on Sexuality (HITOPS), a Princeton-based nonprofit service for adolescents, have decided to implement a trial protocol to offer telephone ECP prescriptions for new patients, says Barbara Reale, CNM, MS, director of clinical services.

Two nurse-midwives and two registered nurses — with a back-up physician as medical director — staff the clinic, which has been offering emergency contraception since the early 1990s. Pills are dispensed at the site when patients come into the clinic, and written prescriptions are given to those using barrier contraceptive methods and to first-time method users. Heretofore, telephone prescriptions have been called in only for existing patients, and they usually have been called in during the weekends when the clinic is not in operation.

With the new change in protocol, staff will take a medical history over the phone from new patients seeking EC. Callers will be required to provide contact information, as well as to schedule a clinic appointment for the next available day. Staff also will ask if callers can be contacted if they fail to make an appointment. The clinic plans to chart statistics for the next six months to determine how many new patient callers enter the clinic for a visit.

EC use is growing at the clinic, with a much larger increase recorded last fall, says Reale. For many teens, EC represents the reason for their first visit to the facility.

Because a teen’s first clinic visit offers a chance to counsel on contraceptives and sexually transmitted diseases, HITOPS officials will carefully monitor the trial telephone protocol. While officials want to help prevent unintended pregnancies, they also want to provide care for the adolescents who seek their services, she notes.

Reference

1. Hatcher RA, Trussell J, Stewart F, et al. Contraceptive Technology. 17th ed. New York City: Ardent Media; 1998.