Emergency contraception moves into mainstream

What is the policy for providing emergency contraception (EC) at your facility? About 81% of respondents to the 2004 Contraceptive Technology Update Contraception Survey say their facilities prescribe EC on site and provide emergency contraceptive pills (ECPs) at any time, which continues a trend of strong support for the method.

Stephani Cox, APN, CNP, DPS, director of patient services at Planned Parenthood Springfield (IL) Area, says the number of EC users have increased significantly over the past year.

"We accept patients in need of EC at any time on any day as walk-in," she says. "We talk about it with all of our patients when they are here for their annuals, negative pregnancy tests, and [at] just about any other opportunity."

The nurse practitioners carry a weekend pager for EC, and the number is advertised on the telephone message system, Cox says. "We also have included the pager number and EC information in with our monthly billing statements."

Tina Mladenka, MSN, OGNP, a Pocatello, ID-based community health nurse practitioner, also reports that the number of EC patients has grown in the last year. "We get the word out primarily through talking with women during their annual exams," she says.

Custer Family Planning, a not-for-profit family planning agency in Bismarck, ND, provides emergency contraception information at its front door with free condom packs, reports JoElle Thomas, WHCNP, nurse practitioner. Every patient receives information about the method at annual examination time, she states.

When it comes to advance provision of EC, more than half (54%) of 2004 survey respondents say their facilities now offer such a service. This year marks CTU’s first analysis of advance provision practice. The Washington, DC-based American College of Obstetricians and Gynecologists urged its members in March 2002 to issue advance EC prescriptions.

It is easier to offer advance provision, says Thomas. It gives the patients more control, and patients like it, she reports.

"Often, patients are relieved just to know they can have that convenience," observes Cox. "Usually, the patients who don’t choose to take it to have on hand relate that it is due to the financial outlay at that particular time, but they often will come back and get one later."

According to A Pocket Guide to Managing Contraception, clinicians can choose from two approaches in offering advance provision: Give women pills in advance, or give them a prescription with refills in advance.1

Most facilities are using the levonorgestrel-only EC pill Plan B, marketed by Barr Pharmaceuticals of Pomona, NY. About 63% say they are using the drug, up from 2003’s 58% figure. About 9% report use of Preven, also marketed by Barr, and about 10% select from one of the 19 oral contraceptives approved by the Food and Drug Administration (FDA) for EC use. The remaining percentage did not list a particular choice.

"Our patients experience far less nausea with Plan B and so are more willing to take it, and it is more effective than other EC methods," states Cox. "The evidence-based method of taking both Plan B pills at the same time also is especially attractive to patients."

Clinicians who prescribe progestin-only EC are moving to administering a single dose (1.5 mg) of the drug following research conducted by the Geneva-based World Health Organization that indicates a single dose of levonorgestrel to be as effective in reducing the risk of pregnancy as two 0.75 mg doses taken 12 hours apart.2

Clinicians who have relied on Preven as an EC option will have to substitute the FDA-approved OCs with Barr Pharmaceuticals’ recent decision to withdraw the dedicated ECP from the market. The company says it made the move to better focus its EC efforts on Plan B.

Family planning providers are waiting to see if the FDA will approve Barr Pharmaceuticals’ request to take Plan B over the counter. If the measure is approved, Plan B may be available over the counter (OTC) to women ages 16 and older.

The company changed its request to seek dual marketing of the drug after the FDA denied the company’s original request for OTC status.

"The company currently anticipates a decision on its application by the FDA by January 2005," says Carol Cox, Barr Pharmaceuticals’ vice president of investor relations and corporate communications.

References

1. Hatcher RA, Zieman M, Cwiak C, et al. A Pocket Guide to Managing Contraception. Tiger, GA: Bridging the Gap Foundation, 2004.

2. Von Hertzen H, Piaggio G, Ding J, et al. Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: A WHO multicentre randomized trial. Lancet 2002; 360:1,803-1,810.