One call does it all for women seeking ECPs

The condom broke. The diaphragm remained on the bedside table. No protection was available, and intercourse occurred. For women in Georgia, each of those situations now can be remedied with a toll-free call to the Emergency Contraception Connection operated by Planned Parenthood of Georgia in Atlanta.

No matter where women are located in the state, they can receive a confidential medical assessment over the telephone. If the assessment indicates candidacy for emergency contraceptive pills (ECPs), a prescription is called in to a convenient local pharmacy.

"I think that all of us are concerned about reducing the need for abortion," says Kay Scott, president and chief executive officer of the Georgia organization. "One of things that we wanted to do was to make sure that emergency contraception was out there for the people most in need."

A survey of local Planned Parenthood clients revealed large gaps in knowledge about emergency contraception. Most of the women either knew nothing of the method or incorrectly believed it was a form of abortion, says Scott.

Even providers affiliated with the organization’s medical board and local health maintenance organizations weren’t clued in on all the facts about emergency contraception or the need for easy access. Planned Parenthood of Georgia set out to expand knowledge of ECPs through an extensive marketing campaign and the development of the Emergency Contraception Connection hotline.

Through a start-up grant from an anonymous private foundation, the organization developed a series of billboard, radio, and newspaper ads about the availability of emergency contraception, as well as designed a Web site. Pocket cards and posters were developed for use in each of the five state Planned Parenthood facilities. The pocket cards, which mirror the newspaper ads, show an illustration of a bed with the caption, "More accidents happen here than in the kitchen." The card then gives a short explanation of emergency contraception, its availability through the Connection hotline and Planned Parenthood clinics, and telephone numbers.

Making the assessment

The highlight of the program is the Emergency Contraception Connection hotline. The hotline was activated in February and, in its short period of operation, has resulted in a 30% increase in ECP use, says Scott. The hotline is staffed from 9 a.m. to 5 p.m. by a full-time counselor, who does the initial telephone assessment, and a nurse practitioner, who reviews the assessments for candidacy and calls in the prescriptions under medical protocol.

The hotline was envisioned as a seven-day-a-week venture. In monitoring usage patterns, however, the lack of calls on Sunday led to removing that day of service. Most calls occur on Monday, Thursday, Friday, and Saturday, with Monday showing the highest volume of use, she says.

Planned Parenthood of Georgia developed a proprietary computer program to prompt the counselor through the required steps in gathering the needed medical history and informed consents needed for potential ECP candidacy. Depending on the number of questions the patient asks, an average call takes about 20 minutes, says Lisa Ferguson, call center coordinator.

The computer also allows the agency to track usage features, such as number of calls, average age of patient, and other items for efficient use of statistical information.

To cover the cost of the service, Planned Parenthood of Georgia charges a $40 fee, made payable by credit card over the telephone. While the need for a credit card does limit the access to the hotline, agency officials believe the hotline is meeting the needs of many Georgia women. Women who do not have credit card access may visit one of the clinics, which offer subsidized and sliding-scale care, Scott notes.

Unless the Preven Emergency Contraceptive Kit (Gynétics, Belle Mead, NJ) is specifically requested, the hotline calls in a prescription for a single pack of birth control pills. The hotline provides the instructions on how to take the pills for emergency contraception. Callers in rural areas especially like the privacy of picking up a package of birth control pills because they are not labeled as emergency contraception, Scott says.

Opening the door

Although a physical exam is not required, each caller is reminded to follow up with her health care provider or drop by a Planned Parenthood clinic for a visit, she says. That advice, given at the end of each hotline session, is particularly important when it comes to those callers who use no regular form of birth control. While the agency does not limit the number of times a woman can access emergency contraception, it does point out that ECPs are not intended as a regular form of birth control. Some have wondered if such unlimited availability encourages women to be irresponsible in protection against pregnancy.

"We use the analogy that we all wear seat belts, but that it doesn’t give us license to drive like maniacs," counters Scott. "Our goal is that every woman of childbearing age has emergency contraception in her medicine cabinet, so if she needs it, it’s there."

Resource

For more on the Emergency Contraceptive Connection, contact:

Kay Scott, Planned Parenthood of Georgia, 100 Edgewood Ave., Suite 1604, Atlanta, GA 30303. Telephone: (404) 688-9305, extension 312. Fax: (404) 688-0621. Web site: www.ecconnection.org.