title: Pharmacy-based interventions for initiating effective contraception following the use of emergency contraception: a pilot study.
abstract: OBJECTIVE
  In Scotland most women get emergency contraception (EC) from pharmacies. Pharmacists currently cannot provide effective ongoing contraception after EC. In this pilot study, we aimed to determine the feasibility of a larger study designed to ascertain if pharmacy-based interventions can increase the uptake of effective contraception after EC.
  
  
  METHODS
  This is a pilot study of women presenting for levonorgestrel EC to community pharmacies in Edinburgh, UK, in 2012. Pharmacies were cluster randomized to provide either standard care or one of two interventions: (a) one packet of progestogen-only pills (POPs), giving women 1 month to arrange ongoing contraception; (b) invitation to present the empty EC packet to a family planning clinic (FPC) for contraceptive advice (rapid access).
  
  
  RESULTS
  One hundred sixty-eight women were recruited from 11 pharmacies to POP (n=56), rapid access (n=58) and standard care (N=54) groups, respectively. Telephone follow-up was conducted successfully in 102 women (61%) 6-8 weeks later to determine current contraceptive use. In the POP arm, 35/39 (90%) women used the pills provided, and 9/28 women (32%) in the rapid access arm attended the FPC. The proportion of women using effective contraception at follow-up was significantly greater in both POP [56% (22/39), p=<0.001] and rapid access [52% (13/25), p=0.006] groups compared to standard care [16% (5/31)]. The relative probability of a woman using an effective method of contraception versus barrier/no method, after use of EC, was 3.13 [95% confidence interval (CI), 1.90-5.13] in the POP group and 2.57 (95% CI, 1.55-4.27) in the rapid access group.
  
  
  CONCLUSIONS
  This promising pilot study suggests that simple pharmacy-based interventions may increase the uptake of effective contraception after EC. A larger study is required to provide further validation of these findings.
  
  
  CONCLUSIONS
  For women obtaining EC from a pharmacy, simple interventions such as supplying 1 month of a POP, or offering rapid access to a FPC, hold promise as strategies to increase the uptake of effective contraception after EC.
authors.affiliation: Department of Reproductive and Developmental Sciences, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 5SU, United Kingdom; Chalmers Sexual Health Centre, 2A Chalmers Street, Edinburgh, EH3 9ES, United Kingdom. Electronic address: michieluc@yahoo.co.uk.
authors.forename: L
authors.initials: L
authors.lastname: Michie
authors.affiliation: Department of Reproductive and Developmental Sciences, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 5SU, United Kingdom; Chalmers Sexual Health Centre, 2A Chalmers Street, Edinburgh, EH3 9ES, United Kingdom.
authors.forename: S T
authors.initials: ST
authors.lastname: Cameron
authors.affiliation: Department of Reproductive and Developmental Sciences, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 5SU, United Kingdom; London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Glasier
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom.
authors.forename: N
authors.initials: N
authors.lastname: Larke
authors.affiliation: Department of Public Health and Health Policy, NHS Lothian, Waverley Gate, 2-4 Waterloo Place, Edinburgh, EH1 3EG.
authors.forename: A
authors.initials: A
authors.lastname: Muir
authors.affiliation: Pharmacy Department, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh, EH10 5HF.
authors.forename: A
authors.initials: A
authors.lastname: Lorimer
mesh_terms: D000293:Adolescent; D000328:Adult; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D044363:Contraception, Postcoital; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use*; D003281:Contraceptives, Postcoital; D037001:Directive Counseling; D005193:Family Planning Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016912:Levonorgestrel; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010594:Pharmacies; D010865:Pilot Projects; D011372:Progestins / Q000627:therapeutic use*; D012606:Scotland; D055815:Young Adult
chemical_list: D003278:Contraceptives, Oral, Hormonal; D003281:Contraceptives, Postcoital; D011372:Progestins; D016912:Levonorgestrel
keywords: LARC; Levonelle; Morning-after pill; POP; Quick-start