Emergency contraception status report: Work to do
Is emergency contraception included in your standard counseling session on birth control? If it isn’t, then you constitute the majority of American providers who are increasing prescriptions for emergency contraceptive pills (ECPs) yet are failing to include information about the method during routine patient discussions.
A new survey by the Kaiser Family Foundation in Menlo Park, CA, reveals that only about 10% of obstetrician/gynecologists, 9% of family practice physicians, and 11% of nurse practitioners or physician assistants say they include information on emergency contraception every time or almost every time in patient counseling.1 A companion public opinion poll reveals that many women and men remain unaware or misinformed on emergency contraception and, therefore, may not ask about it on their own.
"The Catch-22 is that the providers know but are waiting for the patients to ask, and the patients don’t know and therefore can’t possibly ask," says Felicia Stewart, MD, director of reproductive health programs at the Kaiser Foundation.
Once women are given information about the method, however, the survey shows that almost half say it is an option they would consider if faced with the possibility of an unintended pregnancy.
Raise the profile of emergency contraception in your clinic, Stewart urges. Make sure every person who answers the telephone knows about the method. Include emergency contraception in your counseling sessions and check your patient handouts and charts. For example, if there is a poster in your waiting room on different kinds of birth control, make sure emergency contraception is on the list.
EC information goes national
The Emergency Contraception World Wide Web site (http://opr.princeton.edu/ec/) registered its 175,000th visitor on New Year’s day, reports James Trussell, PhD, director of the Office of Population Research at Princeton (NJ) University and associate dean of the university’s Woodrow Wilson School of Public and International Affairs. The Reproductive Health Technologies Project in Washington, DC, and the Office of Population Research sponsor the site, as well as the toll-free Emergency Contraception Hotline (1-888-NOT-2-LATE). The hotline has received more than 75,000 calls since its inception Feb. 14, 1996, he says.
Public service announcements for print, radio, television, and outdoor venues such as billboards and bus placards are helping to get the message out. An intense public education campaign is ongoing in four test cities Chicago, Los Angeles, San Diego, and Seattle and is scheduled to kick off in the first quarter of this year in Miami and Philadelphia, Trussell says.
Almost half of all women and men are more likely to have learned about ECPs from television news than any other source of information, according to the Kaiser Foundation survey. Only 5% of women and 1% of men who have heard of ECPs say they learned about them from health care providers, findings show.
Gynétics to produce ECPs
Expect the awareness of ECPs to expand when Gynétics of Belle Mead, NJ, begins marketing such a designated product. According to company founder Roderick Mackenzie, the company has targeted 1998 to bring ECPs to the market.
Many details must be addressed before Gynétics receives final approval from the U.S. Food and Drug Administration, Mackenzie says.
"You have to perform the manufacturing, quality control, the chemistry, all of these processes to a very significantly high demand in order to file a New Drug Application," he explains. "We’re in the process of doing all those things, and we are not being specific about where we are in that stretch or whether we’re talking beginning, middle, or end of the year."
Such attention to detail can only bode well for Gynétics. Mackenzie, former president of Ortho Pharmaceutical Corp. in Raritan, NJ, also served as founder of GynoPharma, the company responsible for the successful U.S. introduction of the Copper T 380A intrauterine device.
Gynétics’ own market research echoes the Kaiser report’s findings on the low level of ECP awareness, Mackenzie says, adding that education is vital in understanding the process and comprehending that ECPs are not abortifacients.
Most women want ECPs to be prescription drugs so they can be covered under insurance and HMO reimbursement plans, Gynétics’ research shows. Women surveyed by the company say they also would like the chance to talk over use of ECPs with their physician or nurse practitioner before taking them.
"We think the nurse practitioner or nurse midwife, whoever is the advanced care practitioner, is going to be a significant factor in counseling women because women have a lot of questions about this," Mackenzie says. "Women are very concerned about anything that happens after the moment of intercourse, and they need to be counseled on that. This information is more likely to come from a nurse than from a physician."
(Editor’s note: A pilot program in Washington state is increasing ECP access through collaborative drug therapy among pharmacists and local health care providers. See story at right.)
Reference
1. Kaiser Family Foundation. Is the Secret Getting Out? 1997 National Surveys of Americans and Health Care Providers on Emergency Contraception. Menlo Park, CA; 1997.
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