Include pharmacists in the loop when it comes to ECP education
Only 3 of 100 NYC pharmacists gave correct info before Preven launch
Whether you are writing prescriptions for Preven or for single packs of the 11 other combined oral contraceptives declared safe and effective as emergency contraceptive pills (ECPs), remember that education plays a large role in the process. This education needs to be extended not only to patients, but to the pharma cists who fill the prescriptions outside clinic facility walls.
Less than a year after the U.S. Food and Drug Administration approved the Preven Emergency Contraceptive Kit as the first product specifically marketed for emergency contraception, pharmaceutical distribution has exceeded company projections. Preven has 65% to 70% all-commodities distribution, according to Roderick Mackenzie, chairman of Gynétics of Belle Mead, NJ, marketer of the Preven kit. "What that means is that Preven can be purchased by women in most of their local drug stores," says Mackenzie. "All-commodities distribution pharmacies fill between 65 [and] 70% of all prescriptions filled in the U.S."
Preven sales have soared at family planning clinics, inner-city medical facilities, and college health centers, with 1.3 million sold in the first three months they were available in 1998.1
Before the September 1998 debut of Preven, Planned Parenthood of New York City conducted a telephone interview of 100 metro pharmacists to assess their knowledge of emergency contraception. They were graded on whether they stated three key points:
• High doses of normal birth control pills are the most common method of emergency contraception.
• ECPs can be taken up to 72 hours after unprotected sex.
• ECPs are available only through prescription.
Rating of the responses showed 37 as poor, meaning the pharmacists gave no or only incorrect information; 24 as fair; 28 as good; and eight as very good. Only three responses were graded as excellent, whereby the pharmacist correctly informed the caller of all three key facts about emergency contraception.
"The survey sprung directly from questions and comments coming from our patients who had been receiving either no information or misinformation from their local pharmacists," says Alexander Sanger, president of the New York Planned Parenthood affiliate. "We were worried about women stopping at the pharmacist with this misinformation and waiting to see whether or not they got pregnant."
Druggists’ learning curve
Family planners are quite familiar with the timetable that has evolved since the FDA affirmed the safety and efficacy of the use of certain oral contraceptives in emergency contraception in a Feb. 25, 1997, notice in the Federal Register. How ever, pharmacists may not have been as aware of the steps leading to the launch of the first dedicated ECP product, according to Susan Winckler, RPh, director of policy and legislation for the American Pharmaceutical Associa tion in Washing ton, DC. The association is the largest U.S. pharmacist organization, representing more than 53,000 pharmacists.
When the FDA published its 1997 Federal Register notice, it was not accompanied by publicity from the companies who manufacture the pills listed in the notice, says Winckler. When the Preven kit made its debut in 1998, the term "emergency contraception" may not have been in pharmacists’ everyday language, she surmises.
Education has been an important part of Preven’s product launch, according to Gynétics. Before the market introduction of the drug, every pharmacy in the United States received notification of the FDA approval, a description of the contents of the Preven Kit, and an explanation that Preven works the same way birth control does, says Mackenzie. In addition, the company provided an overview of the marketing effort, ordering information, and access to Gynétics’ toll-free hotline and Web site. News of the availability of Preven was covered by every major pharmacy journal.
Planned Parenthood of New York City plans to partner with pharmacist professional trade associations and local schools of pharmacy to offer educational and promotional opportunities on emergency contraception. It also is following up with the pharmacies included in its survey to make sure pharmacists have correct emergency contraception information in hand.
Sanger also sees direct consumer advertising as an important way to raise awareness of emergency contraception. The New York affiliate has run two sets of subway advertisements that resulted in a 62% increase in emergency contraception appointments at Planned Parenthood clinics. (Planned Parenthood of Georgia also is using advertising to promote its Emergency Contraception Connection, a statewide toll-free hotline that provides over-the-phone medical assessments and ECP prescriptions to qualified candidates. For details, see story, p. 64.)
Three of the ads — two versions in English and one in Spanish — ran for six weeks in New York City subways. The ads are simply designed, with rumpled sheets in the background and descriptive "pillow talk" spelled out on the foreground. They read: "Oooh . . . oooh . . . oops!" and "Ohhh . . . ohhh . . . uh-oh!" The text also includes this fact: "Emergency contraception can prevent pregnancy up to three days after sex," the logo, and a toll-free number. National Planned Parenthood Federation of America organization in New York City has adopted the campaign.
By educating pharmacists and patients on emergency contraception, there will be fewer barriers to access, which can only bode well for women, says Sanger.
Washington a success
Getting information directly into pharmacists’ hands has been an important element in the success of expanding ECP access through a novel Washington state project. The pilot project is a collaboration among the Program for Appropriate Technology (PATH), the Washington State Phar macists Association, the University of Wash ington Department of Pharmacy, the Washington State Board of Pharmacy, and Elgin DDB Need ham advertising agency, all in Seattle. (See Contraceptive Technology Update, June 1998, p. 79, for an overview of the project.)
PATH has just completed a workshop to help other states replicate the project, which allows pharmacists to dispense ECPs directly through a collaborative agreement with a provider with prescriptive authority. The joint agreement allows the pharmacist to screen, counsel, and prescribe ECPs to women under a standard protocol agreement.
The Washington State Pharmacists Association has conducted a three-hour continuing education training for pharmacists in the state, with more than 800 pharmacists trained since the project began, says Jane Hutchings, MPH, senior program officer at PATH. ECP training, based on the training offered through the project, has been incorporated into the curricula of the two state pharmacy schools at the University of Washington in Seattle and Washington State University in Pullman.
The pharmacist training has emphasized several critical points, including these:
• ECPs are regular birth control pills. Their mechanism of action is the same as regular daily cyclical birth control pills, and pharmacists have been filling prescriptions for birth control pills for years.
• ECPs do not dislodge or have an adverse effect on an established pregnancy and therefore are very different than RU-486 (mifepristone).
All training participants receive a notebook covering therapeutic and dispensing information, patient care issues, collaborative agreements, public relations, referral resources for ongoing contraception, and other reproductive health issues. The notebooks also include reprints of the Federal Register notice and the practice pattern on emergency contraception from the American College of Obstetricians and Gynecologists in Washington, DC, both of which address the safety of ECPs and the approved use of oral contraceptives for ECP use. (See resource listing, below, for more on the pharmacists’ project, as well as information on providing ECPs.)
While the project’s grant only targeted three large training sessions, organizers quickly found that smaller "quick response" talks made the difference, says Don Downing, RPh, pharmaceutical care provider with the University of Washington, Washington State University, and the Washington State Pharmacists Association.
These "guerrilla sessions" were set up after interest was identified within a group of pharmacists in a given part of the state, with organizers going directly to hospitals, staff rooms, and other locations to provide training to smaller numbers of enthusiastic practitioners. Interested doctors and nurses were invited to the training free of charge, and these invitations resulted in raised awareness of how pharmacists could lower barriers to access.
"Pharmacists here received information on ECPs from multiple channels," Hutchings says. "In addition to answering basic questions about ECPs and dispelling misinformation, this outreach also provided information on unintended pregnancy and the public health need for ECPs."
Reference
1. Henry J. Kaiser Family Foundation. Emergency con traception: Sales figures show widespread use as demand increases. Kaiser Daily Reproductive Health Report. Menlo Park, CA; March 3, 1999.
Resources
For more on the Washington state pilot project to increase access to emergency contraception, contact:
• Jane Hutchings, MPH, Program for Appropriate Technology in Health, 4 Nickerson St., Seattle, WA 98109. Telephone: (206) 285-3500. Fax: (206) 285-6619. E-mail: [email protected].
To order provider and patient materials on emergency contraception, contact:
• Marketing Department, Planned Parenthood Federation of America, 810 Seventh Ave., New York, NY 10019. Telephone: (800) 669-0156, 9 a.m.-5 p.m. EST. Fax: (212) 261-4362. Item No. 5410, "Emergency Contraception: Resources for Providers," contains key information on providing ECPs. Each packet is $5, with 15% shipping and handling; sales tax charged only in California, District of Columbia, Florida, Georgia, and Illinois. Visit the Program for Applied Technology Web site at http://www.path.org/acog to print out an Adobe Acrobat PDF order form, which also allows providers to order other pertinent EC items.
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