Provision of contraception after emergency contraception from the pharmacy: evaluating the acceptability of pharmacy for providing sexual and reproductive health services

摘要

In the United Kingdom (UK) there is easy access to a wide range of contraceptiveudmethods, available at no cost. In addition, oral emergency contraception (EC) (1.5 mgudlevonorgestrel) is now widely available from the community pharmacy. In spite of this,udunintended pregnancy is common. In 2014 in England and Wales, 184,571 induced abortionsudwere performed, and in Scotland, the corresponding figure was 11,475.udLong acting reversible methods such as contraceptive implants and intrauterineudcontraception, are amongst the most effective methods available and National Institute forudHealth and Care Excellence (NICE) recommends that increased uptake can lead to fewerudunintended pregnancies. However, uptake of long acting reversible contraceptive (LARC)udmethods remains low. The majority of women who require to use EC do so followingudunprotected sex or an accident with a condom. Increasingly women in Great Britain prefer toudattend a pharmacy for EC rather than a sexual and reproductive health (SRH) service orudgeneral practitioner (GP). Starting an effective on-going method of contraception after ECuduse is clearly important if women are to avoid unintended pregnancy. Communityudpharmacists in the UK and most other high income countries are usually unable to provideudany on-going contraception except condoms. So we have created a situation where EC isudprovided almost solely from settings where other more effective methods of contraceptionudcannot be immediately provided.udNovel strategies are therefore required to facilitate both uptake and continuation of the mostudeffective methods of contraception, in order to prevent unintended pregnancy for moreudwomen. This thesis presents a mixture of biomedical, clinical and health services research toudevaluate a series of strategies aimed at improving uptake of the most effective methods ofudcontraception.udTwo studies investigated patient knowledge and information provision relating toudcontraceptive methods. The first sought to determine if women held misconceptions aboutudintrauterine methods of contraception, and revealed that although myths persist in a smalludnumber of women, a lack of knowledge about these methods was also evident. The secondudstudy aimed to determine if the use of a digital video disc (DVD) to provide contraceptiveudinformation was acceptable and informative to women, and identified that it is, and couldudpossibly enhance patient consultations.udStudies three, four and five investigated strategies aimed at increasing the uptake of effectiveudon-going contraception, following emergency contraception provided from a communityudpharmacy, and patient and health care provider attitudes to such approaches. They showedudthat simple interventions such as supplying one month of a progestogen only pill (POP), orudoffering rapid access to a family planning clinic (FPC), hold promise as strategies to increaseudthe uptake of effective contraception after EC and that both women and clinicians wereudpositive about such measures. Additionally, the problems encountered in conducting theseudstudies provided valuable feedback to inform further development of research methods in theudcommunity pharmacy setting, and larger scale studies of such interventions.udCommunity SRH services may be well placed to deliver more abortion care in the UK, andudconsequently this may result in greater uptake of contraception post abortion. Study sixudaimed to determine the views of health professionals working in SRH regarding theirudattitudes towards providing more abortion services and also the views of staff within oneudcommunity SRH centre in Scotland where a service providing early medical abortion wasuddue to commence. It showed there is clear support amongst health professionals inudcommunity SRH in the UK towards greater participation in provision of abortion careudservices.