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Flash back five years ago: 44% of participants in the 1996 Contraceptive Technology Update Contraception Survey say they provide emergency contraceptive pills (ECPs) on site and provide them anytime. Fast forward to 2001, when 80.6% of survey respondents indicate ready access to the method. (See chart, below.)
In the span of five years, access to emergency contraception (EC) has taken the fast track, according to responses to the CTU annual survey.
When the newsletter began monitoring EC access in 1996, 28% of respondents said they prescribed on site in emergencies only, 13% indicated they counseled and referred to another provider for prescriptions, and 11% reported they would not — or could not — discuss the method.
Five years forward, those respective numbers dropped to 13.7%, 4%, and 1.1%. Less than 1% in the 2001 survey said they provide counseling only.
"The number of patients seeking ECPs has increased in the past year because we just started offering ECPs about a year ago," says Linda Hedlund, MD, medical supervisor at Arlington (VA) County Department of Human Services. "We offer ECPs for our family planning clients, tell them about it when they are here for a visit, [as well as use] bulletin boards and printed materials." (See patient education handouts on ECPs enclosed in this issue.)
Clinicians at Kaiser Permanente Northern California in Oakland have been very aggressive in getting the word out on ECPs, reports Ruth Shaber, MD, women’s health leader.
A variety of patient education materials on ECPs, including posters in the exam rooms, wallet-size information cards, and articles in newsletters to members, are used. Clinicians also use prophylactic prescribing to women who depend upon barrier methods, withdrawal, or rhythm for contraception, says Shaber. In addition, providers are reminded that copper intrauterine devices are an option for those women who present for EC between three to five days following unprotected intercourse.
Providers go to Plan B
In 1996, EC proponents were bolstered by the Food and Drug Administration’s (FDA) advisory committee opinion that certain oral contraceptives could be used safely and effectively for EC. (See CTU, September 1996, p. 107, for more information on the opinion.) Further impetus was given with the agency’s Feb. 25, 1997, publication in the Federal Register [62 Fed Reg 8609] affirming the safety and efficacy of ECPs. (See CTU, the May 1997 issue, p. 53, for coverage of the publication.)
However, the advent of two dedicated EC products — Preven from Gynétics of Belle Mead, NJ, and Plan B from Women’s Capital Corp. of Bellevue, WA — has changed the landscape of providers’ EC prescribing practices. Preven received FDA approval in September 1998, with approval of Plan B following in July 1999. (CTU reported on the Preven approval in the November 1998 issue, p. 141; Plan B’s approval was published in the September 1999 issue, p. 108.)
In CTU’s 1999 survey, about 15% of survey respondents indicated use of Preven, with about 85% using oral contraceptives (OCs) sanctioned by the FDA for EC. In 2000, about 21% of responses reported use of Preven, and about 36% indicated use of Plan B. The remaining 43% said they were using OCs for EC.
Plan B jumped ahead in 2001, with 62.5% of respondents reporting use of the drug. About 11% said they prescribed Preven, and 25.6% used OCs for EC.
"Your survey confirms our own telephone survey showing that Plan B is broadly accepted as the new standard of care," says Sharon Camp, PhD, Women’s Capital Corp. president. "It would appear that we have doubled our market share among your clinicians since last year’s survey."
Expand pharmacy access
The FDA’s 2000 ruling that expanded Plan B’s shelf life to 18 months has allowed the drug to move into retail pharmacy markets. While more drug stores are carrying the product, Women’s Capital Corp. is asking clinicians to assist the company in expanding access to Plan B.
"We have asked clinicians to help us get Plan B stocked in any areas where it is still not readily available by contacting local pharmacies themselves or giving us the names of pharmacies their patients use most often so that we can follow up," says Camp. "Since our paid sales force is still quite small, we are not able to be everywhere at once, [so] we greatly appreciate our large volunteer sale force.’"
To help prescribers find Plan B in local pharmacies, the company has compiled a pharmacy directory on its miniature web site at HealthCentral.com (http://planb.healthcentral.com/AccessByState. html) and soon will add the feature to its own web site at www.go2planb.com.
The directory is not a complete listing because many pharmacies order through wholesalers and the company does not necessarily have access to this information, says Camp. (EC proponents are moving forward in seeking over-the-counter access to ECPs. Read more on this subject in the article on p. 101. )