Initiating Contraception After Emergency Contraception From Pharmacy
Condition: Contraceptive Use After Emergency Contraception
MeSH terms: Emergencies
Study type: Interventional

Summary: 
      Pharmacists do not provide immediate contraception to women after emergency contraception
      (EC); they can only give advice on local contraceptive services.

      The investigators wish to establish the following 2 pharmacy- based interventions in NHS
      Lothian, designed to increase uptake of effective contraception as soon as possible, after EC

        1. Pharmacists would provide one packet of progestogen-only pills, giving women one month
           to arrange an appointment with contraceptive services.

        2. Rapid access to a family planning clinic upon presentation of the empty EC packet. Women
           would be seen as a 'walk-in' and contraception provided.

      If feasible, these interventions could reduce unintended pregnancies.

      Participating pharmacies will be randomised to provide one of the interventions, or standard
      care (verbal/written advice on local contraceptive services).

      Women requesting EC from study pharmacies will be recruited by the research nurse/doctor to
      participate in the study that will involve them consenting to contact by telephone 6-8 weeks
      after EC by the researcher, to evaluate the interventions in terms of :

      (i) determine women's experiences/ views of the interventions and control. (ii) determine if
      women have commenced effective contraception and if not , reasons why.

      A subset of 12 women will also be invited for in-depth interview to collect more detailed
      qualitative data on their EC experience.

      The investigators also wish to (iii) explore pharmacists views on the interventions

      Data from this pilot will enable the investigators to determine whether a larger multisite
      study is feasible. The aims of a larger study being to determine if either of the two
      interventions being tested result in an increased proportion of women using effective ongoing
      contraception compared to the control.
    

Detailed description: 
      The investigators propose to test 2 pharmacy based interventions to increase uptake of
      effective contraception after EC:

        1. Pharmacists would provide one packet of progestogen-only pills to women, so that they
           would have 28 days to arrange an appointment with contraceptive services to get a supply
           of ongoing contraception.

        2. Rapid access to a family planning clinic upon presentation of their empty(used) packet
           of EC. Women would be seen as a 'walk-in' (without appointment) and ongoing
           contraception discussed and provided.

      These interventions would be compared with the status quo, i.e. pharmacists give verbal
      advice and written information on local contraceptive services where ongoing contraception
      can be accessed.

      The interventions that we are testing are low cost i.e one packet of progestogen-only pills
      (£3 for most costly brand) plus additional consultation time with the pharmacist (estimated
      20 mins@ £1 per minute), versus the staff consultation time in a family planning clinic. In
      the family planning clinic, women would be seen as a 'walk-in' and so this may not add costs,
      since staff are already present.These interventions could, if shown to be effective, offer
      huge costs savings to the NHS, by reducing the costs of unintended pregnancies (abortion,
      miscarriage, birth).
    

Intervention name(s): rapid access; one month progestogen only pill
Intervention type(s): Other; Other
Intervention description(s): Provision of box which the participant can take to local family planning clinic (contraceptive service) allowing rapid access (i.e. will be seen by a health professional for a consultation regarding contraception there and then).; Provision of 1 month supply of a progestogen only pill (levonorgestrel 35mcg - Norgeston, Bayer, UK)
Other intervention name(s): Norgeston (Bayer, UK)
Intervention MeSH terms: Progestins
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: emergency contraception; community pharmacy