Views and attitudes of oral contraceptive users towards the their availability without a prescription in the Republic of Ireland
Background: Previous studies show that provision of oral contraceptive pill (OCs) without a prescription is safe, feasible and effective and that users are interested in obtaining contraception in this way, especially if a pharmacist screening is involved. A recent national survey conducted in the Republic of Ireland has highlighted that unintended pregnancy resulting from the failure of OCs could be linked to poor compliance due to costs and difficulty of access.
Objective: To evaluate views and attitudes of OC users towards the availability of OCs without a prescription in the Republic of Ireland.
Methods: A cross sectional survey was conducted using an opportunistic sample of OC users aged 18 to 50 years. Sixty community pharmacists were recruited nationwide. Data were collected using self-completed questionnaires. The questionnaires comprised information on: demographic data, need of the service, views on the availability of OCs without prescription, advantages and concerns around the service, role of pharmacists and cost implications for private and public patients.
Results: A total of 488 eligible OC users completed the survey. The majority of the respondents (71.7%;n = 350/488) reported to have missed a pill for reasons connected to the OCs prescription status and 55.5% (n = 268/488) of the respondents reported to have felt distressed on at least one occasion because they could not renew their OC prescription. A total of 87.9% (n = 429/488) of the respondents said they were in favour of OCs being available without prescription and 92% (n = 448/488) said they were likely to obtain OCs without prescription if available. Convenience and ease of access were indicated as the main advantages of availing of OCs without prescription, while safety was the biggest concern reported. Over 88% (n = 430/488) of the respondents indicated that pharmacists would be able to safely supply OCs without prescription. Private patients expected to save an average of 27.3% on their OC if obtained without prescription.
Conclusions. OC users in the Republic of Ireland are in favour of OCs being available without prescription and are willing to obtain it this way, providing that pharmacists supply them according to protocols that facilitate the safety and the efficacy of the supply. An easier and more convenient access to OCs could also reduce the likelihood of missed pills and bring considerable savings to users.
2. McBride O, Morgan K, McGee H. Irish Contraception and Crisis Pregnancy Study 2010 (ICCP-2010). A Survey of the General Population. Dublin: HSE Crisis pregnancy Programme; 2010. Available from: http://crisispregnancy.ie/wp-content/uploads/2012/06/ICCP-2010_REPORT.pdf (accessed 2013 Oct 28).
3. Grindlay K, Burns B, Grossman D. Prescription requirements and over-the-counter access to oral contraceptives: A global review. Contraception. 2013;88(1):91-96. doi: 10.1016/j.contraception.2012.11.021
4. Committee on Gynaecologic Practice, American College of Obstetricians and Gynaecologists. Committee opinion No 544: Over-the-counter access to oral contraceptives. Obstet Gynecol. 2012;120(6):1527-1531. doi: 10.1097/01.AOG.0000423818.85283.bd
5. Grossman D, Grindlay K, Li R, Potter JE, Trussell J, Blanchard K. Interest in over-the-counter access to oral contraceptives among women in the United States. Contraception. 2013;88(4):544-552. doi: 10.1016/j.contraception.2013.04.005
6. McIntosh J, Rafie S, Wasik M, McBane S, Lodise NM, El-Ibiary SY, Forinash A, Kachlic MD, Rowe E, Besinque K. Changing Oral Contraceptives from Prescription to Over-the-Counter Status: An Opinion Statement of the Women’s Health Practice and Research Network of the American College of Clinical Pharmacy. Pharmacotherapy. 2011;31(4):424-437. doi: 10.1592/phco.31.4.424
7. Grossman D. Moving oral contraceptives over-the-counter as a strategy to reduce unintended pregnancy. Ann Intern Med. 2013;158(11):839-840. doi: 10.7326/0003-4819-158-11-201306040-00629
8. Howard D, Wall J, Strickland J. Physician attitudes toward over the counter availability for oral contraceptives. Matern Child Health J. 2013;17(10):1737-1743. doi: 10.1007/s10995-012-1185-6
9. Wallis L. Women's access to contraception. Am J Nurs. 2013;113(2):18. doi: 10.1097/01.NAJ.0000426677.67622.16
10. Emron WN. Increasing access to combination oral contraceptives. Contraception Report. 1998;8(6):4-8
11. Grossman D, Jarvis S. Should the contraceptive pill be available without prescription? BMJ. 2009;338:202-203.
12. Jarvis S. Should the contraceptive pill be available without prescription? No. BMJ. 2008;337:a3056. doi: 10.1136/bmj.a3056
13. Grossman D. Should the contraceptive pill be available without prescription? Yes. BMJ. 2008;337:a3044. doi: 10.1136/bmj.a3044
14. Parsons J, Adams C, Aziz N, Holmes J, Jawad R, Whittlesea C. Evaluation of a community pharmacy delivered oral contraception service. J Fam Plann Reprod Health Care. 2013;39(2):97-101. doi: 10.1136/jfprhc-2012-100304
15. Grossman D, Fernandez L, Hopkins K, Amastae J, Garcia SG, Potter JE. Accuracy of self-screening for contraindications to combined oral contraceptive use. Obstet Gynecol. 2008;112(3):572-578. doi: 10.1097/AOG.0b013e31818345f0
16. Shotorbani S, Miller L, Blough DK, Gardner J. Agreement between women's and providers' assessment of hormonal contraceptive risk factors. Contraception. 2006;73(5):501-506
17. Doshi JS, French RS, Evans H, Wilkinson CL. Feasibility of a self-completed history questionnaire in women requesting repeat combined hormonal contraception. J Fam Plann Reprod Health Care. 2008;34(1):51-54. doi: 10.1783/147118908783332203
18. Grossman D, White K, Hopkins K, Amastae J, Shedlin M, Potter JE. Contraindications to combined oral contraceptives among over-the-counter compared with prescription users. Obstet Gynecol. 2011;117(3):558-565. doi: 10.1097/AOG.0b013e31820b0244
19. Xu H, Eisenberg DL, Madden T, Secura GM, Peipert JF,. Medical contraindications in women seeking combined hormonal contraception. Am J Obstet Gynecol. 2014;210(3):210. doi: 10.1016/j.ajog.2013.11.023
20. Raine TR, Harper CC, Rocca CH, Fischer R, Padian N, Klausner JD, Darney PD. Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: a randomized controlled trial. JAMA. 2005;293(1):54-62.
21. Hopkins K, Grossman D, White K, Amastae J, Potter JE. Reproductive health preventive screening among clinic vs. over-the-counter oral contraceptive users. Contraception. 2012;86(4):376-382. doi: 10.1016/j.contraception.2012.03.003
22. Cohen LS, Parker TM, McGhee TB. Birth control within reach: a national survey on women's attitudes toward and interest in pharmacy access to hormonal contraception. Contraception. 2006;74(6):463-470.
23. Grindlay K, Foster DG, Grossman D. Attitudes toward over-the-counter access to oral contraceptives among a sample of abortion clients in the United States. Perspect Sex Reprod Health. 2014;46(2):83-89. doi: 10.1363/46e0714
24. Potter JE, White K, Hopkins K, Amastae J, Grossman D. Clinic versus over-the-counter access to oral contraception: choices women make along the US-Mexico border. Am J Public Health. 2010;100(6):1130-1136. doi: 10.2105/AJPH.2009.179887
25. American Medical Association. Report of Reference Committee E. 2013; pp 14-15. Resolution 507. Support of Over The Counter Sale of Oral Contraceptive. Chicago: American Medical Association; 2013. Available from: http://www.ama-assn.org/assets/meeting/2013a/a13-refcomm-e-annotated.pdf (accessed 2013 Oct 28).
26. Potter JE, McKinnon S, Hopkins K, Amastae J, Shedlin MG, Powers DA, Grossman D. Continuation of prescribed compared with over-the-counter oral contraceptives. Obstet Gynecol. 2011;117(3):551-557. doi: 10.1097/AOG.0b013e31820afc46
27. Foster DG, Hulett D, Bradsberry M, Darney P, Policar M. Number of oral contraceptive pill packages dispensed and subsequent unintended pregnancies. Obstet Gynecol. 2011;117(3):566-572. doi: 10.1097/AOG.0b013e3182056309
28. Grossman D, Fuentes L. Over-the-counter access to oral contraceptive as a reproductive healthcare strategy. Curr Opin Obstet Gynecol. 2013;25(6):500-505. doi: 10.1097/GCO.0000000000000019
29. Royal College of Obstetricians and Gynaecologists. Faculty of Sexual and Reproductive Health Care Clinical Effectiveness Unit. Combined hormonal contraception. London: Faculty of Sexual and Reproductive Health Care; 2011. Available from: http://www.fsrh.org/pdfs/CEUGuidanceCombinedHormonalContraception.pdf (accessed 2013 Oct 28).
30. World Health Organization. Medical Eligibility Criteria for Contraceptive Use. 4th ed. World Halth Organization. 2009. Available from http://whqlibdoc.who.int/publications/2010/9789241563888_eng.pdf?ua=1 (accesesd 2014 Aug 16).
31. Centers for Disease Control and Prevention (CDC). U.S. Medical Eligibility Criteria for Contraceptive Use. MMWR Recomm Rep. 2010;59(RR-4):1-86.
32. Gardner JS, Miller S, Downing DF, Le S, Blough D, Shotorbani S. Pharmacist prescribing of hormonal contraceptive: result of the Direct Access study. J Am Pharm Assoc (2003). 2008;48(2):212-221. doi: 10.1331/JAPhA.2008.07138
33. The Department of Health and Children. Menopause information and services available in Ireland. Dublin: The Women’s Health Council; 2008. Available from: http://www.dohc.ie/about_us/divisions/whc_menopause/menopause_information_in_Ireland.pdf?direct=1 (accesed 2013 Oct 28).
34. Fox N, Hunn A, Mathers N. Sampling and sample size calculation. The NIHR RDS for the East Midlands / Yorkshire & the Humber; 2007
35. McColl E, Jacoby A, Thomas L, Soutter J, Bamford C, Steen N, Thomas R, Harvey E, Garratt A, Bond J. Design and use of questionnaires: a review of best practice applicable to surveys of health service staff and patients. Health Technol Assess. 2001;5(31):1-256.
36. Boynton PM, Greenhalgh T. Selecting, designing and developing your questionnaire. BMJ. 2004;328(7451):1312-1315.
37. Bowers D. Medical Statistics from Scratch: An Introduction for Health Professionals. 2nd ed. Chichester: Wiley; 2008.
38. HPRA Ireland. Press release 17/07/14. HPRA publishes lists of potential medicines to be sold without prescription. Dublin: HPRA; 2014. Available from: http://www.hpra.ie/docs/default-source/default-document-library/pr-list-of-active-substances-17-07-2014.pdf?sfvrsn=0 (accessed 2014 Aug 16).
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