Removing Barriers: Access to Emergency Contraception in New Mexico

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Removing Barriers Access to Emergency
Contraception in New Mexico

• Bruce G. Trigg, MD
• Medical Director, STD Program, District 1
• New Mexico Department of Health

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In May 2003, New Mexico became the 4th
state, after Washington, California, and Alaska,
to allow pharmacists to provide EC directly to
consumers.
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New Mexicans potentially have the least
restrictive access to EC in the U.S.
Significant barriers to access still remain.
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The Land of Enchantment Land of Poverty and
Social Inequity

• Ranked 48th in personal income per capita
• 17,689 in 1998
• Ranked 1 in percent of population below poverty
  line (20.4) in 1998
• Ranked 1 in lack of health insurance
• 22 of pop. without health insurance for an
  entire year between 2000 and 2002 (U.S. Census
  Bureau)

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NM Pregnancy Risk Assessment Monitoring System
(PRAMS)

• NM Department of Health led by CDC
• Sample survey of 2,210 NM resident women with
  live birth in year 2000
• 43.6 of mothers had an unintended pregnancy

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Intention of Pregnancy New Mexico, 1999
Sooner then intended (57 Later never
unintended (43)
Source NM Pregnancy Risk Assessment and
Monitoring System
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The New Mexico Model

• Pharmacists in New Mexico have prescriptive
  authority regulated by the Board of Pharmacy with
  approval of the Board of Medical Examiners and of
  Nursing
• Regulations approved Dec. 2002
• Protocols approved May 2003

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New Mexico Model

• Protocol modified from NM Department of Health
  Family Planning (Title X) protocol
• Allows prescription of all hormonal EC
  medications
• Requires completion of training by Department of
  Health, Planned Parenthood, ACPE, or similar
  health authority
• Additional 2 hours of approved training every two
  years

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Certification Process

• Three hour ACPE-approved training under auspices
  of NM Pharmaceutical Association
• Completed by
• 90 pharmacists
• 40 pharmacy technicians
• 80 pharmacy students
• EC trained pharmacists currently work in 30
  pharmacies state-wide (12 of total)

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Training Requirements

• Current standards for EC
• Indications for EC
• Interviewing patients
• Counseling on safety, efficacy, potential adverse
  effects
• Evaluation for drug interactions
• Referral to PCP for follow-up care

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Training Requirements

• Informed consent
• Record management
• Adverse events
• Notification of patients PCP within 15 days with
  signed consent of patient or guardian

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Website for Pharmacist Rx

• Http//www.nm-pharmacy.com/body_pharmacist_prescri
  bing.htm
• Emergency Contraception Protocol
• EC Consent Form
• EC Client Questionnaire Form (encounter)
• EC Key Facts Form
• EC Instructions for Use Form
• EC Starting on-Going Contraception Form
• EC Sign up for Directory Form

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Access to EC in NM

• 14 pharmacies in 10 cities and towns listed on
  internet for pharmacist prescribing
• All 50 NM Department of Health offices provide EC
  on walk-in basis
• Family Planning and STD programs
• Other providers Planned Parenthood, community
  based clinics, school based clinics and private
  practices

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EC Working Group

• NM Department of Health Department
• University of New Mexico Health Sciences Center
• Rio Grande Planned Parenthood
• New Mexico Pharmaceutical Association
• Public and private Sector Physicians
• Advocacy Groups NARAL

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EC Working Group Agenda

• Support pharmacist prescribing program
• Advocate for insurance coverage of EC
• Work with HMOs and hospitals to include EC, and
  specifically Plan B, on formularies
• Getting the word out about EC and pharmacy access
  to
• Primary care providers
• Students in health sciences
• News media

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Successes

• Recent grant to Rio Grande Planned Parenthood for
  social marketing and pharmacist back-up
  consultations
• Favorable news articles in newspapers throughout
  state
• State law passed 2003 requires emergency rooms to
  offer EC to rape victims

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Challenges

• NM Medical Society vetoed adoption of prevention
  of unplanned pregnancy for a clinical prevention
  initiative among among primary care physicians
• Small group of Right-To-Life pharmacists sent
  letters to legislators and pharmacists in
  opposition to pharmacist prescribing of EC