Emergency contraception supply in Australian pharmacies after the introduction of ulipristal acetate: a mystery shopping mixed-methods study

Objective: To explore the supply of emergency contraception (EC) from Australian community pharmacies after the introduction of ulipristal acetate (UPA) and to explore pharmacists' knowledge, decision-making, attitudes and beliefs surrounding supplying EC. Study design: A mixed-methods approach of mystery shopping with structured interview was employed. From August to November 2017, 20 pharmacy students mystery-shopped 10 community pharmacies in metropolitan Sydney, Australia, requesting the morning after pill. Each pharmacy was visited five times with varying scenarios. Structured interviews were conducted immediately postvisit. Visit data were analyzed descriptively and comparatively. Interviews were transcribed verbatim and categorically analyzed. Results: Of 50 planned visits, 43 were analyzed. EC was supplied in 38 requests by pharmacists (54% male). Levonorgestrel (LNG) was more frequently supplied than UPA (74% vs. 26%). UPA was only supplied when intercourse occurred >72 h prior. Directions for use were provided in 35 supplies. No difference in questioning or counseling was found based on sex of requester. Female pharmacists provided more counseling points (MED=4 [IQR=4-5] vs. MED=3 [IQR=0-4]; p<.01). Two pharmacists asked all guideline questions, and no pharmacist provided all guideline counseling points. Interviews elicited supply guidelines, regulatory and clinical knowledge, financial considerations, privacy and stock availability as factors influencing EC supply. Conclusions: EC was supplied in accordance with local legislation in all instances, with the majority supplied within the licensed timeframe for each EC formulation ; LNG was supplied more frequently than UPA. UPA was only supplied in the 72-120-h timeframe. Clinical and regulatory knowledge, availability and cost to consumer were identified as factors influencing supply. (C) 2018 Elsevier Inc. All rights reserved.