Obstetrical opportunities: will pharmacy ever realize them?

Based on a survey of the American College of Clinical Pharmacy Women's Health Practice and Research Network and our own experience, the pharmacy profession has limited involvement in obstetric pharmacotherapy. We believe that such involvement in pregnancies with complicated conditions can result in significant improvement of pregnancy outcomes. Moreover, we believe this involvement would be welcomed by the physicians caring for these patients. This commentary documents current obstetrical pharmacy practices and proposes changes for the profession of pharmacy to consider.

An update on contraceptive therapy options.

The introduction of new contraception formulations and different routes of administration offers women more options when choosing birth control methods. Despite new options, there are still risks to consider when prescribing contraception to women on an individual basis. In the past 5 years alone, there has been the introduction of extended and continuous cycle oral contraceptives, a new subdermal implant, and shorter hormone-free intervals in 28-day cycles. Cardiovascular risks including stroke, myocardial infarction, and venous thromboembolism are risks that must still be considered in certain populations. In 2005, the Food Drug and Administration issued a press release concerning the higher exposure to estrogen in the transdermal patch compared with 35-µg oral contraceptives. This statement led to concerns of serious adverse events. Women who have no contraindications for contraception continue to struggle with adherence to daily, weekly, and even monthly regimens. Patients must take responsibility for taking their contraception as scheduled or risk becoming pregnant. The relationship of weight and efficacy of combined hormonal contraception is a concern that many health care practitioners have, and unfortunately, the data available do not answer the question at this time. The most important aspect of prescribing contraception is communication with the patient. Taking complete histories and prescribing contraceptive methods on an individualized basis will offer the patient the optimal method available to the patient.

An update on osteoporosis.

Osteoporosis is a skeletal disease that currently affects more than 25 million men and women in the United States. This silent affliction presents asymptomatically as the compromised bone composition in the body goes unrealized and may ultimately lead to fractures. Without treatment or preventative measures, the risks of morbidity and mortality are increased. Complications arising from osteoporosis are often a result of disease-related fractures, which can lead to decreased efficiency of activities of daily life, disabling pain, loss of independent living, and, in some instances, death. Early diagnosis is crucial, and treatment or prevention is highly recommended for the most optimal outcome. Individualized therapy is necessary due to the multitude of therapeutic options. As the population of Americans older than 65 years is expected to double by the year 2050, osteoporosis prevention and treatment will be vital to effective patient care.

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.

Addressing the issue of unintended pregnancy is a national priority. One proposed strategy to reduce unintended pregnancy is to improve access to oral contraceptives by changing them to over-the-counter (OTC) status. Existing data indicate that oral contraceptives meet safety criteria required of OTC products. Available literature demonstrates that women can self-screen for contraindications to oral contraceptives and can do this as well as clinicians, and experience with OTC emergency contraception suggests that OTC oral contraceptives would not increase sexual risk-taking behavior. Women support OTC access to oral contraceptives, but express an interest in accessing pharmacist counseling. On the basis of these data, the Women's Health Practice and Research Network of the American College of Clinical Pharmacy supports changing oral contraceptives to OTC status under two conditions: that they are sold where a pharmacist is on duty and that there are mechanisms in place to cover OTC contraceptives through Medicaid. Future research should address the issues of out-of-pocket costs to individuals, label-comprehension studies, and models for pharmacist reimbursement for time spent counseling on contraception.