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Emergency contraception from the pharmacy 20 years on: a mystery shopper study
  1. Anna Glasier1,
  2. Paula Baraitser2,
  3. Lisa McDaid3,4,
  4. John Norrie5,
  5. Andrew Radley6,7,
  6. Judith M Stephenson8,
  7. Claire Battison5,
  8. Richard Gilson9,
  9. Sharon Cameron1,10,
  10. Trial Steering Committee
  11. Data Monitoring Committee
      1. 1Obstetrics & Gynaecology, University of Edinburgh, Edinburgh, UK
      2. 2Department of Sexual Health, King's College London Faculty of Life Sciences and Medicine, London, UK
      3. 3MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
      4. 4Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
      5. 5Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
      6. 6Directorate of Public Health, NHS Tayside, Dundee, UK
      7. 7Division of Cardiovascular Medicines and Diabetes, Ninewells Hospital and Medical School, Dundee, United Kingdom
      8. 8Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
      9. 9Institute for Global Health, University College London (UCL), London, UK
      10. 10Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
      1. Correspondence to Professor Sharon Cameron, Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK; sharon.cameron{at}


      Background Emergency contraception (EC) was approved in the UK as a pharmacy medicine for purchase without prescription in 2001. Twenty years later we conducted a study to characterise routine practice pharmacy provision of EC.

      Study design Mystery shopper study of 30 pharmacies in Edinburgh, Dundee and London participating in a clinical trial of contraception after EC.

      Methods Mystery shoppers, aged ≥16 years, followed a standard scenario requesting EC. After the pharmacy visit, they completed a proforma recording the duration of the consultation, where it took place, and whether advice was given to them about the importance of ongoing contraception after EC.

      Results Fifty-five mystery shopper visits were conducted. The median reported duration of the consultation with the pharmacist was 6 (range 1–18) min. Consultations took place in a private room in 34 cases (62%) and at the shop counter in the remainder. In 27 cases (49%) women received advice about ongoing contraception. Eleven women (20%) left the pharmacy without EC due to lack of supplies or of a trained pharmacist. Most women were generally positive about the consultation.

      Conclusions While availability of EC from UK pharmacies has undoubtedly improved access, the necessity to have a consultation, however helpful, with a pharmacist introduces delays and around one in five of our mystery shoppers left without getting EC. Consultations in private are not always possible and little advice is given about ongoing contraception. It is time to make EC available without a pharmacy consultation.

      • contraceptive agents, female
      • contraceptives, postcoital
      • pharmaceutical services
      • surveys and questionnaires

      This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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      • Correction notice This paper has been corrected since it was published online. Sharon Cameron's affiliations have been updated.

      • Collaborators Trial Steering Committee: Professor Peter Brocklehurst, Dr Lucy Michie, Professor Kaye Wellings, Joanna Loudon, Kirsten Stuart, Emily Whittaker. Data Monitoring Committee: Professor Claire Anderson, Professor Elizabeth Allen, Professor Caroline Moreau.

      • Contributors AG, SC, JN and CB designed the mystery shopper study. Data were analysed by AG, SC and CB with input from all authors into interpretation of the results. AG and SC prepared the first draft of the manuscript. All authors contributed to revising the manuscript and approved the final version.

      • Funding The Bridge-It study is funded by the National Institute for Health Research’s (NIHR) Health Technology Assessment (HTA) Programme (HTA Project:15/113/01). LM is funded by the UK Medical Research Council (MRC) and Scottish Government Chief Scientist Office (CSO) at the MRC/CSO Social & Public Health Sciences Unit, University of Glasgow (MC_UU_12017/11, SPHSU11).

      • Competing interests AG is a member of HRA Pharma scientific advisory board. PB is a Clinical Director of the not-for profit community interest company SH:24 that provides online sexual health services in partnership with the NHS. AR is in receipt of research grants, educational grants and consultancy with Gilead, research grants from Roche and BMS, and educational grants from Abbvie. JN is Deputy Chair of the NIHR/HTA General Board Committee. NIHR/HTA funded this research.

      • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

      • Patient consent for publication Not required.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. as above.

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