PloS one
Do community pharmacies unnecessarily recommend oral emergency contraception? A nationwide mystery caller investigation in Germany
By Langer B, Beck A, Dreier AM and 7 others.
Abstract
Background
Since 2015, oral emergency contraceptives (ECs) have been available in German community pharmacies without prescription as over-the-counter medicines. Given the financial burden, unnecessary hormonal exposure and associated side effects, systematic information gathering is crucial to prevent unnecessary recommendations. This study aimed to determine whether pharmacy staff ask the checklist questions recommended by the German Federal Chamber of Pharmacists (BAK) guideline and provide correct recommendations when oral EC is not indicated (appropriate outcome), and to examine associated factors.
Methods
A nationwide study using the simulated patient methodology - considered the "gold standard" - was conducted with a stratified random sample of 376 community pharmacies across Germany. Eight trained female mystery callers aged 21-24 simulated a scenario in which a combined oral contraceptive was forgotten once after sexual intercourse. However, the pill could still be taken within the 12-hour window, making oral EC unnecessary according to the BAK guideline. To ensure quality, each call was monitored by a second observer.