Introduction of an Online Emergency Contraception Prescription Service

Introduction of an Online Emergency Contraception Prescription Service in San Francisco Susan S. Philip 1, Katherine Ahrens 1, Jacqueline Moro 2, Deb Levine 3, Kyle T. Bernstein 1, and Jeffrey D. Klausner 1 1 STD Prevention and Control Services, San Francisco Department of Public Health 2 University of California, San Francisco 3 Internet Sexuality Information Services, Inc.

Background • 2002 California law allows trained pharmacists to counsel and dispense Emergency Contraception (EC) without a prescription – No age restrictions for females – Counseling fees may apply • August 2006, the FDA approved EC as an OTC product for those ≥ 18 • Online EC Service developed to provide convenient, ready access to EC for women in San Francisco

Online Emergency Contraception • Initiated 2006 from the San Francisco City Clinic website: www. sfcityclinic. org • Asked to certify age ≥ 18, then can print or fax prescription to a local pharmacy • Autofax confirmation to STD Section began in February 2007

Objectives 1. Describe use of the online prescription service by women in San Francisco 2. Evaluate association with STD clinic visits 3. Evaluate association with STD morbidity

February – October 2007 105 prescriptions Missing name, duplicate name+DOB+date 83 evaluable 76 unique persons Repeat users: 1 x 2 dates 1 x 3 dates 1 x 5 dates

Of the 76 Unique Users Feb-Oct 2007: Birthdates available 84% (64/76) Average 22 Linked to SF STD clinic database 21% (16/76) Total # STD Clinic visits 49 Visits before first online EC script use 37 Visits after first online EC script use 12 1 st visit after using online EC prescription 31% (5/16) Positive chlamydia or gonorrhea test 19% (3/16)

Limitations • Cannot easily verify autofax data • Women may access care at outside clinics • Did not have information about how users arrived to site, ease of use or reason for use

Conclusions • Novel online EC service has been regularly used • For some women, may serve as initial connection to further STD or reproductive health services • Of women matched to services, there was STD morbidity

Next Steps • Develop systems to use “moment of opportunity” with EC to further reinforce sexual health and STD screening in young women • Advocacy for decreased cost of EC

Acknowledgements San Francisco City Clinic staff Caryn Graves, Internet Sexuality Information Services, Inc.

Online Emergency Contraception Volume: February - September 2007 Feb March 9 faxes/month April May June July 12 faxes/month August September