Objectives: A postal questionnaire survey was conducted to assess what staff in UK accident and emergency (A&E) departments thought of providing an emergency contraception service, the degree of enthusiasm in and level of provision of the service, and staff attitudes to the introduction or continuation of provision of the service.
Methods: A questionnaire was sent to all 560 departments providing A&E services in the UK.
Results: Of the 560 units sent questionnaires, 355 (63.4%) replied. Half the units were located in small county towns, and a quarter in large towns. Requests for emergency contraception were received by 96% of responding units, but only 57% provided treatment. Requests for emergency contraception in 84 of these units ranged between one and 50 per month. The A&E senior house officer (SHO) and the gynaecology SHO and registrar prescribed most of the pills. Nurses were more involved in nurse led or general practitioner (GP) led units. Initial treatment only was given by 77% of providing units while the remainder also discussed subsequent contraception. Follow up was arranged with GPs by 92 units, and with family planning clinics by 66 units. Information packs were available in only 37 providing units. A total of 155 of providing units felt it was worthwhile and 56% of respondents thought emergency contraception should be provided by A&E departments. However, 91 units could identify one or more groups within the hospital who were antagonistic to provision by A&E departments, of which non-A&E medical staff formed the largest group. Over the counter availability of emergency contraception was not supported by 62% of respondents.
Conclusion: The results show that while the female population appears to see a need for emergency contraception services to be provided in A&E departments, there is some reluctance by UK A&E departments to provide the service. Given the current interest in approaches to reducing unplanned pregnancies, especially in teenagers, provision of emergency contraception by A&E departments requires a pragmatic approach to ensure their cooperation in providing the service when alternative sources of provision are not available.
PIP: Attitudes toward emergency contraception were assessed in a questionnaire mailed in 1995 to the 560 UK departments that provide accident and emergency services. Consultants, general practitioners, and nurses from 355 departments (63.4%), half of which were located in small county towns, replied. Although 338 units (96.3%) reported they had received requests for emergency contraception, only 198 (57.2%) provided such treatment. Initial treatment only was offered by 150 of the providing units (76.9%); only 45 (23%) also discussed subsequent contraception. Follow-up was organized with general practitioners by 92 units and with family planning clinics by 66 units. 155 of the providing units (82.9%) felt emergency contraception was a worthwhile service. Overall, 177 respondents (55.8%)--78.9% of those already providing emergency contraception and 28.1% of nonproviding units--thought this regimen should be available from emergency departments. Among the reasons cited for opposing such a strategy were unprotected sexual intercourse is a social rather than an acute medical problem, lack of adequate time for counseling and follow-up, and sufficient family planning programs in the area to provide this service. 91 units (42.1%) could identify professional groups (primarily other medical staff) within the hospital who would oppose the introduction or continuation of emergency contraceptive services in the emergency room. Finally, 201 respondents (61.7%) did not support over-the-counter availability of emergency contraception. These findings indicate there is a lack of consensus on whether unprotected intercourse constitutes a medical problem requiring emergency treatment and revealed an appreciable degree of reluctance on the part of accident and emergency departments to provide this service.