Advanced Provision of Emergency Contraception: Utilizing Technology to Increase Prescription Fill Rates

Eighty-five percent of the 750,000 teenage pregnancies per year in the United States are
unintended (Guttmacher Institute). Approximately half of all teenage pregnancies end in the
birth of a child; the remaining proportion end in either abortion (30%) or miscarriage
(20%). It has been estimated that if Emergency Contraception (Plan B) was used after every
contraception failure, it could prevent 50% of unintended pregnancies and 60-70% of
abortions annually.

Previous studies have showed the effectiveness of emergency contraception decreases with
time after intercourse; the sooner it is taken—even if it means a matter of hours—the more
effective it is in preventing pregnancy. Based on previous studies, it is clear that
relying on obtaining emergency contraception on the same day or even the day after
unprotected intercourse is not guaranteed. For example, approximately 27% of pharmacies
called by the adolescent mystery caller did not have the medication available the day of the
call and almost all of the pharmacies not stocking the medication would take greater than 24
hours to obtain it through their ordering system.

Thus, the concept of advanced provision of emergency contraception has been proposed to
assure that the medication can be taken as soon as possible. Although this practice is
known to be safe and has not shown any association with increased sexual risk or behaviors,
it is unclear how often/if adolescents will fill a prescription for a medication that is not
needed at the time of a medical encounter.

The investigators propose a randomized pilot study (n=60) of a text-messaging intervention
that aims to increase the rate at which prescriptions for emergency contraception are
filled. Based on practice norms in the BMC Adolescent Center, sexually active female
adolescents (ages 13-21) in both the control and intervention groups will be provided a
prescription for emergency contraception. The intervention group, however, will receive
follow-up text message on their phone reminding them to fill the prescription.

Boston Medical Center Health Plan will provide prescription fill data regarding the
prescriptions written at the time of enrollment. Approximately 6 weeks after enrollment,
all study participants will be contacted for a follow-up survey.