Pharmacists participating in a scheme to offer chlamydia screening to young women requesting emergency contraception (EC), did not offer it comprehensively. They were less likely to offer testing to women who were married, in a long-term relationship or who had recently been tested.

Six PCTs in Manchester had contracted with 76 pharmacies to provide EC to women under 25. Those pharmacies that issued at least 40 prescriptions per year were invited to offer postal chlamydia screening to these patients. The participating pharmacists underwent a programme of STI training.

The distribution of the kits was monitored showing that most pharmacies did not offer screening to the majority of patients requesting EC. Kits were offered to only a quarter of the women given EC.

A qualitative study was carried out to try to determine why pharmacists had not offered screening to all eligible women.

A total of 26 pharmacists completed exit questionnaires at the end of the study and 12 took part in an in-depth interview.

The qualitative survey focussed on attitudes and views. Precise data was not discussed.

Participating pharmacists found the unpaid training and the work professionally rewarding. According to the exit questionnaires, the pharmacists were less inclined to offer screening with EC prescriptions if the client was married or in a long-term relationship and more inclined to offer screening to young women under 16, students and in situations where they were personally aware of the patient's circumstances.

However, using structured qualitative interviews it became clear that there were discrepancies between answers given in the questionnaires and actual practice.

Most of the pharmacists were male and some felt anxious about discussing sexual health with girls under 16. The monitoring data confirmed that this group had accepted fewer kits.

There was an obvious tension between the commercial imperatives of running the business and keeping customers content, and offering advice and screening that they felt customers may not want.

One pharmacist held the view that women from ethnic minorities were generally ‘married and faithful' and therefore did not need to be screened.

The dispensing of EC by community pharmacists saves women time and avoids the need to make appointments with their GP or at a sexual health clinic. A previous study found that some pharmacists were declining to dispense on ethical and religious grounds and others were making value judgements about the customer as part of their decision on whether to dispense or not.1 This study looking at the offer of chlamydia screening found similarly diverse practice.

The pharmacists surveyed here undertook specific training in sexual health and chlamydia screening in their own time and offered the service free of charge to their customers and for this they are to be commended.

However, that screening was offered preferentially implies that at times they were acting expediently and at others were making value judgements. The tendency to decline to offer screening to girls under 16 is an opportunity missed.

It could be argued that some screening is better than none but it does highlight the need for proper training and adequate resources if inroads into chlamydia infection are to be realised.

Dr Chris Barclay 

• Thomas G, Humphries G, Ozakinci G et al. A qualitative study of pharmacists' views on offering chlamydia screening to women requesting emergency hormonal contraception. BJOG 2010; 117:109-113

References

1 Cooper RJ, Bissell P, Wingfield J. Ethical, religious and factual beliefs about the supply of emergency hormonal contraception by UK community pharmacists. J Fam Plann Reprod Health Care. 2008;34(1):47-50