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Biomedical subjects

Rachel L Couchenour

Publications and source records attributed to Rachel L Couchenour.

3 recordsLinked to original sources

Perceptions of pharmacists as providers of immunizations for adult patients.

Pharmacists have been involved with patient care at the Family Medicine Center, affiliated with the Medical University of South Carolina, for over 20 years. In 1999, to add to existing clinical services, pharmacists administered immunizations (influenza and pneumonia) to over 400 adult patients during clinic visits in designated patient care rooms. A few months after the immunization period, both health care providers and immunized patients were asked to respond to a survey regarding their opinions of pharmacist-administered immunizations. Response rates were 71% for health care providers and 16% for all immunized patients. Most (90%) of the health care respondents felt comfortable with pharmacists providing immunizations and thought it was appropriate for pharmacists to provide this service. However, 35% of the providers did not agree that pharmacists should provide immunizations in local pharmacies. Most (97%) of the immunized patients felt comfortable with their provider but did not recall that a pharmacist had administered the immunization. In addition, 64% questioned the qualifications of a pharmacist to administer immunizations, and only 43% felt comfortable having a community pharmacist administer a vaccine. By extrapolation of these data, one can determine that patients do not regard pharmacists as qualified providers of immunizations. Further study of patient perception of pharmacists in this role is being conducted.

Adult↗

Hormonal emergency contraception.

In the 1960s, high-dose estrogen was identified as a highly effective emergency contraceptive but was associated with a high frequency of nausea and vomiting. The combination of low-dose estrogen and a progestin (the Yuzpe regimen) is highly effective and much better tolerated. Recently, a progestin-only regimen containing levonorgestrel was found to be more effective than the Yuzpe regimen and caused significantly less nausea and vomiting. Danazol, an antigonadotropin, is well tolerated but has questionable efficacy Mifepristone has several pharmacologic actions that make it highly effective with an adverse-effect profile similar to that of the Yuzpe regimen. Progress has been made in the last 3 years toward increasing the number of emergency contraceptives that are accessible to women in the United States, and several highly effective options are available. The most effective and well-tolerated regimen available is levonorgestrel. However, the barriers to access and low patient and provider awareness limit the impact of emergency contraception on the rate of unintended pregnancies.

Contraception↗