Introduction of an Online Emergency Contraception Prescription Service in San Francisco

Background:
Emergency Contraception (EC) is available to women 18 and older without prescription in California, but may require an additional pharmacy consult fee.

Objective:
To describe the initial use of an online EC prescription service in San Francisco

Method:
The service began in 2006, with autofax confirmation to SFDPH initiated in February 2007. From the SF STD clinic website (sfcityclinic.org), after certifying they are over 18, women can print a prescription for EC or fax it directly to a local pharmacy. We evaluated names and available birthdates to assess use of the service from February to October 2007 and matched them to any clinical visits in our database.

Result:
A total of 84 unduplicated faxes were received, representing 76 unique individuals. From February to May, there were an average of 8.5 faxes per month, increasing to 11.8 per month from June to September. Three people downloaded prescriptions on multiple dates (2, 3, and 5 prescriptions each). Overall, 84.2% (64/76) of people gave valid birthdates with an average age of 22 years. Additionally, 21.1% (16/76) could be matched by name and birth date to clinic visits. They accounted for 23 faxes and had a total of 49 visits: 37 before the date of the fax, and 12 after, including 5 women (31.3%) with an initial visit after the date of the first fax. Of the 16 women matched to visits, three had a positive chlamydia or gonorrhea test (18.8%).

Conclusion:
The prescription service was regularly used, and may have served as an initial introduction to the STD clinic for some women. Of those women who accessed clinical services, there was substantial STD morbidity.

Implications:
Online EC services not only provide a convenient and important family planning function but may also help connect women at risk for STDs to clinical services.