Sexual health services enhance access to care


Community pharmacists can positively impact patients’ sexual and reproductive health, but barriers remain including remuneration, workload and legislation

Pharmacists’ role in sexual and reproductive health is “feasible and highly accepted by users” in several areas including screening, vaccination and prescribing, a scoping review published in BMJ Open has found.

Researchers from the University of Alberta in Canada reviewed 41 articles that involved such community pharmacy services in high-income countries. The majority were from the US (20 articles), the UK (13 articles), with the remainder from Australia (3) and single studies from some other countries including Canada and Spain.

More than two-thirds of studies (71%) were published between 2015 and 2020.

Screening

Twenty-six studies evaluated sexually transmitted and bloodborne infections services provided by community pharmacists: nine (35%) were related to chlamydia, seven (27%) were focused on HIV, five (19%) on HPV and five (19%) on hepatitis C.

Users reporting a high level of satisfaction with services provided for chlamydia screening. Convenience, location, short waiting times and no appointments needed and a non-judgmental approach were reported as benefits.

Some studies also reported positive experiences with HIV screening at community pharmacies. However, challenges included obtaining the sample, integration into the daily workflow, pharmacists’ remuneration, costs and referral to care. Similar challenges to HIV PrEP services were also seen.

HPV vaccination

Five studies explored community pharmacists providing HPV vaccination.

Three studies targeted adolescents and/or younger adults, one targeted individuals between nine and 26 years old filling acne or birth control prescriptions at the pharmacy, and one did not specify the target group.

Important barriers reported included limitations on policy and legislation. In some states in the US, community pharmacies are not included as qualified provider sites for vaccinating age-eligible adolescents. Similar barriers are seen in Australia, where pharmacists are currently not enabled to vaccinate for HPV.

“As a consequence, this limits the reach to young people and the integration of the service into primary care systems,” said the authors.

Professor Lisa Nissen, Head of the School of Clinical Sciences in the Faculty of Health at the Queensland University of Technology, told AJP that there are limited reasons to restrict pharmacists’ participation in HPV vaccination in Australia.

“As we look to expand the range of vaccine that pharmacist administer, the HPV vaccine would be a logical addition to the group available in the various Australian jurisdictions,” said Professor Nissen, who has led important research on pharmacist vaccination.

HPV is incorporated in the school program across the country and optimisation of the dose schedule has reduced the number of vaccines that are needed to complete the treatment course, she pointed out.

“In Australia, pharmacists would play a role in picking up children who have missed school-based programs or who had gaps in their vaccination schedules. It would be important for those vaccines to ideally be funded through the National Immunisation Program (NIP) allowing equity of access regardless of the provider—i.e. not disadvantaging people who chose to receive it through the pharmacy for example,” said Professor Nissen.

“Access to the vaccine would facilitate completion of vaccine schedules and potential increased uptake in many parts of the community where school programs may not fully serve the needs of particular groups.”

Contraception

Of the 12 studies focused on contraception, six studies assessed prescribing hormonal contraception, three focused on injectable contraceptive administration and two on emergency contraception (EC) provision.

One study found that community pharmacists in Oregon, US, issued 10% of new contraceptive prescriptions (oral or transdermal methods) during 2016-2017.

Another study reported that pharmacists in Oregon and California prescribed different contraceptive methods, including oral (95.7%), patch (1.6%), vaginal ring (2.6%) and injectable (0.1%).

The availability of hormonal contraceptives and progestin-only emergency contraceptive pill in community pharmacies is due to approved legislation in some states in the USA and Canada.

Policy limitations remain a barrier in Australia, as community pharmacists are as yet unable to prescribe contraception—although they are able to provide emergency contraception with counselling.

Limited continued dispensed arrangements mean Australian pharmacists are able to provide supply of a single full pack of oral contraceptives when a patient needs the medicine urgently but is unable to access a script.

Meanwhile, as of July this year, UK pharmacists can provide some types of oral contraceptive pill over the counter.

One of the studies in the scoping review showed that pharmacists’ prescription service was associated with improved contraception continuation rates as pharmacists were significantly more likely to prescribe a 6-month supply than other prescribers.

It was also suggested that pharmacists can assist women by administering injectable contraceptives at the time of picking up their refill. Convenient access to community pharmacies made this service feasible with high acceptance rates by women.

Greater uptake of services

“Our results reveal pharmacists are engaged in a wide range of activities beyond traditional pharmacy services, signalling that pharmacists play a more significant role in delivering services in a number of sexual and reproductive health areas,” said the authors.

“Generally, studies included in this review found the provision of sexual and reproductive services by pharmacists enhanced access to care, users’ experiences and the uptake of services.

“[These] services provided by pharmacists at community pharmacies reached vulnerable and high-risk groups … This is particularly relevant to emphasise now, as the COVID-19 pandemic has dramatically impacted public health …

“The pandemic has had repercussions on access to routine and preventive services, shortage of products and supplies and service delivery capacity.”

They suggest that pharmacists can be positioned as sexual and reproductive healthcare providers, using community pharmacies as an “access point”.

However integration of services into the daily workflow, pharmacists’ remuneration, cost and reimbursement for patients and policy regulations are commonly reported barriers that need to be considered and overcome.

See the full study in BMJ Open

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