Should pharmacists be able to prescribe contraceptives?

contraception women's health contraceptive birth control pill

Study shows state expansion of hormonal contraception prescribing authority to pharmacists helps women obtain better access and prevent unintended pregnancy

US researchers have looked at the impact of expanding pharmacist practice at the state level to include prescribing self-administered hormonal contraception.

California passed legislation in 2013, followed by Oregon in 2015, allowing pharmacists to prescribe self-administered hormonal contraceptives directly to patients according to state-wide protocols developed by the respective state board of pharmacy.

Protocols were implemented in early 2016, requiring pharmacists to complete training, review patients’ health history, measure blood pressure and refer as needed.

Research led by the Kaiser Permanente Santa Clara Medical Center studied 391 pharmacies across California and Oregon within a supermarket-based pharmacy chain providing hormonal contraception services on a walk-in basis, and the patients who utilised those services, between August 2016 and February 2017.

Results published in the journal Contraception found pharmacists effectively provided hormonal contraception services and supplies to most patients seeking hormonal contraception.

Over the 6.5-month study period, 93% (n = 1970) of the 2117 visits led to a hormonal contraception prescription being issued and dispensed by a pharmacist.

The remaining 7% (n = 147) did not meet criteria to access hormonal contraception through a pharmacist and were referred to their general practitioner for follow-up care. Elevated blood pressure (≥140/90 mmHg) was the most common reason for referral.

Of the 1970 birth control prescriptions provided by 381 trained pharmacists, 95.7% were for the pill.

Among pill prescriptions, most were for a combination pill (98%), followed by progestin-only (2%).

Less commonly, pharmacists prescribed the vaginal ring (n = 51, 2.6%), transdermal patch (n = 31, 1.6%), and injectable (n = 2, 0.1%).

There were no referrals for an intrauterine device or implant.

Since 91% of patients had used some hormonal contraception in the past, the authors suggest they may have been seeking a familiar method, or a self-administered method readily available at the pharmacy.

The protocols allowed for up to one year of prescription supply quantities, in the form of initial quantity plus any refills.

The supply quantities authorised ranged from one to 13 packs, most commonly for a full year’s supply, written as either single pack or multiple pack refills.

Researchers say previous studies have found women who received a 12-month supply of oral contraceptives showed increased adherence and a 30% reduction in unintended pregnancies compared to patients who received a one-month or three-month supply.

“Pharmacist prescribing services may further help reduce the incidence of unintended pregnancy and abortion when pharmacists can prescribe and dispense a one-year supply of self-administered hormonal contraception for a patient with health insurance,” they say.

Meanwhile barriers to obtaining contraception through a GP include difficulty obtaining an appointment, inconvenient clinic hours, high co-pays and not wanting to have a pelvic examination, they say.

While patients in the study had to pay a flat service fee to access the for pharmacist hormonal contraception services, legislation passed in California and Oregon following the study that allowed for reimbursement by each state’s Medicaid program.

This will increase patient access as well as pharmacist participation, the researchers point out.

During the study period, Colorado became the third state to expand pharmacists’ scope of practice to including prescribing hormonal contraception.

Further study in additional states and types of pharmacy settings (e.g. independent, chain and big-box pharmacies) will be valuable, the researchers conclude.

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