Pharmacist Outlooks on Prescribing Hormonal Contraception Following Statewide Scope of Practice Expansion

Sally Rafie,Emily Richards,Sharon Landau,Samantha Rafie,Tracey Wilkinson

doi:10.3390/pharmacy7030096

Abstract

In an effort to increase access to contraception, the pharmacist scope of practice is being expanded to allow prescribing. While this is being accomplished in the United States by a variety of models, legislation that allows pharmacists to prescribe hormonal contraception under a statewide protocol is the most common. This study was designed to explore the outlooks of pharmacists regarding prescribing contraception in the period following the first state legislation and prior to statewide protocol development and availability. A qualitative study of community pharmacists in California using structured phone interviews explored their opinions regarding access to contraception in pharmacies and outlooks regarding prescribing. Data were analyzed using an inductive approach to identify themes. Among the thirty participants, the majority worked in a chain pharmacy. Themes were identified in five overarching domains: Pharmacist barriers, system barriers, patient issues, safety concerns, and pharmacist role. Most were unfamiliar with the new law, yet were interested in expanding access for patient benefit despite foreseeing challenges with implementing the service in community pharmacies. Barriers will need to be addressed and requisite training disseminated widely to facilitate successful implementation and thus improve access on a broad scale. Further research following protocol implementation is needed to understand service implementation, as well as patient utilization and satisfaction.

Highlights

There are many challenges to birth control access in the United States (US), including costs of clinic visits, difficulties getting an appointment, required annual checkups, the time required for clinic visits, restrictions on the number of packs of prescription contraceptives dispensed, and the limited period in which prescriptions can be refilled [1]
In a survey of US women, 67% indicated that they would personally benefit from not having to pay for a doctor or clinic visit if they could access hormonal contraception directly at the pharmacy [2]
It consisted of 21 open-ended questions to generate discussion on pharmacist prescribing of hormonal and emergency contraception, including sample patient vignettes to prompt additional discussion: (1) Repeat patient coming in for emergency contraception on multiple occasions, (2) patient is late refilling her birth control and has no refills left, (3) patient is filling a prescription for a new medication, topiramate, and you notice she has birth control pills on her profile, (4) an obese woman asking for emergency contraception, and (5) 17 year-old is interested in starting contraception (Appendix A)

Summary

Introduction

There are many challenges to birth control access in the United States (US), including costs of clinic visits, difficulties getting an appointment, required annual checkups, the time required for clinic visits, restrictions on the number of packs of prescription contraceptives dispensed, and the limited period in which prescriptions can be refilled [1]. One strategy is to create additional access points at community pharmacies by expanding the pharmacist scope of practice at the state level to include prescribing of contraception. In a survey of US women, 67% indicated that they would personally benefit from not having to pay for a doctor or clinic visit if they could access hormonal contraception directly at the pharmacy [2]. While the prescription-only status remains unchanged, states have begun expanding their pharmacist scope of practice to include prescribing of contraception under statewide collaborative practice agreement or protocol or dispensing under statewide standing order [4].

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Methods

Discussion

Conclusion