Pharmacy and clinic partnerships to expand access to injectable contraception

Abstract

ObjectivesTo explore the potential of pharmacist-administered contraceptive injections and feasibility and acceptability among patients, pharmacists, and clinicians. SettingThroughout California, 27 pharmacists practicing in 26 community independent and chain pharmacies partnered with 19 clinics/physician offices. Practice descriptionTIn spring 2003, Pharmacy Access Partnership launched a 2-year demonstration program in which established users of depot medroxyprogesterone acetate (e.g., Depo-Provera—Pfizer) hormonal contraception at participating clinics were given the option of returning to their regular clinic for reinjection or going to a participating pharmacist trained in injection technique and contraceptive management. Practice innovationProgram feasibility and acceptability by patients, pharmacists, and clinicians were evaluated to offer insights into the potential of pharmacistadministered depot medroxyprogesterone injections. InterventionIntake forms collected during pharmacy reinjection visits, data from interviews with pharmacists and clinicians, and evaluations with patients. Main outcome measuresTo determine whether contraceptive reinjection at a pharmacy is feasible and acceptable for patients, pharmacists, and clinicians and to determine the characteristics of women most likely to use the service. ResultsA total of 69 women received 143 depot medroxyprogesterone injections during the project. Patients were ethnically and racially diverse and spanned a wide age range (19–45 years). Women 20 years of age or older used pharmacists’ services more frequently than did younger patients, perhaps because they were more familiar with the injections and they more often worked, therefore needing the expanded hours offered by the community pharmacy setting. Experiences of two pharmacies with successful programs are described. ConclusionThe pharmacy option for reinjection is most viable for women who can comfortably manage their injection cycle, prefer not to have to schedule a clinic appointment quarterly, and do not require the ongoing attention and appointment supervision available from the clinic. To be successful, program promotion requires provider support, integration, and involvement at the clinic level.