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Ahmed Z, Gu Y, Sinha K, Mutowo M, Gauld N, Parkinson B. A qualitative exploration of the over-the-counter availability of oral contraceptive pills in Australia. PLoS One 2024; 19:e0305085. [PMID: 38857242 PMCID: PMC11164330 DOI: 10.1371/journal.pone.0305085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 05/23/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION The prevention of unintended pregnancy is a public health issue affecting women worldwide. In Australia, women are required to get a prescription to obtain the oral contraceptive pill (OCP), which may limit access and be a barrier to its initiation and continuing use. Changing the availability of the OCP from prescription-only to over-the-counter (OTC) is one solution, however, to ensure success policymakers need to understand women's preferences. Telehealth services also might serve as an alternative to obtain prescriptions and increase accessibility to OCPs. This study aims to explore the preferences for OTC OCPs among Australian women, and whether the expansion of telehealth impacted women's preferences. METHODS A mixed methods approach was used to explore women's preferences regarding access to the OCP. Focus group discussions (FGDs) were conducted to organically identify the preferences followed by an empirical ranking exercise. Three FGDs in two phases were conducted, pre and post-expansion of telehealth in Australia due to the COVID-19 pandemic. Convenience sampling was employed. The technique of constant comparison was used for thematic analysis where transcripts were analysed iteratively, and codes were allowed to emerge during the process to give the best chance for the attributes to develop from the data. RESULTS Thematic analysis revealed that women perceived OTC availability of OCPs as a mechanism to increase the accessibility of contraception by reducing cost, travel time, waiting time, and increasing opening hours. They also believed that it would increase adherence to OCPs. However, some potential safety concerns and logistical issues were raised, including pharmacist training, access to patient's medical history, the ability to discuss other health issues or undertake opportunistic health screening, adherence to checklists, and privacy in the pharmacy environment. Following the expansion of telehealth, accessibility issues such as opening hours, travel time, and location of the facility were considered less important. CONCLUSIONS The participants expressed their support for reclassifying OCPs to OTC, particularly for repeat prescriptions, as it would save valuable resources and time. However, some safety and logistical issues were raised. Women indicated they would balance these concerns with the benefits when deciding to use OTC OCPs. This could be explored using a discrete choice experiment. The expansion of telehealth was perceived to reduce barriers to accessing OCPs. The findings are likely to be informative for policymakers deciding whether to reclassify OCPs to OTC, and the concerns of women that need addressing to ensure the success of any policy change.
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Affiliation(s)
- Zobaida Ahmed
- Macquarie University Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
- Department of Economics, Macquarie Business School, Macquarie University, Sydney, NSW, Australia
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
- Department of Economics, Macquarie Business School, Macquarie University, Sydney, NSW, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Kompal Sinha
- Macquarie University Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
- Department of Economics, Macquarie Business School, Macquarie University, Sydney, NSW, Australia
| | - Mutsa Mutowo
- Macquarie University Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
| | - Natalie Gauld
- School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Bonny Parkinson
- Macquarie University Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
- Department of Economics, Macquarie Business School, Macquarie University, Sydney, NSW, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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Sawant-Basak A, Ingle-Jadhav P. Prescription of Oral Contraceptives by Licensed Pharmacists in the USA. J Clin Pharmacol 2024; 64:283-287. [PMID: 38047452 DOI: 10.1002/jcph.2390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
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Berndt VK, Bell AV. Beyond knowledge: Introducing embodied aversion through the case of contraception. Soc Sci Med 2024; 341:116516. [PMID: 38141383 DOI: 10.1016/j.socscimed.2023.116516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 12/25/2023]
Abstract
Family planning programs have largely operated at the individual level, seeking to enhance individuals' knowledge of, change attitudes towards, and improve consistent use of efficacious contraception. Social science research has added to these efforts by emphasizing the structural influences that shape individuals' contraceptive attitudes, beliefs, and behaviors. Such work highlights the importance of embodied knowledge which is informed by social contexts and provides individuals with a sense of assuredness in knowing which contraception works well for them (and within their bodies). However, through qualitative analysis of in-depth interviews with 59 self-identified women conducted from 2017 to 2018 across the state of Delaware in the United States, we argue that there is a powerful facet of contraceptive decision-making that lies beyond articulatable, conscious knowledge, which we name "embodied aversion." We draw on affect theory and stigma theory to introduce embodied aversion as an influential feeling and orientation away from implantable and insertable contraceptive methods that arises from internalized stigma around the reproductive body. Embodied aversion overpowers conscious understanding of contraceptive benefits like efficacy, ease of use, and longevity. Our research presents embodied aversion as a missing piece of contraceptive understanding that we argue is vital in more fully conceptualizing experiential dimensions of contraceptive use. Doing so enhances patient-centered care, shared decision-making, and reproductive autonomy.
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Affiliation(s)
- Virginia Kuulei Berndt
- Department of Social Sciences, Texas A&M International University, 5201 University Blvd., Laredo, TX, 78941, USA.
| | - Ann V Bell
- Department of Sociology & Criminal Justice, University of Delaware, 18 Amstel Ave., Newark, DE, 19716, USA.
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Abrams LM, Look KA. Community pharmacists and improving contraception access: Relationships between contraceptive counseling and dispensing contraceptives. Res Social Adm Pharm 2023; 19:1602-1605. [PMID: 37709642 DOI: 10.1016/j.sapharm.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/08/2023] [Accepted: 09/10/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Experiences of contraceptive counseling and obtaining contraceptives vary for women of childbearing age based on education level, race, ethnicity, and health insurance. Community pharmacists are an important resource for improving access to contraceptive care in states with over-the-counter access to and pharmacist prescribing of contraceptives. OBJECTIVES We first aimed to determine how patient education level, race, ethnicity, insurance, and patient-provider race concordance influenced the likelihood of receiving contraceptive counseling. The second aim was to determine how receiving contraceptive counseling influenced the likelihood of being dispensed contraceptives by a pharmacist. METHODS Pearson chi-square tests and logistic regression were used to address study aims. RESULTS Older women and those with Medicaid were less likely to receive contraceptive counseling. Race concordance had no influence on counseling. Counseling and education level were strong predictors of being dispensed contraceptives. Race, ethnicity, Medicaid, and marital status were negatively associated with being dispensed contraceptives. CONCLUSIONS Inequities exist in access to contraceptive care for women of diverse backgrounds as well as those insured through Medicaid. State-level policy advancements and over the counter access to oral contraceptives may provide pharmacists a unique opportunity to provide contraceptive care for women without access to a primary care provider.
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Affiliation(s)
- Lucille M Abrams
- University of Wisconsin-Madison, School of Pharmacy, Rennebohm Hall, 777 Highland Ave, Madison, WI, 53705, USA.
| | - Kevin A Look
- University of Wisconsin-Madison, School of Pharmacy, Rennebohm Hall, 777 Highland Ave, Madison, WI, 53705, USA.
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Zuniga C, Forsberg H, Grindlay K. Experiences of progestin-only pill users in the United States and attitudes toward over-the-counter access. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:104-112. [PMID: 37038840 DOI: 10.1363/psrh.12223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
CONTEXT Removing the prescription requirement and making oral contraceptive pills available over the counter (OTC) could increase contraceptive access in the United States. Despite current efforts to make a progestin-only pill (POP) available OTC, there are no qualitative data exploring the experiences of POP users and their perspectives on making POPs available OTC. METHODS We conducted six online, asynchronous focus group discussions with 36 POP users between July and November 2020. We stratified focus group discussion placement based on three reasons for POP use: breastfeeding, having a contraindication to estrogen (for a reason other than breastfeeding), and for any other reason. We thematically analyzed these data using inductive and deductive coding. RESULTS The majority of participants described their overall POP experience as positive, mostly because they experienced minor or no side effects and thought the pill was effective. Participants overwhelmingly supported OTC availability of POPs and expressed interest in purchasing an OTC POP. Over one-third of participants had very limited knowledge or held inaccurate assumptions about POPs before they started using this method and many stressed the need to disseminate accurate information and resources about POPs to the public. CONCLUSIONS Most focus group discussion participants were satisfied with POPs and supported OTC access. While misconceptions and concerns about POPs should be addressed, an OTC POP has the potential to be a safe, effective, and convenient contraceptive option in the United States.
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Affiliation(s)
| | | | - Kate Grindlay
- Ibis Reproductive Health, Cambridge, Massachusetts, USA
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Jacobsohn T, Nguyen BT, Brown JE, Thirumalai A, Massone M, Page ST, Wang C, Kroopnick J, Blithe DL. Male contraception is coming: Who do men want to prescribe their birth control? Contraception 2022; 115:44-48. [PMID: 35550379 PMCID: PMC9560967 DOI: 10.1016/j.contraception.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/15/2022] [Accepted: 04/29/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To assess men's preferences for healthcare provider from whom they would obtain hormonal male contraceptive (HMC) methods. STUDY DESIGN We asked participants from 3 clinical trials of investigational HMC methods-an oral pill (11β-Methyl-19-nortestosterone-17β-dodecylcarbonate, 11β-MNTDC), intramuscular or subcutaneous injection (Dimethandrolone undecanoate), and transdermal gel (Nestorone and testosterone)-to rank their top 3 preferred HMC providers from a list including: men's health doctor (urologist/andrologist), hormonal doctor (endocrinologist), reproductive health doctor (OB/GYN), family planning clinician (community health worker, midwife, nurse practitioner), regular doctor (family medicine/internal medicine), and community pharmacist. We examined preferences based on their rankings and conducted bivariate analyses. Collapsing the various specialists (men's health doctor, hormonal doctor, reproductive health doctor, and family planning clinician) into a single provider type, we examined participant demographics against provider preference (regular doctor, pharmacist, or specialist). RESULTS Participants across the 3 trials (n = 124) ranked their regular doctor (44%) and community pharmacist (18%) as their most preferred HMC provider; these preferences did not differ significantly by trial and drug formulation. Specialists in family planning (13%), men's health (12%), reproductive health (10%), and hormones (4%) were least frequently ranked as their preferred provider. Older and higher educated participants more often preferred specialists over regular doctors and pharmacists (p = 0.02 and p = 0.01). CONCLUSIONS Despite receiving contraceptive steroid hormones and care from endocrinologists and family planning specialists in a clinical trial, participants would prefer to obtain contraception from their regular doctor. IMPLICATIONS As most men expect to obtain hormonal male contraceptives from their regular doctor when commercially available, primary care physicians should become familiar with HMCs and be prepared to provide counseling and options accordingly.
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Affiliation(s)
- Tamar Jacobsohn
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, United States
| | - Brian T Nguyen
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States.
| | - Jill E Brown
- Uniformed Services University of Health Sciences, Bethesda, MD, United States
| | - Arthi Thirumalai
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Michael Massone
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Stephanie T Page
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Christina Wang
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Jeffrey Kroopnick
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, United States
| | - Diana L Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, United States
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Association of Pharmacist Prescription of Contraception With Breaks in Coverage. Obstet Gynecol 2022; 139:781-787. [DOI: 10.1097/aog.0000000000004752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/27/2022] [Indexed: 10/18/2022]
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Stone RH, Cieri-Hutcherson NE, Vernon V, Arellano R, Mospan C, Harris JB, Barnes KN, Griffin BL, Lodise NM, Patel J, Rafie S, Vest K. Curricular Considerations for Preparing Student Pharmacists to Prescribe Hormonal Contraception. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2022; 86:8667. [PMID: 34385172 PMCID: PMC10159422 DOI: 10.5688/ajpe8667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/02/2021] [Indexed: 05/06/2023]
Abstract
In 2014, the pharmacist's role in the United States expanded to include prescribing hormonal contraception, and this practice is currently addressed by policy in 14 states and the District of Columbia. Training and education requirements for this expanded scope of practice vary between states and are changing rapidly. The objective of this review is to examine how student pharmacists are taught to provide contraceptive care, specifically for prescribing ongoing hormonal contraception and emergency contraception, and to identify potential gaps in the United States pharmacy curricula related to contraception. Despite steady adoption into community pharmacy practice, there is sparse literature assessing educational methods used to teach contraceptive care. This review offers recommendations to promote consistent and comprehensive student pharmacist education in providing contraceptive care across institutions, regardless of state policy status.
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Affiliation(s)
| | | | - Veronica Vernon
- Butler University, College of Pharmacy and Health Sciences, Indianapolis, Indiana
| | - Regina Arellano
- Midwestern University, College of Pharmacy - Downers Grove, Downers Grove, Illinois
| | - Cortney Mospan
- Wingate University, School of Pharmacy, Wingate, North Carolina
| | | | - Kylie N Barnes
- University of Missouri - Kansas City, School of Pharmacy, Kansas City, Missouri
| | - Brooke L Griffin
- Midwestern University, College of Pharmacy - Downers Grove, Downers Grove, Illinois
| | - Nicole M Lodise
- Albany College of Pharmacy and Health Sciences, Albany, New York
| | - Jaini Patel
- Midwestern University, College of Pharmacy - Downers Grove, Downers Grove, Illinois
| | - Sally Rafie
- University of California San Diego Health, San Diego, California
| | - Kathleen Vest
- Midwestern University, College of Pharmacy - Downers Grove, Downers Grove, Illinois
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Parry RA, Seamon G, Scott MA, Tak CR. North Carolina Pharmacists' Support for Hormonal Contraception Prescription Status Change. J Pharm Pract 2022:8971900221074966. [PMID: 35325584 DOI: 10.1177/08971900221074966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pharmacist-prescribed hormonal contraception (HC) may offer additional avenues of access for patients; however, it is unknown whether pharmacists would support over-the-counter access to contraception over pharmacist-prescribed models. OBJECTIVE The objective of this study was to understand how North Carolina (NC) pharmacists believed HC should be classified and how pharmacist and pharmacy characteristics were associated with those beliefs. METHODS This study was a secondary analysis of a cross-sectional, anonymous, online survey completed by 587 licensed NC pharmacists. The primary outcome of interest was how pharmacists believed HC should be classified: prescription-only, pharmacist-prescribed, behind-the-counter, or over-the-counter. Multinomial bivariate and multivariable regression analyses were conducted to describe the association between pharmacist and pharmacy characteristics with the outcomes of interest through odds ratios and adjusted odds ratios, respectively. Chi-square tests were used to examine the association of geographic location with distribution of attitudes toward HC classification. RESULTS Fifty-one percent of NC pharmacists supported classification of HC as pharmacist-prescribed, while 23% supported non-prescription (behind- or over-the-counter) classification. Controlling for pharmacist demographics and pharmacy characteristics, completing residency training was significantly associated with supporting pharmacist-prescribed vs prescription-only classification (adjusted odds ratio (aOR) = 2.55, P = .02). Pharmacists had higher odds of supporting pharmacist-prescribed vs prescription-only HC if they agreed that they were well trained to do so (aOR = 3.14, P < .01). Distribution of attitudes about classification of HC did not significantly differ by geographic location (P = .14). CONCLUSIONS Most NC pharmacists support deviating from the current prescription-only classification of HC, with more support for pharmacist-prescribed classification. Continuing education programs should focus on training pharmacists to feel more confident prescribing HC.
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Affiliation(s)
- Rachel A Parry
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, 2331The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gwen Seamon
- Mountain Community Health Partnership, Burnsville, NC, USA
| | - Mollie Ashe Scott
- UNC Health Sciences, Mountain Area Health Education Center, Asheville, NC, USA.,Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, 2331The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Casey R Tak
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, 2331The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
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Atkins K, Kennedy CE, Yeh PT, Narasimhan M. Over-the-counter provision of emergency contraceptive pills: a systematic review. BMJ Open 2022; 12:e054122. [PMID: 35288384 PMCID: PMC8921871 DOI: 10.1136/bmjopen-2021-054122] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 02/10/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To synthesise evidence around over-the-counter (OTC) emergency contraceptive pills (ECPs) to expand the evidence base on self-care interventions. DESIGN Systematic review (PROSPERO# CRD42021231625). ELIGIBILITY CRITERIA We included publications comparing OTC or pharmacy-access ECP with prescription-only ECPs and measuring ECP uptake, correct use, unintended pregnancy, abortion, sexual practices/behaviour, self-efficacy and side-effects/harms. We also reviewed studies assessing values/preferences and costs of OTC ECPs. DATA SOURCES We searched PubMed, CINAL, LILACS, EMBASE, clinicaltrials.gov, WHO International Clinical Trials Registry Platform, Pan African Clinical Trials Registry, Australian New Zealand Clinical Trials Registry, Cochrane Fertility Regulation and International Consortium for Emergency Contraception through 2 December 2020. RISK OF BIAS For trials, we used Cochrane Collaboration's tool for assessing risk of bias; for other studies, we used the Evidence Project risk of bias tool. DATA EXTRACTION AND SYNTHESIS We summarised data in duplicate using Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence Profile tables, reporting findings by study design and outcome. We qualitatively synthesised values/preferences and cost data. RESULTS We included 19 studies evaluating effectiveness of OTC ECP, 56 on values/preferences and 3 on costs. All studies except one were from high-income and middle-income settings. Broadly, there were no differences in overall ECP use, pregnancy or sexual behaviour, but an increase in timely ECP use, when comparing OTC or pharmacy ECP to prescription-only ECP groups. Studies showed similar/lower abortion rates in areas with pharmacy availability of ECPs. Users and providers generally supported OTC ECPs; decisions for use were influenced by privacy/confidentiality, convenience, and cost. Three modelling studies found pharmacy-access ECPs would lower health sector costs. CONCLUSION OTC ECPs are feasible and acceptable. They may increase access to and timely use of effective contraception. Existing evidence suggests OTC ECPs do not substantively change reproductive health outcomes. Future studies should examine OTC ECP's impacts on user costs, among key subgroups and in low-resource settings.
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Affiliation(s)
- Kaitlyn Atkins
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Community Pharmacists' Knowledge, Willingness, and Readiness to Prescribe Oral Contraceptives in Saudi Arabia. Healthcare (Basel) 2022; 10:healthcare10030503. [PMID: 35326981 PMCID: PMC8956115 DOI: 10.3390/healthcare10030503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/28/2022] [Accepted: 03/05/2022] [Indexed: 11/25/2022] Open
Abstract
Background: The role of community pharmacists (CPs) in various healthcare settings is well documented in the literature including providing safe and easy access to medications. Oral contraceptives (OCPs) are the most frequently used method of terminating unwanted pregnancies worldwide. Objective: This study aims to evaluate the Community pharmacist’s knowledge, willingness, and readiness to prescribe OCPs in Saudi communities in Saudi Arabia. Methods: This is across sectional, self-administered questionnaire-based study conducted between May and November 2021 in the central region of Saudi Arabia. The results were presented as frequencies and percentages. Chi-square tests were used to sort significant association between groups. Results: Out of 368 CPs who got the questionnaire, 347 completed (94.3%). Most of CPs were be-tween the ages of 25 and 35, with 76.9% working in chain pharmacies. Of the surveyed CPs, 45.5% had >24 months of experience in community pharmacies. 41.8% of them prescribed more than six prescriptions for OCPs/week. The patients’ safety (77.2%), physician’s resistance (54.5%), and CPs objection based on religious purposes (36.9%) and lack of time (29.7%) were the most commonly cited barriers among CPs. CPs who worked in chain pharmacies were significantly too busy (p = 0.038) to prescribe OCPs. Also, community pharmacists with experience of more than two years significantly agreed not to prescribe OCPs due to religious convictions (p = 0.009). Conclusion: The current study revealed that most of the CPs were knowledgeable about OCPs. Additionally, most of them were likely to prescribe oral contraceptives. We further suggest overcoming the barriers associated with contraceptives among CPs and providing sufficient training to improve the oral contraceptive prescriptions in CPs is needed.
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Accessibility of Pharmacist-Prescribed Contraceptives in Utah. Obstet Gynecol 2021; 138:871-877. [PMID: 34735383 PMCID: PMC8594517 DOI: 10.1097/aog.0000000000004594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess pharmacy participation in and accessibility of pharmacist-prescribed contraception after legislation effective in the state of Utah in 2019. METHODS A secret-shopper telephone survey was used to assess participation in pharmacist-prescribed contraception. Geospatial analysis was used to map the distribution of participating pharmacies by population characteristics. RESULTS Of all operating Class A retail pharmacies in Utah, 127 (27%) were providing pharmacist-prescribed contraception 1 year after implementation of the Utah standing order. Oral contraceptive pills were widely accessible (100%); however, other allowed methods were not (vaginal ring 14%; contraceptive patch 2%). Consultation fees and medication costs varied widely. Participating pharmacies were mainly concentrated in population centers. Assuming access to a personal vehicle, urban areas with a high percentage of Hispanic people (Utah's largest minority race or ethnicity group) have access to a participating pharmacy within a 20-minute driving distance. However, access in rural areas with a high percentage Hispanic or other minority were limited. We identified 235 (40%) census tracts with a high proportion of Utah's residents living below the poverty line or of minority race or ethnicity who also had low access to pharmacist-prescribed contraception. CONCLUSIONS Although the pharmacy-based model is intended to increase access to contraception, practical availability 1 year after the authorization of pharmacist-prescribed contraception in Utah suggests that this service does not adequately serve rural areas, particularly rural areas with a high proportion of minorities and those living below the federal poverty line.
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Yous T, Allemann S, Lutters M. Physicians' Opinion Regarding Extended Access to Hormonal Contraception in Switzerland. PHARMACY 2021; 9:pharmacy9040184. [PMID: 34842813 PMCID: PMC8628942 DOI: 10.3390/pharmacy9040184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Access to hormonal contraceptives (HC) strongly differs between countries and varies from over the counter (OTC) to prescription-only availability. This study aimed to identify opinions among physicians in Switzerland regarding extended access to HC. (2) Methods: Web-based survey among physicians (gynecologists, general practitioners, and pediatricians) in Switzerland. (3) Results: Hundred sixty-three physicians, mainly gynecologists, participated in this survey and 147 (90%) were included for analysis. A total of 68% (n = 100) answered that prescription-only status could be extended under certain conditions but physicians were concerned about patients' safety (97%, n = 142). Moreover, there was concern about insufficient patient education on HC (93%, n = 136) and that women may forego preventive examinations (80%, n = 118). Participants did not support OTC availability (93%, n = 136). Pharmacists prescribing (including initiation of HC) revealed controversial results, but a combined access model (initial prescription from physician and follow-up prescriptions by pharmacists) found acceptance in 70% (n = 103). (4) Conclusions: Participating physicians stated that prescription-only status for HC could be lifted under certain conditions but also some concerns, e.g., patients' safety or neglection of preventive examinations, were raised. Future research should focus on specific conditions in which extended access to HC could be agreed on.
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Affiliation(s)
- Tamara Yous
- Department of Medical Sciences, Private University of the Principality of Liechtenstein, 9495 Triesen, Liechtenstein
- Correspondence:
| | - Samuel Allemann
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, 4051 Basel, Switzerland;
| | - Monika Lutters
- Clinical Pharmacy, Cantonal Hospital of Baden, 5404 Baden, Switzerland;
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Evaluation of Student Pharmacists' Attitudes and Perceptions of Hormonal Contraception Prescribing in Indiana. PHARMACY 2021; 9:pharmacy9040185. [PMID: 34842821 PMCID: PMC8628905 DOI: 10.3390/pharmacy9040185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022] Open
Abstract
Community pharmacists’ scope of practice is expanding to include hormonal contraceptive prescribing. Prior to introducing statewide legislation, it is important to assess the perceptions of future pharmacists. A cross-sectional survey was distributed to 651 third- and fourth-year professional students enrolled at three colleges of pharmacy in Indiana. Data were collected between September and October 2019 to assess students’ attitudes about prescribing hormonal contraceptives, readiness to prescribe, perceived barriers, and desire for additional training. In total, 20.9% (n = 136) students responded. Most (89%, n = 121) believe that pharmacist-prescribed hormonal contraceptives would be beneficial to women in Indiana, and 91% (n = 124) reported interest in providing this service. Liability, personal beliefs, and religious beliefs were the most commonly cited perceived barriers. Most students felt they received adequate teaching on hormonal contraceptive methods (90%, n = 122) and hormonal contraceptive counseling (79%, n = 107); only 5% (n = 7) felt ready to provide the service at the time of survey completion. Student pharmacists in their final two years of pharmacy school are interested in prescribing hormonal contraceptives and believe that this service would be beneficial. This expansion of pharmacy practice would likely be supported by future pharmacists who feel the service could provide benefit to women seeking hormonal contraceptives in Indiana.
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Soon JA, Whelan AM, Yuksel N, Rafie S. Enhancing access to contraception through pharmacist prescribing across Canada. Can Pharm J (Ott) 2021; 154:356-362. [PMID: 34777642 PMCID: PMC8581806 DOI: 10.1177/17151635211034534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/02/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Judith A. Soon
- Faculty of Pharmaceutical Sciences, University of British Columbia
- Department of Family Practice, University of British Columbia
| | | | - Nesé Yuksel
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta
| | - Sally Rafie
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California–San Diego, California
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Newlon JL, Reed JB, Stone RH, Satterfield KG, Meredith AH. Pharmacist‐prescribed
hormonal contraception services: A systematic review of implementation studies. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Jenny L. Newlon
- Purdue University College of Pharmacy West Lafayette Indiana USA
| | - Jason B. Reed
- Purdue University Libraries and School of Information Studies West Lafayette Indiana USA
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Thaxton L, Clark E, Wu JA, Herman A, Sussman AL, Espey E. Perspectives on pharmacy access to hormonal contraception among rural New Mexico women. Contracept X 2021; 3:100069. [PMID: 34430846 PMCID: PMC8367852 DOI: 10.1016/j.conx.2021.100069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/23/2022] Open
Abstract
Objective In 2017, New Mexico approved an amendment allowing pharmacists to prescribe and dispense hormonal contraception. We interviewed rural New Mexico women to determine their perceptions of pharmacy access to hormonal contraception. Study design We conducted semi-structured telephone interviews with women recruited from rural New Mexico communities. The interview guide explained the amendment followed by questions about the advantages and disadvantages of pharmacy access to hormonal contraception within rural communities. Results Between November 2017 and May 2018, we recruited 32 women to participate. Participants were young (26/32 18–29 years old), gravid (27/31), employed (30/32), white (22/32) and Hispanic (26/31). The majority used Medicaid as their primary insurance (16/28). Most participants were supportive of pharmacy access to hormonal contraception. Participants saw their rural communities as facing health care barriers, some of which could be alleviated by pharmacy access. Perceived benefits of pharmacy access included convenience of pharmacy hours, shorter wait times, and no need for an appointment. Participants expressed concerns about lack of privacy in their pharmacies. Many expressed trust in their pharmacist to review side effects and explain usage of contraception- a role that was considered separate from that of a primary care provider who offers regular medical visits for routine screening and nuanced or complex discussions about contraception. Some participants expressed that pharmacy access could be especially beneficial for teens. Conclusions Rural New Mexico women were supportive of pharmacy access to contraception and accept pharmacists as trusted members of the health care team. Implications Rural New Mexico women find benefit in pharmacy access to hormonal contraception, citing improved access to contraceptives in their communities.
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Affiliation(s)
- Lauren Thaxton
- Department of Women's Health, University of Texas at Austin Dell Medical School, Austin, TX, United States
| | - Elizabeth Clark
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Jocelyn Aubrey Wu
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Alexandra Herman
- Department of Pharmacy Practice & Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, United States
| | - Andrew L Sussman
- Department of Family and Community Medicine and University of New Mexico Comprehensive Cancer, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Eve Espey
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM, United States
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Pharmacist-Prescribed Hormonal Contraception: Does Didactic Hormonal Contraception Education Affect Student Pharmacist Perceptions of This Professional Activity? PHARMACY 2021; 9:pharmacy9030145. [PMID: 34449736 PMCID: PMC8396284 DOI: 10.3390/pharmacy9030145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/17/2022] Open
Abstract
Since 2014, select states have allowed pharmacists to prescribe hormonal contraception (HC). This study describes student pharmacists’ perceptions of a pharmacist’s scope of practice, education, and interest, and identifies differences between students who have completed didactic HC content in their professional curriculum versus those who have not. A voluntary online survey was emailed to all students in three Georgia pharmacy schools. Descriptive statistics were reported. Likert square responses were dichotomized, and Chi square testing identified differences between groups. A total of 1256 students were invited, 35% completed the survey, of those 68% had received HC didactic content in their curriculum. Regardless of HC education, most students “agree” or “strongly agree” that pharmacists are adequately educated to prescribe HC (92% vs. 86%, p = 0.05) and prescribing HC is within the pharmacist’s scope of practice (89% vs. 84%, p = 0.12). Although not currently permitted in Georgia, most are interested in prescribing (97% vs. 96%, p = 0.5). Of the students who have received HC didactic content, 87% felt “moderately”, “well”, or “extremely well-educated” regarding HC prescribing clinical skills. Regardless of didactic training, pharmacy students believe pharmacists are prepared to prescribe HC and support pharmacist-prescribed HC as a part of their future professional scope of practice.
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Howard D. Over-the-Counter Hormonal Contraception: The Time Has Come. Popul Health Manag 2021; 24:436-438. [PMID: 34406090 DOI: 10.1089/pop.2020.0244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Denise Howard
- Department of Obstetrics and Gynecology, Geisinger Health System, Danville, Pennsylvania, USA
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Newlon JL, Bentley JP, Snyder ME, Zillich AJ, Rafie S, Illingworth Plake KS. Impact of pharmacist prescribing through direct pharmacy access policies on access to hormonal contraception. J Am Pharm Assoc (2003) 2021; 62:194-201.e1. [PMID: 34454867 DOI: 10.1016/j.japh.2021.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVE This study assesses the impact of direct pharmacy access (DPA) policies that allow pharmacists to prescribe hormonal contraceptives on women's access by comparing access among 3 groups: (1) women in a state without DPA (Indiana), (2) women in a state with DPA, but not using DPA, and (3) women in a state with DPA and using DPA. METHODS This cross-sectional survey, including a scale to measure access to contraceptives, perception items, and demographics, was distributed through Amazon Mechanical Turk (Amazon.com, Inc). Kruskal-Wallis tests and linear regression analysis were used. RESULTS The sample size was 316. When controlling for education, income, and age, the women not using DPA (in Indiana and a DPA state, respectively) reported significantly higher levels of approachability (P < 0.001 and P < 0.001, respectively), acceptability (P < 0.001 and P < 0.001, respectively), availability and accommodation (P < 0.001 and P = 0.009, respectively), affordability (P < 0.001 and P < 0.001, respectively), and appropriateness (P < 0.001 and P < 0.001) access than the women using DPA. The women using DPA reported significantly lower levels of privacy access than those not using DPA in a DPA state (P = 0.004) when controlling for education, income, and age. However, 78.9% of women using DPA agreed DPA made obtaining contraceptives easier. Most of the women who had never used DPA were previously unaware of DPA (81.1% in DPA states and 86.2% in Indiana) but felt that it would improve access (82.8% and 80.0%, respectively). CONCLUSION Understanding the effects of DPA policies on women's access to contraceptives can inform future policies and support implementation. Lower levels of access across all dimensions among those using DPA may be influenced by imperfect implementation and failure to legislatively enable the sustainability of this service rather than pharmacists' ability to improve women's access.
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21
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Kentucky pharmacists' perceptions regarding provision of hormonal contraception. J Am Pharm Assoc (2003) 2021; 61:e42-e51. [PMID: 34366288 DOI: 10.1016/j.japh.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/30/2021] [Accepted: 07/15/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although Kentucky pharmacists recently gained authority to provide protocol-driven care for 13 conditions, provision of prescription hormonal contraception (HC) services is not currently authorized. A board-approved protocol allowing for provision of nonprescription over-the-counter (OTC) emergency contraception (EC) was recently approved by the Kentucky Board of Pharmacy but has yet to be implemented. OBJECTIVES The objectives of this study were (1) to assess Kentucky pharmacists' interest in providing prescription HC and OTC EC services via protocol and (2) to identify perceived benefits/barriers regarding provision of prescription HC. METHODS An online questionnaire was disseminated electronically to a convenience sample of Kentucky pharmacists. The questionnaire collected (1) demographic information, (2) opinions regarding provision of prescription HC and OTC EC, and (3) perceived benefits and barriers regarding provision of prescription HC. For analysis, responses were limited to pharmacists in community-based practice. McNemar's test was used to identify statistically significant differences in support by dosage form. In addition, a multivariable logistic regression model was used to examine associations between demographic factors and support for pharmacist provision of prescription HC. RESULTS We received 151 responses from community-based pharmacists. Support for provision of prescription HC was highest for oral (61%) and transdermal (54%) forms. We found no statistically significant differences in support among demographic factors other than number of years in practice, with more recent graduates being at higher odds of support. In addition, time, reimbursement, training, and belief in the need for pelvic exams were the most commonly cited barriers to implementation. With regard to OTC EC provision, pharmacists were largely supportive (62%) and confident in their abilities. CONCLUSIONS Community-based pharmacists in Kentucky are supportive of provision of oral, vaginal, and transdermal prescription HC as well as OTC EC via protocol. Barriers, including time, reimbursement, training, and belief in the need for pelvic exams, should be addressed to increase support for prescription HC provision.
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22
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Hoopes AJ, Timko CA, Akers AY. What's Known and What's Next: Contraceptive Counseling and Support for Adolescents and Young Adult Women. J Pediatr Adolesc Gynecol 2021; 34:484-490. [PMID: 33333260 DOI: 10.1016/j.jpag.2020.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 12/03/2020] [Accepted: 12/08/2020] [Indexed: 11/25/2022]
Abstract
The low rates of actual contraceptive failure and high rates of contraceptive use among young women highlight that choice of contraceptive method and patterns of contraceptive use greatly influence unintended pregnancy risk. Promoting contraceptive use among adolescent and young adult women requires supportive health systems and health providers who understand this population's evolving developmental needs. It also requires an awareness of effective tools for counseling patients, while being mindful of the power dynamics operational during clinical encounters to avoid inadvertently coercive interpersonal dynamics. Missed opportunities to provide such patient-centered care can lead to unplanned pregnancies and suboptimal health and social consequences for young women. Unfortunately, health providers often lack the tools and resources to appropriately identify and meet individual young women's contraceptive needs. This article summarizes the evidence supporting contraceptive counseling strategies linked with contraceptive initiation among young women, and evidence-based approaches for supporting contraceptive adherence and continuation after method initiation. It also orients readers to the unique neurodevelopmental factors that influence the shared decision-making process during contraception counseling sessions with young women. New and emerging approaches for supporting contraceptive initiation, adherence, and continuation are reviewed.
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Affiliation(s)
- Andrea J Hoopes
- The Adolescent Center, Adolescent Medicine, Kaiser Permanente Washington, Bellevue, Washington
| | - C Alix Timko
- Eating Disorder Assessment and Treatment Program, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania; The PolicyLab at the Roberts Center for Pediatric Research, Philadelphia, Pennsylvania
| | - Aletha Y Akers
- Adolescent Gynecology Consultative Service, The Craig Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
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Grindlay K, Wollum A, Karver J, Grossman D. Over-the-counter oral contraceptive use among women in Mexico: results from a national survey. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:205-210. [PMID: 33431615 DOI: 10.1136/bmjsrh-2020-200778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/17/2020] [Accepted: 12/19/2020] [Indexed: 06/12/2023]
Abstract
AIM In Mexico, many pharmacies sell oral contraceptives (OCs) over the counter (OTC); however, little is known about the background characteristics of OTC pill users. The primary objective of this study was to understand the characteristics of OTC OC users in Mexico, including whether there were differences by age, urbanicity, and insurance status. This information is instructive as other countries explore allowing OTC access to OCs. METHODS We analysed the nationally representative 2014 Mexican National Survey of Demographic Dynamics (ENADID) among a sample of OC users aged 15-54 years (n=1970). We performed multivariable logistic models to understand the characteristics associated with OTC access, with age, urbanicity, and insurance status as our primary predictors of interest. Additionally, we descriptively explored knowledge of how frequently to take OCs by pill source and age. RESULTS Some 54% of pill users, including 66% of those aged 15-17 years, obtained their OCs OTC. In multivariable regression we found no differences in OTC access by age. However, being uninsured (adjusted odds ratio (AOR) 1.86, 95% CI 1.23 to 2.82) (compared with employer-based public insurance) and living in an urban area (AOR 4.73, 95% CI 3.37 to 6.66) (compared with rural area) were associated with a higher odds of OTC access among pill users. Women's knowledge of how frequently to take OCs was similar between OTC and prescription users within age groups. CONCLUSIONS These findings point to the importance of OTC availability of OCs for pill users of all ages and uninsured and urban women in Mexico in particular.
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Affiliation(s)
- Kate Grindlay
- Ibis Reproductive Health, Cambridge, Massachusetts, USA
| | | | - Jonathan Karver
- Poverty & Equity Global Practice, The World Bank, Washington, District of Columbia, USA
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, California, USA
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Das P, Samad N, Al Banna H, Sodunke TE, Hagan JE, Ahinkorah BO, Seidu AA. Association between media exposure and family planning in Myanmar and Philippines: evidence from nationally representative survey data. Contracept Reprod Med 2021; 6:11. [PMID: 33789777 PMCID: PMC8015027 DOI: 10.1186/s40834-021-00154-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although women in South Asia and South-east Asia have developed their knowledge regarding modern contraceptive and other family planning techniques, limited information exists on the influence of mass media exposure on the utilization of contraceptives and family planning. The current study examined the association between media exposure and family planning in Myanmar and Philippines. METHODS The study analyzed data from the 2017 Philippines National Demographic and Health Survey (NDHS) and 2015-16 Myanmar Demographic and Health Survey (MDHS). Three family planning indicators were considered in this study (i.e., contraceptive use, demand satisfied regarding family planning and unmet need for family planning). A binary logistic regression model was fitted to see the effect of media exposure on each family planning indicator in the presence of covariates such as age group, residence, education level, partner education level, socio-economic status, number of living children, age at first marriage, and working status. RESULTS The prevalence of contraception use was 57.2% in the Philippines and 55.7% in Myanmar. The prevalence of demand satisfied regarding family planning was 70.5 and 67.1% in the Philippines and Myanmar respectively. Unmet need regarding family planning was 16.6% and 19.9% in the Philippines and Myanmar respectively. After adjusting for the covariates, the results showed that women who were exposed to media were more likely to use contraception in Philippines (aOR = 2.24, 95% CI = 1.42-3.54) and Myanmar (aOR 1.39, 95% CI = 1.15-1.67). Media exposure also had a significant positive effect on demand satisfaction regarding family planning in the Philippines (aOR = 2.19, 95% CI = 1.42-3.37) and Myanmar (aOR = 1.34, 95% CI = 1.09-1.64). However, there was no significant association between media exposure and unmet need in both countries. CONCLUSIONS The study established a strong association between mass media exposure and the use and demand satisfaction for family planning among married and cohabiting women in Philippines and Myanmar. Using mass media exposure (e.g., local radio, television- electronic; newspapers) to increase both access and usage of contraceptives as well as other family planning methods in these countries could be pivotal towards the attainment of United Nations Sustainable Development Goal 3 (SDG 3) of improving maternal health.
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Affiliation(s)
- Pranta Das
- Department of Statistics, University of Dhaka, Dhaka, Bangladesh
| | - Nandeeta Samad
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Hasan Al Banna
- Institute of Social Welfare and Research, University of Dhaka, Dhaka, Bangladesh
| | | | - John Elvis Hagan
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana.,Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana. .,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.
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Berndt VK, Bell AV. Contextualizing barriers to long-acting reversible contraception in Delaware. Contraception 2021; 103:439-443. [PMID: 33607118 DOI: 10.1016/j.contraception.2021.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We conducted this study to examine barriers to long-acting reversible contraception (LARC) that persist in the context of a large-scale LARC program, Delaware Contraceptive Access Now (Del-CAN), that has actively endeavored to remove such barriers. STUDY DESIGN In 2016-2017, we conducted in-depth interviews with 86 self-identified women of reproductive age, diverse along the lines of age, race, and class, in the state of Delaware on their attitudes, beliefs, and behaviors regarding contraception. We analyzed the interviews using an inductive coding process. RESULTS We found that, even in the midst of Del-CAN's efforts, meso and macro-level contexts, including provider-patient communication and clinic/practice structures, reinforced LARC barriers related to knowledge, access, and side effects. CONCLUSIONS The multi-level contexts and nuances we illuminate in our study currently fall outside the purview of well-intentioned, large-scale initiatives such as Del-CAN, that attempt to address and ameliorate oft-researched barriers. Thus, these barriers persist within provider-patient interactions and clinic/practice policies and structures. IMPLICATIONS The evaluated LARC-based intervention, Del-CAN, cannot fully address issues around provider autonomy, inadequate provider-patient communication, or practice-specific policies and criteria. In order for this intervention, and others like it, to be successful, they must be aware of and prepared to address such dimensions in their efforts.
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Affiliation(s)
- Virginia Kuulei Berndt
- Department of Sociology & Criminal Justice, University of Delaware, Newark, DE, United States.
| | - Ann V Bell
- Department of Sociology & Criminal Justice, University of Delaware, Newark, DE, United States
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Eckhaus LM, Ti AJ, Curtis KM, Stewart-Lynch AL, Whiteman MK. Patient and pharmacist perspectives on pharmacist-prescribed contraception: A systematic review. Contraception 2021; 103:66-74. [PMID: 33130109 PMCID: PMC11283818 DOI: 10.1016/j.contraception.2020.10.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/24/2020] [Accepted: 10/12/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Increasingly, states authorize pharmacists to prescribe hormonal contraception to patients without a prescription from another healthcare provider. The purpose of this review is to investigate pharmacist and patient perspectives on pharmacist-prescribed contraception in the United States. STUDY DESIGN We searched Medline, Embase, PsycInfo, CINAHL, Scopus, and the Cochrane Library from inception through July 10, 2019. We included qualitative and mixed-methods studies, quantitative surveys, observational studies, and randomized trials in the United States. Risk of bias was assessed using tools for quantitative and qualitative studies. RESULTS Fifteen studies met inclusion criteria, including studies on pharmacists and student pharmacists (n = 9), patients (n = 5), and both (n = 1). Study samples ranged from local to national. Studies had moderate to high risk of bias, primarily due to low response rates and lack of validated instruments. Most pharmacists (57-96%) across four studies were interested in participating in pharmacist-prescribed contraception services. Among patients, 63-97% across three studies supported pharmacist-prescribed contraception, and 38-68% across four studies intended to participate in these services. At least half of pharmacists across four studies felt comfortable prescribing contraception, though pharmacists identified additional training needs. Pharmacists and patients identified several reasons for interest in pharmacist-prescribed contraception services, including increasing patient access, reducing unintended pregnancies, and offering professional development for pharmacists. They also identified barriers, including payment, time and resource constraints, liability, and patient health concerns. CONCLUSIONS Most pharmacists and patients across 15 studies were interested in expanded access to contraception through pharmacist-prescribed contraception. Findings on facilitators and barriers may inform implementation efforts. IMPLICATIONS Pharmacist-prescribed contraception is a strategy to expand patient access to contraception. Reducing barriers to implementation could improve participation among pharmacists and patients.
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Affiliation(s)
- L M Eckhaus
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, United States; Oak Ridge Institute for Science and Education, 1299 Bethel Valley Rd, Oak Ridge, TN 37830, United States.
| | - A J Ti
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, United States.
| | - K M Curtis
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, United States.
| | - A L Stewart-Lynch
- Duquesne University School of Pharmacy, 600 Forbes Ave, Pittsburgh, PA 15282, United States.
| | - M K Whiteman
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, United States.
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Turnbull G, Scott RH, Mann S, Wellings K. Accessing emergency contraception pills from pharmacies: the experience of young women in London. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:27-31. [PMID: 32576555 DOI: 10.1136/bmjsrh-2019-200339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Over-the-counter provision of emergency contraception pills (ECP) has increased since deregulation of progestogen-only formulations and is now the most common public health service provided by UK pharmacists. Important questions relate to women's perceptions of their experience of receiving ECPs from pharmacists. METHODS Qualitative study: in-depth interviews with young women reporting ECP use, recruited from clinic (10); pharmacy (6) and community settings (5) in London. RESULTS Key advantages of pharmacy provision were ease and speed of access and convenience. Disadvantages included a less personal service, inadequate attention to information needs and to prevention of recurrence of ECP need, and unsupportive attitudes of pharmacy staff. Suggested service improvements included increasing privacy, providing more contraceptive advice, adopting a more empathetic approach and signposting follow-up services. CONCLUSION Pharmacies are important in the choice of settings from which ECPs can be obtained and many aspects of pharmacy provision are appreciated by young women. There is scope to further enhance pharmacists' role.
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Affiliation(s)
| | - Rachel H Scott
- Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Sue Mann
- Reproductive Health, Public Health England, London, UK
| | - Kaye Wellings
- London School of Hygiene and Tropical Medicine, London, UK
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Wollum A, Zuniga C, Lezama N, Grossman D, Grindlay K. A Randomized Study Evaluating the Effect of Evidence-Based Information on Clinician Attitudes About Moving Oral Contraceptives Over the Counter. J Womens Health (Larchmt) 2020; 30:1626-1636. [PMID: 33297830 DOI: 10.1089/jwh.2020.8706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To assess whether evidence-based information on progestin-only pills (POPs) and over-the-counter (OTC) oral contraceptives (OCs) increases support among clinicians for bringing a POP or combined oral contraceptive (COC) OTC and to identify concerns clinicians may have about OTC access to OCs. Materials and Methods: In 2018 a survey of 778 clinicians assessed support for bringing a POP and COC OTC before and after receiving evidence-based information, which was pretested through in-depth interviews. Clinicians were randomized into two groups, stratified by clinician type. One group received information about OTC access to OCs generally, and the second group received OTC information plus information about POPs. Levels of support between arms were compared using robust Poisson models. Results: Before receiving information, 31% of clinicians supported moving a POP OTC. After receiving information, 39% of clinicians who only received OTC information supported moving a POP OTC compared to 61% who received OTC and POP information (relative risk = 1.53, 95% confidence interval: 1.34 to 1.75). Support for bringing a COC OTC increased marginally for those who received OTC and POP information, while support among those who received only OTC information increased by 12 percentage points (to 50%). Among clinicians opposed to moving a POP OTC after receiving information, top concerns included safety (26%), effectiveness (19%), potential for incorrect use (19%), and loss of preventive screenings (15%). Conclusion: Evidence-based information, particularly around POPs, has the potential to change clinician attitudes and address misconceptions about POPs and OTC access.
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Affiliation(s)
| | | | - Niara Lezama
- Ibis Reproductive Health, Cambridge, Massachusetts, USA
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California, USA
| | - Kate Grindlay
- Ibis Reproductive Health, Cambridge, Massachusetts, USA
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Extended Access to Hormonal Contraception in Pharmacies: A Survey among Swiss Pharmacists. PHARMACY 2020; 8:pharmacy8040210. [PMID: 33182547 PMCID: PMC7712984 DOI: 10.3390/pharmacy8040210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/21/2020] [Accepted: 11/06/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Worldwide the availability to Hormonal Contraceptives (HC) varies from over the counter (OTC) to prescription-only access. In various countries pharmacists are allowed to prescribe HC, although conditions may be different. In Switzerland, HC require a prescription from a physician, although Swiss law allows pharmacists to dispense prescription-only medications in justified exceptional cases without a valid physician’s prescription. This study aimed to identify current dispensing practices for HC in Swiss pharmacies, pharmacists’ knowledge about HC, and their opinion and interest about expanding access to HC. Methods: Web-based survey among Swiss pharmacists. Results: This survey was completed by 397 registered pharmacists and 331 (83%) were included for analysis. The survey showed that 21% of respondents regularly dispense HC without prescription and that a high number of participants are either very interested (57%, n = 189) or rather interested (33%, n = 110) in extended pharmacy access to HC. The majority did not or rather not support physician’s prescription-only status (77%, n = 256) or OTC availability (94%, n = 310). Furthermore, surveyed pharmacists are willing to train for contraception services (90%, n = 299). According to participants, resistance of physicians is the most relevant barrier to this service (88%, n = 292). Conclusion: Surveyed pharmacists are interested in extended access to HC.
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Berndt VK, Bell AV. "This is what the truth is": Provider-patient interactions serving as barriers to contraception. Health (London) 2020; 25:613-629. [PMID: 33124481 DOI: 10.1177/1363459320969775] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Contraception is a vital component of women's reproductive health, but not all women use it consistently and effectively. Many studies explore individual-level barriers to contraceptive use, yet interactional barriers are important to understand since contraception is primarily obtained through provider-patient interactions. Thus, through interviews with 86 women and 51 providers in the United States, we employ a framework of biomedicalization to study how such interactions, including the knowledge bases that inform them, shape women's contraceptive decision-making. We find that when women's embodied knowledge and providers' biomedical knowledge differ, providers' preferences supersede women's. Providers, however, overlook this hierarchy, instead viewing their relationships with patients as empowering equal partnerships. This pattern precludes women from achieving their desired contraceptive method and highlights the process through which women's concerns become barriers to contraceptive use. Moreover, these findings reflect how provider-patient hierarchies continue to thrive despite purported patient-centered care models.
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Mitchell M, Stauffenberg C, Vernon V, Mospan CM, Shipman AJ, Rafie S. Opposition to Pharmacist Contraception Services: Evidence for Rebuttal. PHARMACY 2020; 8:E176. [PMID: 32977545 PMCID: PMC7711847 DOI: 10.3390/pharmacy8040176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 11/16/2022] Open
Abstract
Pharmacist contraception services are growing across the United States. Several states have authorized pharmacists to prescribe contraception, and the interest in other states continues to grow. Opposition to these practices exists and centers on discussions related to safety, training, cost, and fragmentation of care. We review these arguments and provide evidence refuting these concerns. Pharmacist-prescribed contraception increases access to care, and patients express interest in utilizing this service at the pharmacy. Pharmacists follow evidence-based recommendations. Counseling on preventative services and referral to other providers is part of contraception care by pharmacists. Training programs have been developed to equip both pharmacy students and pharmacists with the knowledge, skills, and tools needed to successfully provide these services. This article can serve as a guide for pharmacists and advocates when discussing pharmacist-prescribed contraception with policymakers, patients, and other healthcare professionals.
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Affiliation(s)
- Madeline Mitchell
- College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN 46208, USA; (M.M.); (C.S.)
| | - Courtney Stauffenberg
- College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN 46208, USA; (M.M.); (C.S.)
| | - Veronica Vernon
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN 46208, USA;
| | | | - Allie Jo Shipman
- National Association of State Pharmacy Associations, North Chesterfield, VA 23235, USA;
| | - Sally Rafie
- Birth Control Pharmacist, San Diego, CA 92122, USA
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Long-Lasting, Patient-Controlled, Procedure-Free Contraception: A Review of Annovera with a Pharmacist Perspective. PHARMACY 2020; 8:pharmacy8030156. [PMID: 32872116 PMCID: PMC7558341 DOI: 10.3390/pharmacy8030156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 11/22/2022] Open
Abstract
Annovera (segesterone acetate and ethinyl estradiol vaginal system) is a US Food and Drug Administration FDA-approved long-lasting, reversible contraceptive that is fully administered by the user and does not require a procedure for insertion or removal. The vaginal system is in the shape of a ring and contains low doses of a novel progestin, egesterone acetate, and ethinyl estradiol. It is made of silicone and is fully pliable and flexible. The vaginal system is reusable for 13 cycles, using a 21 days in/7 days out regimen, providing women with the ability to control their fertility. Particularly now during the COVID-19 pandemic when access to contraception has been further reduced, patients may benefit from a method that is both long-lasting and patient-controlled.
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Rodriguez MI, Edelman AB, Skye M, Anderson L, Darney BG. Association of Pharmacist Prescription With Dispensed Duration of Hormonal Contraception. JAMA Netw Open 2020; 3:e205252. [PMID: 32432710 PMCID: PMC7240351 DOI: 10.1001/jamanetworkopen.2020.5252] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
IMPORTANCE Since 2016, 11 states have expanded the scope of pharmacists to include direct prescription of hormonal contraception. Dispensing greater than 1 month's supply is associated with improved contraceptive continuation rates and fewer breaks in coverage. Scant data exist on the practice of pharmacist prescription of contraception and its outcomes compared with traditional, clinic-based prescriptions. OBJECTIVE To compare the amount of hormonal contraceptive supply dispensed between pharmacists and clinic-based prescriptions. Prescribing patterns were assessed by describing prescribing practices for women with contraindications to combined hormonal contraception. Characteristics of women seeking hormonal contraception directly from pharmacists were also described. DESIGN, SETTING, AND PARTICIPANTS This cohort study surveyed women aged 18 to 50 years who presented to pharmacies in California, Colorado, Hawaii, and Oregon for hormonal contraception prescribed by a clinician or a pharmacist between January 30 and November 1, 2019. EXPOSURES Pharmacist or clinic-based prescription of contraception. MAIN OUTCOMES AND MEASURES Months of contraceptive supply dispensed. RESULTS Four hundred ten women (mean [SD] age, 27.1 [7.7] years) were recruited who obtained contraception directly from a pharmacist (n = 144) or by traditional clinician prescription (n = 266). Women obtaining contraception from a pharmacist were significantly younger (82 [56.9%] vs 115 [43.2%] participants aged 18-24 years; P = .03), had less education (38 [26.4%] vs 100 [37.6%] with a bachelor degree; P = .002), and were more likely to be uninsured (16 [11.1%] vs 8 [3.0%] participants; P = .001) compared with women with a prescription from a clinician. Pharmacists were significantly more likely to prescribe a 6-month or greater supply of contraceptives than clinicians (6.9% vs 1.5%, P < .001) and significantly less likely to only prescribe a 1-month supply (42 [29.2%] vs 118 [44.4%] prescriptions; P < .001). Controlling for all covariates, women seen by pharmacists had higher odds of receipt of a 6-month or greater supply of contraceptives compared with those seen by clinicians (odds ratio = 3.55; 95% CI, 1.88-6.70). Pharmacists were as likely as clinicians to prescribe a progestin-only method to women with a potential contraindication to estrogen (n = 60 women; 8 [20.0%] vs 6 [30.0%], P = .52). CONCLUSIONS AND RELEVANCE These findings suggest that pharmacist prescription of contraception may be associated with improved contraceptive continuation by preventing breaks in coverage through the provision of a greater supply of medication. Efforts are needed to educate prescribing providers on the importance of dispensing 6 months or greater contraceptive supply.
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Affiliation(s)
- Maria I. Rodriguez
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Alison B. Edelman
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Megan Skye
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | | | - Blair G. Darney
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
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Gomez AM, Arteaga S, Aronson N, Goodkind M, Houston L, West E. No Perfect Method: Exploring How Past Contraceptive Methods Influence Current Attitudes Toward Intrauterine Devices. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1367-1378. [PMID: 31429033 DOI: 10.1007/s10508-019-1424-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 02/06/2019] [Accepted: 02/09/2019] [Indexed: 05/22/2023]
Abstract
Little research on contraceptive decision-making takes a holistic perspective to understand women's contraceptive journeys throughout the reproductive life course. This analysis investigated how Black and Latina women's past experiences with contraceptive use and acquisition impact their feelings and attitudes toward future use of intrauterine devices (IUDs). We utilized data from in-depth interviews that explored contraceptive decision-making and knowledge of, interest in, and attitudes toward IUDs among 38 young Black and Latina women collected in 2013 in the San Francisco Bay Area. Here, we focused on the IUD decision-making process among a subsample of 32 women who were not using or had not previously used an IUD. Overall, we found a strong link between past contraceptive experiences and attitudes regarding future use of IUDs. Notably, participants often referenced experiences of side effects with previous methods when explaining their interest-or lack thereof-in IUD use, as well as made links between contraceptive attributes they had experienced positively and attributes of the IUD. A minority of participants described being satisfied with their current method, resulting in a lack of interest in considering IUD use. More than half of participants described distrust, either in healthcare providers owing to previous negative interactions and contraceptive failures of provider-recommended methods or owing to family members' and friends' negative experiences with IUDs. This distrust undergirded their lack of interest in the IUD. These findings highlight the importance of locating contraceptive decision-making in the broader context of reproductive journeys.
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Affiliation(s)
- Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA, 94720-7400, USA.
| | - Stephanie Arteaga
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA, 94720-7400, USA
| | - Natasha Aronson
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA, 94720-7400, USA
| | - Molly Goodkind
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA, 94720-7400, USA
| | - Livia Houston
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA, 94720-7400, USA
| | - Erica West
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA, 94720-7400, USA
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Wollum A, Trussell J, Grossman D, Grindlay K. Modeling the Impacts of Price of an Over-the-Counter Progestin-Only Pill on Use and Unintended Pregnancy among U.S. Women. Womens Health Issues 2020; 30:153-160. [PMID: 32303431 DOI: 10.1016/j.whi.2020.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 12/18/2019] [Accepted: 01/17/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To model the impacts of out-of-pocket cost of an over-the-counter (OTC) progestin-only pill on use and associated unintended pregnancy among U.S. women. STUDY DESIGN Using data from a 2015 nationally representative survey of 2,539 U.S. women aged 15 to 44 assessing interest in using an OTC progestin-only pill, we used discrete survival analysis and a Markov model to analyze women's likelihood of using of an OTC pill at different price points and by sociodemographic characteristics. We modeled the impact of product price on the potential total number of U.S. users and on unintended pregnancies in 1 year among adult women at risk of unintended pregnancy. RESULTS In a model assuming no out-of-pocket costs, more than 12.5 million adults and 1.75 million teens reported likely use of an OTC progestin-only pill if available. Among adults, this resulted in an estimated 8% decrease in unintended pregnancy in 1 year. Adult and teen women on average were willing to pay $15 and $10, respectively, resulting in 7.1 million adult and 1.3 million teen users and an estimated 5% decrease in unintended pregnancy among adults. CONCLUSIONS At low and no out-of-pocket cost, a large population of women in the United States might likely use an OTC progestin-only pill. A low retail price and insurance coverage are necessary to provide equitable access to this method for low-income populations across the United States, fill current gaps in contraceptive access, and potentially decrease unintended pregnancy.
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Affiliation(s)
| | - James Trussell
- Office of Population Research, Princeton University, Princeton University, Princeton, New Jersey
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California
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Meredith AH, Vahary EB, Wilkinson TA, Meagher CG, Vielott T, Ott MA. Adolescents' Perceptions of Contraception Access through Pharmacies. PHARMACY 2020; 8:pharmacy8020053. [PMID: 32231073 PMCID: PMC7356625 DOI: 10.3390/pharmacy8020053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/18/2020] [Accepted: 03/26/2020] [Indexed: 12/03/2022] Open
Abstract
Adolescent pregnancy is an important public health issue, and pharmacist prescribing has the potential to expand contraceptive access and decrease unintended pregnancy. However, little is known about acceptability and uptake of pharmacist prescribing among adolescents, particularly among youth in socially and politically conservative regions of the country. The study objective was to identify how young women in Indiana perceive pharmacist contraceptive prescribing. Participants were recruited from clinics and completed a simulated pharmacist contraception-prescribing encounter; a demographic and behavioral questionnaire; and an in-depth qualitative interview focused on adolescent perspectives on pharmacist prescribing. Data were analyzed using thematic analysis. Sixty young women aged 14–21 years (mean age 17.0 ± 1.7 years) completed in-depth interviews. The majority expressed interest in pharmacist contraceptive prescribing (n = 33, 55.9%). Three overarching themes were identified, focusing on accessibility; quality of care; and pharmacist knowledge and youth friendliness. Subthemes highlighted the need for improved confidential access; a desire for additional pharmacist training in contraception; and interactions with a pharmacist that can relate to the young person. Increased awareness of the perceptions of young people can inform state policies and pharmacy protocols. Pharmacists, because of their accessibility, are well poised and equipped to assist in this public health concern.
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Affiliation(s)
- Ashley H. Meredith
- Department of Pharmacy Practice, Purdue University College of Pharmacy, Indianapolis, IN 46202, USA;
- Correspondence: ; Tel.: +317-880-5407
| | - Emily B. Vahary
- Department of Pharmacy Practice, Purdue University College of Pharmacy, Indianapolis, IN 46202, USA;
| | - Tracey A. Wilkinson
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Carolyn G. Meagher
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (C.G.M.); (T.V.); (M.A.O.)
| | - Thomas Vielott
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (C.G.M.); (T.V.); (M.A.O.)
| | - Mary A. Ott
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (C.G.M.); (T.V.); (M.A.O.)
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Kooner M, Joseph H, Griffin B, Lynch S, Vest K, Stewart-Lynch A, Weaver K. Hormonal contraception prescribing by pharmacists: 2019 update. J Am Pharm Assoc (2003) 2020; 60:e34-e39. [PMID: 32144081 DOI: 10.1016/j.japh.2020.01.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Empowering pharmacists to prescribe contraceptives could help alleviate barriers such as the accessibility of medical centers and the availability, inconvenience, and cost of appointments. Several states have enacted legislation authorizing pharmacists to prescribe hormonal contraceptives. This manuscript provides an overview of each of the states' laws and highlights differences among the states. The objectives of this study were to (1) list the states in which pharmacists currently have the authority to prescribe contraceptives and (2) compare the differences among those states. DATA SOURCES The authors assembled state statutes and regulations on pharmacist prescribing of contraceptives and conducted a literature review for research on pharmacist prescribing of contraceptives using PubMed. SUMMARY Nine states, plus the District of Columbia, authorize pharmacists to prescribe hormonal contraceptives autonomously under a statewide authority, and each state differs in their policy. CONCLUSION For pharmacists to take full advantage of this opportunity and to expand their clinical role, the quality, consistency, and sustainability of these initiatives must be assessed.
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Stone RH, Rafie S, Griffin B, Shealy K, Stein AB. Pharmacist self-perception of readiness to prescribe hormonal contraception and additional training needs. CURRENTS IN PHARMACY TEACHING & LEARNING 2020; 12:27-34. [PMID: 31843161 DOI: 10.1016/j.cptl.2019.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 06/29/2019] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Our objectives were to describe pharmacist perceptions of training and preparation to prescribe hormonal contraception (HC), identify training gaps, and elicit preferred training methods. METHODS In this cross-sectional survey, pharmacists in the United States (US) completed an online 29-item survey. Descriptive statistics were used to analyze responses. RESULTS Of 823 participating pharmacists, 58% felt they received adequate training to prescribe HC. Prescribing any medications within the last five years or completion of residency training were significantly associated with more participants feeling adequately trained. Of those who indicated HC was not covered in their pharmacy school curriculum, most (78%) felt they were either not adequately trained or unsure. Only 36% were aware of the Centers for Disease Control and Prevention US Medical Eligibility Criteria for Contraceptive Use (CDC MEC). Residency-trained pharmacists were statistically more likely to have used the CDC MEC and feel comfortable prescribing for adolescents. Most participants desired more training about switching between products (80%) and patient specific product selection (72%). Preferred methods for additional training were basic (<four hours) live trainings, on-demand webinars, and online self-study programs. CONCLUSIONS As pharmacist scope of practice expands to include prescribing HC, many opportunities remain to ensure pharmacists feel adequately trained to provide this service. Pharmacy educators and training programs should incorporate the findings of this study into their curricula, experiential opportunities, and continuing education offerings. Additional studies are needed on the effectiveness of various training formats and programs.
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Affiliation(s)
- Rebecca H Stone
- Department of Clinical and Administrative Pharmacy, University of Georgia, College of Pharmacy, United States.
| | - Sally Rafie
- UC San Diego Health, 200 W. Arbor Dr. #8765, San Diego, CA 92103, United States.
| | - Brooke Griffin
- Midwestern University, Chicago College of Pharmacy, United States; Mt Sinai Medical Group, United States.
| | - Kayce Shealy
- Presbyterian College, School of Pharmacy, Clinton, SC, United States.
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Meredith AH, Olenik NL, Farris KB, Hudmon KS. Women's perceptions of pharmacist‐prescribed hormonal contraception. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ashley H. Meredith
- Department of Pharmacy Practice Purdue University College of Pharmacy Indianapolis Indiana
- Eskenazi Health Indianapolis Indiana
| | - Nicole L. Olenik
- Department of Pharmacy Practice Purdue University College of Pharmacy Indianapolis Indiana
- Mathes Pharmacy New Albany Indiana
| | - Karen B. Farris
- Department of Clinical Pharmacy University of Michigan College of Pharmacy Ann Arbor Michigan
| | - Karen Suchanek Hudmon
- Department of Pharmacy Practice Purdue University College of Pharmacy Indianapolis Indiana
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Rafie S, Cieri-Hutcherson NE, Frame TR, Griffin B, Harris JB, Horlen C, Shealy K, Stein AB, Stone RH, Vest K, Westberg S, Yancey AM. Pharmacists’ Perspectives on Prescribing and Expanding Access to Hormonal Contraception in Pharmacies in the United States. J Pharm Pract 2019; 34:230-238. [DOI: 10.1177/0897190019867601] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Pharmacist prescribing of contraception is becoming increasingly available in selected states. The objective of this study was to assess US community pharmacists’ perspectives on expanding access, barriers, and facilitators since states have begun pharmacist scope of practice expansions for prescribing contraception. Methods: A survey study of US community pharmacists’ support for expanded access models, pharmacist prescribing practices and interest, and importance of safety, cost, and professional practice issues for prescribing was conducted. Results: Pharmacists are generally supportive of pharmacist prescribing and behind-the-counter models for hormonal contraception and generally opposed to over-the-counter access. A majority (65%) are interested in prescribing hormonal contraception. The top motivation for prescribing contraception is enjoying individual patient contact (94%). Safety concerns (eg, patients not obtaining health screenings) remained most important for pharmacist implementation, followed by cost (eg, lack of payment or reimbursement for pharmacists’ services), and professional practice (eg, pharmacist time constraints and liability) issues. Conclusion: This study provides an updated understanding of attitudes toward models of expanded access to hormonal contraception, interest in prescribing, and barriers and facilitators to this service among community pharmacists. Many barriers such as time and reimbursement remain unchanged. This information can inform policy and implementation efforts.
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Affiliation(s)
- Sally Rafie
- Department of Pharmacy, UC San Diego Health, San Diego, CA, USA
| | - Nicole E. Cieri-Hutcherson
- Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Science, Buffalo, NY, USA
| | - Tracy R. Frame
- Pharmacy Practice Department, Belmont University College of Pharmacy, Nashville, TN, USA
| | - Brooke Griffin
- Chicago College of Pharmacy, Midwestern University, Mt Sinai Medical Group, Downers Grove, IL, USA
| | - John Brock Harris
- Department of Pediatrics & Neonatology, Wingate University School of Pharmacy, Novant Health Hemby Children’s Hospital, Wingate, NC, USA
| | - Cheryl Horlen
- University of the Incarnate Word, Feik School of Pharmacy, San Antonio, TX, USA
| | - Kayce Shealy
- Presbyterian College School of Pharmacy, Clinton, SC, USA
| | - Amy Buros Stein
- Office of Research and Sponsored Programs, Midwestern University, Glendale, AZ, USA
| | - Rebecca H. Stone
- Department of Clinical and Administrative Pharmacy, Mercy Health Center, University of Georgia College of Pharmacy, Athens, GA, USA
| | - Kathleen Vest
- Chicago College of Pharmacy, Midwestern University, Downers Grove, IL, USA
| | - Sarah Westberg
- College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Abigail M. Yancey
- St Louis College of Pharmacy, SSM Health St. Mary’s Clinical Pharmacy Specialist, St. Louis, MO, USA
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Gumbie M, Parkinson B, Cutler H, Gauld N, Mumford V. Is Reclassification of the Oral Contraceptive Pill from Prescription to Pharmacist-Only Cost Effective? Application of an Economic Evaluation Approach to Regulatory Decisions. PHARMACOECONOMICS 2019; 37:1049-1064. [PMID: 31069781 DOI: 10.1007/s40273-019-00804-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVE Unplanned pregnancies can lead to poorer maternal and child health outcomes. The Australian Therapeutic Goods Administration committee rejected reclassifying a range of oral contraceptive pills (OCPs) from prescription to pharmacist-only medicines in 2015, mainly based on safety concerns. Improving access to OCPs may encourage some women to use contraceptives or switch from other contraceptive methods. However, some adverse events may increase and some women may stop using condoms, increasing their risk of sexually transmitted infections. This study aimed to estimate the cost effectiveness of reclassifying OCPs from prescription to pharmacist-only. PERSPECTIVE Healthcare system. SETTING Australian primary care. METHODS A Markov model was used to synthesise data from a variety of sources. The model included all Australian women aged 15-49 years (N = 5,644,701). The time horizon was 35 years. Contraceptive use before reclassification was estimated using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey, while survey data informed use after reclassification. Health outcomes included pregnancies, pregnancy outcomes (live birth, miscarriage, stillbirth, ectopic pregnancy and abortion), sexually transmitted infections, adverse events (venous thromboembolism, depression, myocardial infarction and stroke), ovarian cancer cases and quality-adjusted life-years. Costs included those related to general practitioner and specialist consultations, contraceptives and other medicines, pharmacist time, hospitalisations and adverse events. All costs were reported in 2016 Australian Dollars. A 5% discount rate was applied to health outcomes and costs. RESULTS Reclassifying OCPs resulted in 85.70 million quality-adjusted life-years experienced and costs of $46,910.14 million over 35 years, vs. 85.68 million quality-adjusted life-years experienced and costs of $50,274.95 million with OCPs remaining prescription-only. Thus, reclassifying OCPs was more effective and cost saving. However, a sensitivity analysis found that more research on the probability of pregnancy in women not using contraception and not trying to conceive is needed. CONCLUSION Reclassifying OCPs is likely to be considered cost effective by Australian decision makers.
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Affiliation(s)
- Mutsa Gumbie
- Centre for the Health Economy, Macquarie University, Sydney, NSW, 2109, Australia
| | - Bonny Parkinson
- Centre for the Health Economy, Macquarie University, Sydney, NSW, 2109, Australia.
| | - Henry Cutler
- Centre for the Health Economy, Macquarie University, Sydney, NSW, 2109, Australia
| | - Natalie Gauld
- School of Pharmacy, University of Auckland, Auckland, 1023, New Zealand
| | - Virginia Mumford
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia
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Pharmacist Outlooks on Prescribing Hormonal Contraception Following Statewide Scope of Practice Expansion. PHARMACY 2019; 7:pharmacy7030096. [PMID: 31323818 PMCID: PMC6789671 DOI: 10.3390/pharmacy7030096] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 06/21/2019] [Accepted: 07/16/2019] [Indexed: 12/03/2022] Open
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.
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Beal JL, Illingworth Plake KS. Social and legislative shaping of access to contraceptives and the pharmacist's role: A literature review. Res Social Adm Pharm 2019; 16:628-636. [PMID: 31337541 DOI: 10.1016/j.sapharm.2019.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/05/2019] [Accepted: 07/07/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite years of research and numerous policies, access to contraceptives in the United States remains imperfect. Largely due to lack of access to contraceptives, unintended pregnancy rates remain high. OBJECTIVE To provide researchers and policy-makers with a comprehensive review of the legislative and social landscape that has shaped contraceptive access in the United States, which may help to guide future research and policies. METHODS A narrative overview of existing literature on policies and research regarding women's access to contraceptives was compiled, with a focus on the role of pharmacists. RESULTS Contraceptive access has been heavily influenced by laws and policies throughout the years, and disparities remain in underserved populations. Pharmacists are beginning to play a role in improving access to contraceptives through provision of contraceptives using direct pharmacy access policies. CONCLUSIONS Continued research and new policies aimed at improving contraceptive access are warranted.
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Affiliation(s)
- Jenny L Beal
- College of Pharmacy, Purdue University, 575 Stadium Avenue, West Lafayette, IN, 47907, USA
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Tak CR, Kessler LT, Scott MA, Gunning KM. Pharmacist-prescribed hormonal contraception: A review of the current landscape. J Am Pharm Assoc (2003) 2019; 59:633-641. [PMID: 31300307 DOI: 10.1016/j.japh.2019.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/12/2019] [Accepted: 05/21/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The objective of this article is to review the current supply-side, demand-side, and regulatory landscape of pharmacist-prescribed hormonal contraception (HC) in the United States. SUMMARY Pharmacists appear to be supportive of pharmacist-prescribed HC. However, support does not necessarily indicate likelihood to implement the practice, even when reimbursement mechanisms exist. The likelihood of implementation can be increased with education and training of HC prescribing. Previous investigations suggest that women broadly support accessing contraception within a pharmacy. Expanded access, where available, can improve rates of use and adherence. Women at higher risk for unintended pregnancy, such as younger women and women without health insurance, are likely to use the pharmacy to procure HC. Despite a willingness to pay for HC consultations with pharmacists, costs can remain a significant barrier for many women. CONCLUSIONS Expanding access to HC through pharmacist-prescriptive authority could help curb the rates of unintended pregnancy in the United States. Pharmacists are well positioned for such a role; however, significant barriers for pharmacists and patients remain. Examination of current implementation methods will assist policy makers in overcoming these barriers.
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46
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Gomez AM, McCullough C, Fadda R, Ganguly B, Gustafson E, Severson N, Tomlitz J. Facilitators and barriers to implementing pharmacist-prescribed hormonal contraception in California independent pharmacies. Women Health 2019; 60:249-259. [DOI: 10.1080/03630242.2019.1635561] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, USA
| | - Colleen McCullough
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, USA
| | - Rafaela Fadda
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, USA
| | - Brittany Ganguly
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, USA
| | - Elena Gustafson
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, USA
| | - Nicolette Severson
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, USA
| | - Jacob Tomlitz
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, USA
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Kennedy CE, Yeh PT, Gonsalves L, Jafri H, Gaffield ME, Kiarie J, Narasimhan ML. Should oral contraceptive pills be available without a prescription? A systematic review of over-the-counter and pharmacy access availability. BMJ Glob Health 2019; 4:e001402. [PMID: 31321085 PMCID: PMC6606062 DOI: 10.1136/bmjgh-2019-001402] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/07/2019] [Accepted: 06/08/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction Making oral contraceptives (OC) available over the counter (OTC) could reduce barriers to use. To inform WHO guidelines on self-care interventions, we conducted a systematic review of OTC availability of OCs. Methods We reviewed data on both effectiveness and values and preferences surrounding OTC availability of OCs. For the effectiveness review, peer-reviewed articles were included if they compared either full OTC availability or pharmacist-prescribing (behind-the-counter availability) to prescription-only availability of OCs and measured an outcome of interest. For the values and preferences review, we included peer-reviewed articles that presented primary data (qualitative or quantitative) examining people's preferences regarding OTC access to OCs. We searched PubMed, CINAHL, LILACS and EMBASE through November 2018 and extracted data in duplicate. Results The effectiveness review included four studies with 5197 total participants. Two studies from the 2000s compared women who obtained OCs OTC in Mexico to women who obtained OCs from providers in either Mexico or the USA. OTC users had higher OC continuation rates over 9 months of follow-up (adjusted HR: 1.58, 95 % CI 1.11 to 2.26). One study found OTC users were more likely to report at least one WHO category 3 contraindication (13.4% vs 8.6%, p=0.006), but not category 4 contraindications; the other study found no differences in contraindicated use. One study found lower side effects among OTC users and high patient satisfaction with both OTC and prescription access. Two cross-sectional studies from the 1970s in Colombia and Mexico found no major differences in OC continuation, but some indication of slightly higher side effects with OTC access. In 23 values and preference studies, women generally favoured OTC availability. Providers showed more modest support, with pharmacists expressing greater support than physicians. Support was generally higher for progestogen-only pills compared with combination OCs. Conclusion A small evidence base suggests women who obtain OCs OTC may have higher continuation rates and limited contraindicated use. Patients and providers generally support OTC availability. OTC availability may increase access to this effective contraceptive option and reduce unintended pregnancies. Systematic review PROSPERO registration number CRD42019119406.
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Affiliation(s)
- Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lianne Gonsalves
- Department of Reproductive Health and Research, Organisation mondiale de la Santé, Genève, Switzerland
| | - Hussain Jafri
- WHO Patients for Patients Safety Program, Organisation mondiale de la Sante, Geneve, Switzerland
| | - Mary Eluned Gaffield
- Department of Reproductive Health and Research, Organisation mondiale de la Santé, Genève, Switzerland
| | - James Kiarie
- Department of Reproductive Health and Research, Organisation mondiale de la Santé, Genève, Switzerland
| | - Manjulaa L Narasimhan
- Department of Reproductive Health and Research, Organisation mondiale de la Santé, Genève, Switzerland
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Boog K, Chen ZE, Cameron S. Sexual and reproductive healthcare providers' opinions on expansion of pharmacy-led provision of contraception. BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:bmjsrh-2018-200252. [PMID: 31154320 DOI: 10.1136/bmjsrh-2018-200252] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/18/2019] [Accepted: 05/16/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Reduced funding to contraceptive services in the UK is resulting in restricted access for women. Pharmacists are already embedded in sexual and reproductive health (SRH) care in the UK and could provide an alternative way for women to access contraception. The aim of this study was to determine the views of UK contraception providers about community pharmacist-led contraception provision. METHODS An anonymous questionnaire was distributed to healthcare professionals at two UK SRH events, asking respondents about: (1) the use of patient group directions (PGDs) for pharmacist provision of oral contraception (OC); (2) the sale of OC as a pharmacy medicine or general sales list medicine; (3) the perceived impact of pharmacy provision of OC on broader SRH outcomes; and (4) if other contraceptive methods should be provided in pharmacies. RESULTS Of 240 questionnaires distributed, 174 (72.5%) were returned. Respondents largely supported pharmacy-led provision of all non-uterine methods of contraception, excluding the contraceptive implant. Provision of the progestogen-only pill by PGD was most strongly supported (78% supported initiation). Respondents felt that the use of bridging (temporary) contraception would improve (103/144, 71.5%), use of effective contraception would increase (81/141, 57.4%), and unintended pregnancies would decline (71/130, 54.6%); but that use of long-acting reversible contraception would decrease (86/143, 60.1%). Perceived barriers included pharmacists' capacity and competency to provide a full contraception consultation, safeguarding concerns, and women having to pay for contraception. CONCLUSIONS UK SRH providers were largely supportive of community pharmacy-led provision of contraception, with training and referral pathways being required to support contraception delivery by pharmacists.
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Affiliation(s)
- Katie Boog
- Fife Sexual Health Service, Whytemans Brae Hospital, Kirkcaldy, United Kingdom
| | - Zhong Eric Chen
- Chalmers Centre, Edinburgh, UK
- University of Edinburgh, Edinburgh, UK
| | - Sharon Cameron
- Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
- University of Edinburgh Division of Health Sciences, Edinburgh, UK
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Development of a pharmacist-provided contraceptive service following passage of Oregon House Bill 2879. J Am Pharm Assoc (2003) 2019; 59:S112-S116. [PMID: 31010785 DOI: 10.1016/j.japh.2019.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 02/24/2019] [Accepted: 02/27/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To describe the development and implementation of a pharmacist-provided contraceptive service in a community pharmacy to increase access to hormonal contraceptives and improve quality measure performance following passage of Oregon House Bill 2879. SETTING Community pharmacy embedded within a federally qualified health center (FQHC). PRACTICE DESCRIPTION Not applicable. PRACTICE INNOVATION Women 18 to 50 years of age without evidence of an effective contraceptive method in the electronic medical record were administratively identified. Women were then contacted by pharmacy staff and educated about the opportunity to receive hormonal contraceptives directly from the pharmacy. Women were seen for contraceptive services through scheduled and walk-in appointments. EVALUATION Not applicable. RESULTS From November 1, 2017, to March 31, 2018, 23 women were seen for contraceptive services through the community pharmacy. They averaged 27.2 ± 8.6 years of age and all were Hispanic. The pharmacist prescribed hormonal contraceptives to 78.3% of the women (n = 17). Six women were referred to their primary care provider because pregnancy could not be ruled out (n = 5) or the patient requested a method not within the pharmacists' prescriptive authority (n = 1). No patients were referred to their primary care provider for elevated blood pressure readings, contraindicated disease states, or drug interactions. CONCLUSION A pharmacist-provided contraceptive service was successfully implemented at a community pharmacy within an FQHC. This service was mostly used by young Hispanic women with unmet contraceptive needs. The expanded access to hormonal contraceptives provided by this service may help the health center to achieve quality measures related to contraceptive use and decrease unintended pregnancies in the future.
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Rodriguez MI, Darney BG, Edelman AB, Yee K, Anderson LB, McConnell KJ. Pharmacists expand access to reproductive heaLthcare: PEARL study protocol. BMC Health Serv Res 2019; 19:207. [PMID: 30935394 PMCID: PMC6444429 DOI: 10.1186/s12913-019-4038-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 03/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2016, Oregon became the first of eight states to allow pharmacists to directly prescribe hormonal contraception (HC), including the pill, patch, or ring, without a clinic visit. In the two years following this policy change, the majority of ZIP codes across the state of Oregon had a pharmacist certified to prescribe HC. METHODS We will utilize complementary methodologies to evaluate the effect of this policy change on convenient access to contraception (cost, supply dispensed), safety, contraceptive continuation and unintended pregnancy rates. We will conduct a prospective clinical cohort study to directly measure the impact of provider type on contraceptive continuation and to understand who is accessing hormonal contraception directly from pharmacists. We will concurrently conduct a retrospective analysis using medical claims data to evaluate the state-level effect of the policy. We will examine contraceptive continuation rates, incident pregnancy, and safety measures. The combination of these methodologies allows us to examine key woman-level factors, such as pregnancy intention and usual place of care, while also estimating the impact of the pharmacist prescription policy at the state level. DISCUSSION Pharmacist prescription of HC is emerging nationally as a strategy to reduce unintended pregnancy. This study will provide data on the effect of this practice on convenient access to care, contraceptive safety and continuation rates.
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Affiliation(s)
- Maria I Rodriguez
- Department of Obstetrics and Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN 50, Portland, OR, 97239, USA.
| | - Blair G Darney
- Department of Obstetrics and Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN 50, Portland, OR, 97239, USA
| | - Alison B Edelman
- Department of Obstetrics and Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN 50, Portland, OR, 97239, USA
| | - Kimberly Yee
- Center for Health Systems Effectiveness, Oregon Health &Science University, Portland, USA
| | | | - K John McConnell
- Center for Health Systems Effectiveness, Oregon Health &Science University, Portland, USA
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