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Walpola RL, Issakhany D, Gisev N, Hopkins RE. The accessibility of pharmacist prescribing and impacts on medicines access: A systematic review. Res Social Adm Pharm 2024; 20:475-486. [PMID: 38326207 DOI: 10.1016/j.sapharm.2024.01.006] [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: 11/03/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Pharmacist prescribing has been introduced in several countries as a strategy to improve access to health care and medicines. However, the direct impacts of pharmacist prescribing on medicines access, and the overall accessibility of pharmacist prescribing services, are not well known. OBJECTIVES This systematic review aimed to assess the direct impacts of pharmacist prescribing on medicines access, and the accessibility of pharmacist prescribing services, in community and primary care settings. METHODS PubMed, Embase, and CINAHL were searched for studies published in English between 01 January 2003 to 15 June 2023. Both quantitative and qualitative primary studies were included if they described pharmacist prescribing in a primary care setting. Outcomes included findings related to access to medicines as a result of pharmacist prescribing (primary outcome), and access to pharmacist prescribing services overall (secondary outcome). Narrative synthesis of outcomes was undertaken. RESULTS A total of 47 studies were included from four countries (United States, United Kingdom, Canada, New Zealand). Thirteen studies provided evidence that pharmacist prescribing may improve medicines access in several ways, including: increasing the proportion of eligible people receiving medicines, increasing the number of overall dispensed prescriptions, or reducing time to receipt of treatment. The remainder of the included studies reported on the accessibility of pharmacist prescribing services. Published studies highlight that pharmacist prescribers practicing in community settings are generally accessible, with pharmacist prescribers viewed by patients as easy and convenient to consult. There was limited evidence about the affordability of pharmacy prescribing services, and a number of potential equity issues were observed, including reduced access to pharmacist prescribers in more socioeconomically disadvantaged areas and those with greater proportions of populations at risk of health inequities, such as culturally and linguistically diverse communities. CONCLUSIONS This systematic review found that pharmacist prescribing services were both highly accessible and beneficial in improving access to medicines. However, measures of medicines access varied, and few studies included direct measures of medicines access as an outcome of pharmacist prescribing, highlighting a need for future studies to incorporate direct measures of medicines access when assessing the impact of pharmacist prescribing services.
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Affiliation(s)
- Ramesh L Walpola
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia; School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia.
| | - Dabrina Issakhany
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Ria E Hopkins
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Hunter LA, Packel LJ, Chitle P, Beltran RM, Rafie S, De Martini L, Dong B, Harris O, Holloway IW, Miyashita Ochoa A, McCoy SI. Opportunities to Increase Access to HIV Prevention: Evaluating the Implementation of Pharmacist-Initiated Pre-exposure Prophylaxis in California. Open Forum Infect Dis 2023; 10:ofad549. [PMID: 38023549 PMCID: PMC10651201 DOI: 10.1093/ofid/ofad549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Background Pharmacies are a promising setting through which to expand access to human immunodeficiency virus (HIV) prevention, including pre-exposure and post-exposure prophylaxis (PrEP and PEP, respectively). We aimed to evaluate and inform the implementation of California's Senate Bill 159 (2019), allowing pharmacists to independently prescribe PrEP and PEP. Methods From October through December 2022, we conducted a cross-sectional study of 919 California pharmacists and pharmacy students, primarily recruited via the email listservs of professional organizations. Participants completed an online survey assessing the implementation of pharmacist-initiated PrEP/PEP, including knowledge, attitudes, practices, perceived barriers, and implementation preferences elicited through a discrete choice experiment. Results Among 919 participants (84% practicing pharmacists, 43% in community pharmacies), 11% and 13% reported that pharmacists at their pharmacy initiate PrEP and PEP, respectively. Most believed that pharmacist-initiated PrEP/PEP is important (96%) and were willing to provide PrEP (81%); fewer (27%) had PrEP/PEP training. Common implementation barriers were lack of staff/time and payment for pharmacist services. Participants preferred PrEP implementation models with in-pharmacy rapid oral HIV testing and pharmacists specifically hired to provide PrEP services. Conclusions Despite pharmacists' supportive attitudes, Senate Bill 159 implementation in California pharmacies remains limited, in part due to policy-level and organizational-level barriers. Ensuring PrEP/PEP-related payment for services and sufficient workforce capacity is key to leveraging pharmacists' role in HIV prevention.
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Affiliation(s)
- Lauren A Hunter
- School of Public Health, Division of Epidemiology, University of California, Berkeley, Berkeley, California, USA
| | - Laura J Packel
- School of Public Health, Division of Epidemiology, University of California, Berkeley, Berkeley, California, USA
| | - Pooja Chitle
- School of Public Health, Division of Epidemiology, University of California, Berkeley, Berkeley, California, USA
| | - Raiza M Beltran
- Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California, USA
| | - Sally Rafie
- Birth Control Pharmacist, San Diego, California, USA
- University of California, San Diego Health, San Diego, California, USA
| | - Loriann De Martini
- California Society of Health-System Pharmacists, Sacramento, California, USA
| | - Betty Dong
- School of Pharmacy, University of California, San Francisco, San Francisco, California, USA
| | - Orlando Harris
- School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Ian W Holloway
- Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California, USA
| | - Ayako Miyashita Ochoa
- Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California, USA
| | - Sandra I McCoy
- School of Public Health, Division of Epidemiology, University of California, Berkeley, Berkeley, California, USA
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Rafie S, Hildebrand M, Hurst S, Economou N, Stadnick NA, Mody SK. Barriers and facilitators for pharmacists prescribing emergency contraception under statewide protocol. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Sally Rafie
- Department of Pharmacy UC San Diego Health San Diego California USA
| | - Marisa Hildebrand
- Division of Family Planning, Department of Obstetrics, Gynecology, and Reproductive Sciences University of California San Diego La Jolla California USA
| | - Samantha Hurst
- Herbert Wertheim School of Public Health and Human Longevity Science University of California San Diego La Jolla California USA
| | - Nicole Economou
- Division of Family Planning, Department of Obstetrics, Gynecology, and Reproductive Sciences University of California San Diego La Jolla California USA
| | - Nicole A. Stadnick
- Department of Psychiatry University of California San Diego La Jolla California USA
- Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center Child and Adolescent Services Research Center San Diego California USA
| | - Sheila K. Mody
- Division of Family Planning, Department of Obstetrics, Gynecology, and Reproductive Sciences University of California San Diego La Jolla California USA
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Siddiqui N, Rafie S, Tall Bull S, Mody SK. Access to contraception in pharmacies during the COVID-19 pandemic. J Am Pharm Assoc (2003) 2021; 61:e65-e70. [PMID: 34452840 PMCID: PMC8349401 DOI: 10.1016/j.japh.2021.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/11/2021] [Accepted: 08/03/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND As a result of the coronavirus disease 2019 (COVID-19) pandemic, shifts in traditional contraception access points have presented new challenges, leading people to seek alternative sources of contraception care, including pharmacies. Pharmacists in one-fourth of U.S. states are able to prescribe hormonal contraception, a model known as pharmacy access. Pharmacy access became available in California in 2016 and in Colorado in 2017. OBJECTIVE To characterize how access to contraception products and services in pharmacies changed during the COVID-19 pandemic, including pharmacist prescribing practices and innovations in service delivery. METHODS We conducted a cross-sectional survey among California and Colorado pharmacists from September to October 2020. Survey questions included pharmacist and pharmacy practice site characteristics, prescribing practices, pharmacist perspectives, and pharmacy services in the context of the COVID-19 pandemic. RESULTS A total of 128 pharmacists participated in the study, with 38% (n = 49) from California and 62% (n = 79) from Colorado. Among participants, 41% (n = 53) prescribed contraception, of which 94% (n = 50) continued, 4% (n = 2) started, and 2% (n = 1) suspended during the pandemic. Most participants reported interest (79%) and effort (75%) in prescribing contraception to be about the same during the pandemic. Community need for contraceptive services was perceived to be slightly or much higher (45%) or about the same (47%). Patient interest in pharmacy access was perceived to be slightly or much higher by 26% and about the same by 57% of the participants. When distributing contraception prescriptions, pharmacies increased curbside (from 12% to 52%), home delivery (from 40% to 60%), and mailing options (from 41% to 71%) during the pandemic. CONCLUSIONS Pharmacists prescribing hormonal contraception who participated in this study remained committed to providing this service during the pandemic. Some perceived increased community need for contraception and patient interest in direct pharmacy access. There was an increase in options for patients to receive contraception prescriptions with minimal contact.
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Orr K, Chin J, Cuddeback M, Zimo J, Judge-Golden C, Jarlenski M, Borrero S. Pharmacy availability of emergency contraception in southwestern Pennsylvania: A simulated patient study. Contracept X 2021; 3:100068. [PMID: 34401743 PMCID: PMC8355831 DOI: 10.1016/j.conx.2021.100068] [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: 03/31/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To assess the availability of oral emergency contraception in southwestern Pennsylvania pharmacies. Study design We conducted a simulated patient study to assess on-the-shelf availability of levonorgestrel emergency contraception and immediate availability of ulipristal acetate emergency contraception. Results Only 44% of pharmacies stocked levonorgestrel on-the-shelf and only 5% of pharmacies had ulipristal acetate immediately available. Conclusions We found significant barriers to obtaining timely oral emergency contraception in southwestern Pennsylvania. Implications statement Timely access to emergency contraception is important for people's ability to determine if, when, how, and under what circumstances to have children. Pharmacies in southwestern Pennsylvania need to expand access to oral emergency contraception.
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Affiliation(s)
- Katherine Orr
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Jennifer Chin
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
- Corresponding author.
| | - Maris Cuddeback
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Jessica Zimo
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Colleen Judge-Golden
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, PA, United States
| | - Marian Jarlenski
- Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sonya Borrero
- Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
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Stone RH, Rafie S. Medication abortion: Advocating for mifepristone dispensing by pharmacists. Contraception 2021; 104:31-32. [DOI: 10.1016/j.contraception.2021.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
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Kaller S, Morris N, Biggs MA, Baba CF, Rafie S, Raine-Bennett TR, Creinin MD, Berry E, Micks EA, Meckstroth KR, Averbach S, Grossman D. Pharmacists' knowledge, perspectives, and experiences with mifepristone dispensing for medication abortion. J Am Pharm Assoc (2003) 2021; 61:785-794.e1. [PMID: 34281806 DOI: 10.1016/j.japh.2021.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The U.S. Food and Drug Administration (FDA) restricts dispensing of mifepristone for medication abortion to certified health care providers at clinical facilities, thus prohibiting pharmacist dispensing. Allowing mifepristone dispensing by pharmacists could improve access to medication abortion. OBJECTIVE To assess the feasibility of pharmacists dispensing mifepristone to patients who have undergone evaluation for eligibility and counseling for medication abortion by a clinician. METHODS Before providing a study training on medication abortion, we administered baseline surveys to pharmacists who participated in a multisite mifepristone-dispensing intervention. The survey assessed medication abortion knowledge-using a 15-item score-and perceptions about the benefits and challenges of the model. We administered follow-up surveys in the study's final month that also assessed the pharmacists' satisfaction and experiences with mifepristone dispensing. To investigate the association of the study intervention with the pharmacists' knowledge, perceptions, and experiences dispensing mifepristone, we conducted multivariable linear regression analyses using generalized estimating equation models, accounting for clustering by individual. RESULTS Among the 72 pharmacists invited from 6 pharmacies, 47 (65%) completed the baseline surveys, and 56 (78%) received training. At the study's end (mean 18 months later), 43 of the 56 pharmacists who received training (77%) completed the follow-up surveys. At follow-up, 36 (83%) respondents were very or somewhat satisfied with mifepristone dispensing, and 24 (56%) reported experiencing no challenges dispensing mifepristone. Four (6%) of the 72 pharmacists invited objected to participating in mifepristone dispensing. In regression analyses, average knowledge scores, perceived ease of implementation, and level of support for the pharmacist-dispensing model were higher at follow-up (P < 0.001). CONCLUSION Most pharmacists were willing to be trained, dispensed mifepristone with few challenges when given the opportunity, were satisfied with the model, and had higher knowledge levels at follow-up. Our findings support removal of FDA's restriction on pharmacist dispensing of mifepristone.
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Chen L, Lim J, Jeong A, Apollonio DE. Implementation of hormonal contraceptive furnishing in San Francisco community pharmacies. J Am Pharm Assoc (2003) 2020; 60:963-968.e2. [PMID: 32800456 PMCID: PMC7423572 DOI: 10.1016/j.japh.2020.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/09/2020] [Accepted: 07/18/2020] [Indexed: 11/28/2022]
Abstract
Background In 2013, California passed Senate Bill 493, which allowed pharmacists to furnish hormonal contraceptives without a physician’s prescription. Despite this expanded scope of practice, only 11% of the pharmacies reported furnishing hormonal contraception over the following 6 years. Objectives Our study objectives were to determine the extent of hormonal contraceptive furnishing and identify the factors that led to successful implementation in San Francisco community pharmacies. Methods Backspace we conducted a cross-sectional survey to identify community pharmacies furnishing hormonal contraception in San Francisco. Interviews were coded inductively to identify consistent themes. Semistructured interviews with pharmacists at the locations that furnished contraception identified the factors that had led to successful implementation in local community pharmacies, as well as assessing changes in practice during the coronavirus disease (COVID-19) pandemic. Results San Francisco had 113 operational community pharmacies in April 2020. Of these, 21 locations reported that they furnished hormonal contraception (19%), and we interviewed pharmacists at 12 of those locations. We identified 3 key factors that drove implementation at the pharmacy level: administrative support, advertising, and pharmacist engagement. Additional drivers of implementation involved the nature of the community. The respondents also reported on barriers that continued to slow adoption, including consultation fees, time constraints, and patient privacy. Changes in demand for services owing to COVID-19 risks were inconsistent. Conclusion Our findings suggest strategies that community pharmacies can use to expand their scope of practice and improve quality and continuity of care for patients.
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