As of July 2021, 16 states and Washington DC permit pharmacist prescribing of hormonal contraceptives. The objective of this systematic review is to describe the impact of pharmacist prescribing on hormonal contraceptive access in the United States (U.S.). Using a protocol based on PRISMA guidelines, a librarian performed the literature search for articles published between January 1, 2013 and January 15, 2021. Studies were excluded if they were incomplete (ie, without results) or the full text was not available. Studies that took place outside of the U.S., within the U.S. but in a state that had not implemented pharmacist contraception prescribing at the time the research was initiated, or not written in English, as well as those that were not primary literature (ie, reviews, editorials, opinion papers, etc.) were also excluded from this review. Articles were categorized based on whether the outcomes evaluated (a) uptake of pharmacist-prescribed hormonal contraceptive services, (b) implementation of pharmacist-prescribed hormonal contraceptive services, or (c) impact of pharmacist-prescribed hormonal contraceptive services on patients' access to hormonal contraception. Of 2056 identified articles, 21 articles met the inclusion criteria and were included in the analysis. The majority (n = 16) assessed uptake of the service, whereas eight examined implementation and three evaluated impact of the service on patients' access. More research is warranted on the impact of pharmacist prescribing on patients' access to hormonal contraceptives.
This study assessed pharmacists’ perceptions, barriers, and potential solutions for implementing a policy allowing pharmacists to prescribe hormonal contraceptives in Indiana. A mixed-method survey ( n = 131, 22.3% response rate), using Likert-type scales, dichotomous responses (yes/no), and open-ended questions, was distributed to pharmacy preceptors in Indiana. Pharmacists felt prescribing contraceptives would be beneficial (79.1%) and were interested in providing this service (76.0%), but only 35.6% reported having the necessary resources. Participants with a PharmD were significantly more likely to feel the service would be beneficial (odds ratio [ OR] = 10.360, 95% confidence interval [CI: 1.679, 63.939]) and be interested in prescribing contraceptives ( OR = 9.069, 95% CI [1.456, 56.485]). Reimbursement (86.4%), training courses (84.7%), private counseling rooms (69.5%), and increasing technician responsibilities (52.5%) were identified as ways to ease implementation. Women had significantly greater odds of being more comfortable than men prescribing injections ( OR = 2.237, 95% CI [1.086, 4.605]), and intravaginal rings ( OR = 2.215, 95% CI [1.066, 4.604]), when controlling for age, degree, and setting. Qualitative findings reinforced quantitative findings.
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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