Dispensing mifepristone for medical abortion in Canada: Pharmacists’ experiences of the first year

Abstract

Background: Mifepristone for medical abortion was first dispensed by community pharmacists in Canada directly to patients in January 2017. We asked about pharmacists’ experiences over their first year dispensing mifepristone in order to evaluate the frequency of the new practice and assess availability in urban/rural pharmacies. Methods: From August to December 2019, we invited 433 community pharmacists who had completed a baseline survey at least 1 year prior to participate in a follow-up online survey. We summarized categorical data using counts and proportions and conducted a qualitative thematic analysis of open-ended responses. Results: Among 122 participants, 67.2% had dispensed the product, and 48.4% routinely stocked mifepristone. Pharmacists reported a mean of 26 and median of 3 (interquartile range, 1, 8) mifepristone prescriptions filled in their pharmacies in the previous year. Participants perceived that the benefits of making mifepristone available in pharmacies included increased abortion access for patients ( n = 115; 94.3%), reduced pressure on the health care system ( n = 104; 85.3%), increased rural and remote abortion access ( n = 103; 84.4%) and increased interprofessional collaborations ( n = 48; 39.3%). Few participants reported challenges to maintaining adequate stock of mifepristone, but these challenges included low demand ( n = 24; 19.7%), short expiry dating ( n = 12; 9.8%) and drug shortages ( n = 8; 6.6%). The overwhelming majority, 96.7%, reported that their communities did not resist the provision of mifepristone by their pharmacy. Interpretation: Participating pharmacists reported many benefits and very few barriers to stocking and dispensing mifepristone. Both urban and rural communities responded positively to enhanced access to mifepristone in their community. Conclusions: Mifepristone is well accepted by pharmacists within the primary care system in Canada.

Willingness of Pharmacists to Prescribe Medication Abortion in California

“…13,14 In these pilot programs, patients who received pharmacist-provided abortion medication and follow-up care reported having satisfactory abortion experiences. 13,14 Additionally, previous studies conducted in the US and Canada, [14][15][16][17][18][19][20] where dispensing of medication abortion by pharmacists has been legal since 2017, demonstrate pharmacists' willingness to dispense medication abortion. Among US-based pharmacists, benefits to dispensing medication abortion include the ability to expand abortion access to patients, improve patients' quality of care, streamline delivery of health care services, and make use of pharmacists' expertise.…”

“…14,16,20 Studies conducted in Canada found similar barriers to dispensing medication abortion among pharmacists, with the addition of having low demand among patients, drug shortages, and short expiration dates. [17][18][19] Indeed, more information is needed to inform public health efforts to expand the provision of medication abortion.…”

“…Pharmacists also identified potential barriers to medication abortion dispensing such as employer hesitancy, a lack of private space for patient consultations, safe follow-up for postabortion care, adequate staffing and training needs, established reimbursement mechanisms for medication abortion–related services, and having colleagues with religious, political, or personal objections to providing medication abortion . Studies conducted in Canada found similar barriers to dispensing medication abortion among pharmacists, with the addition of having low demand among patients, drug shortages, and short expiration dates . Indeed, more information is needed to inform public health efforts to expand the provision of medication abortion.…”

“… 14 , 16 , 20 Studies conducted in Canada found similar barriers to dispensing medication abortion among pharmacists, with the addition of having low demand among patients, drug shortages, and short expiration dates. 17 , 18 , 19 Indeed, more information is needed to inform public health efforts to expand the provision of medication abortion. Twenty-seven states, including California, currently allow pharmacists to prescribe hormonal contraceptives, affording a unique opportunity to learn about this pathway to reproductive health services.…”