Implementation of hormonal contraceptive furnishing in San Francisco community pharmacies

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.

The impact of disasters on contraception in OECD member countries: a scoping review

“…Contraceptive choice. Twenty-four articles [24,27,39,40,57,58,67,[113][114][115][116][117][118][119][120][121][122][123][124][125][126], sixteen of which were original research studies [24,58,66,67,75,[113][114][115][116]118,120,[122][123][124][125][126][127], gave insight into contraceptive choice. A number of commonly used hormonal contraceptives (e.g., ring, patch, emergency contraception, IUD) were reported to be absent from the military formulary in the US [27], limiting the choice of contraceptive options for servicewomen.…”

“…Hormonal contraception. While some evidence suggests that the use of hormonal contraception did not increase during the Zika outbreak, there is mixed evidence on whether hormonal contraception use increased during the COVID-19 pandemic [120,121]. There is evidence to suggest that the use of emergency contraception in clinics increased during the COVID-19 pandemic [39].…”

Minnesota Policy on Pharmacist-Prescribed Contraceptives: Benefits, Limitations, and Opportunities for Improvement

“…24 The accessibility of community pharmacists can benefit patients receiving contraceptive prescriptions and enhance contraceptive adherence. 25 Pharmacists already reported their intention to prescribe contraceptive in their practice. 26 The willingness of pharmacists to provide this service is demonstrated across states that have adopted these policies.…”

“…In San Francisco, 21 of 113 community pharmacies in the city provided pharmacist-prescribed contraceptives. 25 In Oregon, the first state to adopt contraceptive prescribing by pharmacies, a survey delivered prior to the policy being enacted showed that 39% of pharmacists planned to provide contraceptive prescribing. 28 Although only 39% of pharmacists planned to provide contraceptive prescribing, this represents a large increase in access for patients who were previously unable to use pharmacies to obtain this service.…”

“…34 It should also be noted that in comparison to a physician appointment, contraceptive prescribing by a pharmacist may be a more costeffective option for patients. 25 In California, many pharmacies waive prescribing fees for patients to increase access to this service. 25…”