Pharmacists expand access to reproductive heaLthcare: PEARL study protocol

BMC Health Serv Res. 2019 Apr 1;19(1):207. doi: 10.1186/s12913-019-4038-9.


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.

Keywords: Access to care; Continuation; Hormonal contraception; Pharmacists.

MeSH terms

  • Contraceptive Agents, Female*
  • Drug Prescriptions*
  • Female
  • Health Services Accessibility
  • Humans
  • Legislation, Drug*
  • Oregon
  • Pharmaceutical Services / legislation & jurisprudence
  • Pharmacists / legislation & jurisprudence*
  • Pregnancy
  • Pregnancy Rate
  • Pregnancy, Unplanned
  • Prospective Studies
  • Research Design
  • Retrospective Studies


  • Contraceptive Agents, Female