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. 2020 May 1;3(5):e205252.
doi: 10.1001/jamanetworkopen.2020.5252.

Association of Pharmacist Prescription With Dispensed Duration of Hormonal Contraception

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Free PMC article

Association of Pharmacist Prescription With Dispensed Duration of Hormonal Contraception

Maria I Rodriguez et al. JAMA Netw Open. .
Free PMC article

Abstract

Importance: Since 2016, 11 states have expanded the scope of pharmacists to include direct prescription of hormonal contraception. Dispensing greater than 1 month's supply is associated with improved contraceptive continuation rates and fewer breaks in coverage. Scant data exist on the practice of pharmacist prescription of contraception and its outcomes compared with traditional, clinic-based prescriptions.

Objective: To compare the amount of hormonal contraceptive supply dispensed between pharmacists and clinic-based prescriptions. Prescribing patterns were assessed by describing prescribing practices for women with contraindications to combined hormonal contraception. Characteristics of women seeking hormonal contraception directly from pharmacists were also described.

Design, setting, and participants: This cohort study surveyed women aged 18 to 50 years who presented to pharmacies in California, Colorado, Hawaii, and Oregon for hormonal contraception prescribed by a clinician or a pharmacist between January 30 and November 1, 2019.

Exposures: Pharmacist or clinic-based prescription of contraception.

Main outcomes and measures: Months of contraceptive supply dispensed.

Results: Four hundred ten women (mean [SD] age, 27.1 [7.7] years) were recruited who obtained contraception directly from a pharmacist (n = 144) or by traditional clinician prescription (n = 266). Women obtaining contraception from a pharmacist were significantly younger (82 [56.9%] vs 115 [43.2%] participants aged 18-24 years; P = .03), had less education (38 [26.4%] vs 100 [37.6%] with a bachelor degree; P = .002), and were more likely to be uninsured (16 [11.1%] vs 8 [3.0%] participants; P = .001) compared with women with a prescription from a clinician. Pharmacists were significantly more likely to prescribe a 6-month or greater supply of contraceptives than clinicians (6.9% vs 1.5%, P < .001) and significantly less likely to only prescribe a 1-month supply (42 [29.2%] vs 118 [44.4%] prescriptions; P < .001). Controlling for all covariates, women seen by pharmacists had higher odds of receipt of a 6-month or greater supply of contraceptives compared with those seen by clinicians (odds ratio = 3.55; 95% CI, 1.88-6.70). Pharmacists were as likely as clinicians to prescribe a progestin-only method to women with a potential contraindication to estrogen (n = 60 women; 8 [20.0%] vs 6 [30.0%], P = .52).

Conclusions and relevance: These findings suggest that pharmacist prescription of contraception may be associated with improved contraceptive continuation by preventing breaks in coverage through the provision of a greater supply of medication. Efforts are needed to educate prescribing providers on the importance of dispensing 6 months or greater contraceptive supply.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Rodriguez reported receiving grants from Arnold Ventures during the conduct of the study; grants from the National Institute on Minority Health and Health Disparities, personal fees from the American Congress of Obstetricians and Gynecologists, and personal fees from Merck and Bayer outside the submitted work. Dr Edelman reported receiving grants from Merck, research monies from HRA Pharma, and author royalties from Up To Date and serving as a consultant for the World Health Organization, the Centers for Disease Control and Prevention, Gynuity Health Projects, FHI 360, Exeltis, and Nexplanon and as a trainer for Merck (with all honorariums declined since 2016) outside the submitted work. Dr Anderson reported receiving grants from Arnold Ventures during the conduct of the study and speaker honoraria from the American Society of Health Systems Pharmacy. No other disclosures were reported.

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