Pharmacist-prescribed contraception using clinical protocols: A review of the gray literature

Victoria Anne Chisari; Helen Benson; Shalom Charlie Benrimoj; Therese Foran; Sarah Dineen-Griffin; Kylie Williams

doi:10.1016/j.contraception.2025.110979

Pharmacist-prescribed contraception using clinical protocols: A review of the gray literature

Contraception. 2025 Sep:149:110979. doi: 10.1016/j.contraception.2025.110979. Epub 2025 May 30.

Authors

Victoria Anne Chisari¹, Helen Benson², Shalom Charlie Benrimoj³, Therese Foran⁴, Sarah Dineen-Griffin⁵, Kylie Williams²

Affiliations

¹ Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia. Electronic address: victoria.chisari@uts.edu.au.
² Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia.
³ Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Granada, Spain.
⁴ School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.
⁵ College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia.

PMID: 40451565
DOI: 10.1016/j.contraception.2025.110979

Abstract

Background: Many women face barriers to starting and continuing contraception due to difficulties in accessing primary care. Pharmacist-prescribed contraceptives have emerged as a strategy to improve access. This approach offers an additional pathway for women to access contraceptive care, with benefits such as lower costs, shorter wait times, and extended hours.

Objectives: This review aims to analyze clinical protocols used by community pharmacists to prescribe and continue hormonal contraceptives and evaluate their quality.

Study design: This review utilized gray literature since protocols are often not formally published. The search involved four processes: searching a gray literature database, using Google, reviewing health agency websites, and consulting international experts. Records were included if they met the definition of a clinical protocol, were for community pharmacist prescribing or continuation of hormonal contraception, and were written in English. Grounded Theory was used for analysis. Quality appraisal was performed using the Appraisal of Guidelines for Research and Evaluation II tool.

Results: Thirty clinical protocols were identified from the USA (n = 23), Canada (n = 2), the UK (n = 2), New Zealand (n = 1), and Australia (n = 2). Pharmacists were authorized to prescribe and continue contraceptives in 27 protocols and continue contraceptives only in three. Key requirements included age restrictions, measurement of blood pressure and body mass index, review by a health professional, patient self-completed screening tools, and use of best-practice guidelines. The lowest-scoring domains in the quality assessment were "Editorial Independence," "Applicability," and "Rigor of Development."

Conclusions: The review provides insights into the current international landscape of pharmacist-prescribed contraception and highlights key components of clinical protocols. It offers valuable information for policymakers to support the development of frameworks for pharmacist-prescribed contraception globally.

Keywords: Clinical protocols; Contraceptive agents; Female; Hormonal contraception; Nonmedical prescribing; Pharmacists.

Publication types

Review

MeSH terms

Clinical Protocols*
Community Pharmacy Services*
Contraception* / methods
Female
Humans
Pharmacists*
Practice Patterns, Pharmacists'*