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Pharmacy’s role in contraceptive counseling and care

Community pharmacists need more support and resources to provide quality contraceptive counseling and care, according to a study published in BMJ Sexual and Reproductive Health.

Danielle Mazza, MD, MBBS, FRACGP, DRANZCOG, department head of the Monash University Department of General Practice in Notting Hill, Victoria, Australia, and colleagues conducted the study. The research focused on Australian community pharmacies to find how contraceptive care is practiced and how it might be improved.

“We examined community pharmacists’ contraceptive knowledge and their attitudes, practices and perceived barriers to and benefits of contraceptive counselling provision,” Mazza and colleagues said.

Researchers noted how community pharmacies in Europe and North America have increased access to sexual and reproductive health due to task-sharing.

“These community pharmacy task-sharing initiatives include pregnancy options counselling, interventions integrating contraceptive care across community and clinic-based services, and legislative amendments providing pharmacists with practice licensing authority to dispense hormonal contraception without a physician's prescription,” the authors wrote.1-4

Between September and December 2020, study authors conducted a nationwide survey by mail. They contacted 2149 community pharmacies and requested a response from a single pharmacist from each location. Nineteen percent (366) of requests were answered, with a median respondent age of 34 years old.

Outcomes from the survey included practices, reported and tested knowledge, attitudes, confidence, benefits, and barriers.1

Most pharmacists (85%), “agreed that contraceptive counselling fits within their current professional activities and emphasized benefits to their patients, including improved access to contraceptive decision support (80%), as being key motivators of counselling,” Mazza and colleagues reported.

Researchers said the most important barriers included lack of assistance tools (54%), lack of training opportunities (5%), and lack of payment mechanisms (66%).

Pharmacists rated their self-knowledge and confidence as highest with combined oral contraceptives and lowest with copper intrauterine devices.

“When tested, pharmacists were very knowledgeable about method, dosage, frequencies and costs, and relatively less knowledgeable about side-effects and IUD suitability for adolescents,” Mazza and colleagues said.

They added that Australian pharmacists have limited opportunities after undergraduate degrees for contraceptive knowledge, which is similar to findings in the United States, where “most pharmacists described contraceptive education in the pharmacy curricula as being inadequate to prepare them for contraception prescribing.”1,5

In areas where general practitioners were scarce, pharmacies were most likely to have a private consultation room and advanced accreditation, according to study authors. They said this provides an opportunity for pharmacists to increase access to contraception methods and counselling in communities that lack these services, and that most pharmacists felt positive about these services.1

To decrease barriers reported by pharmacists, researchers recommended policy level changes such as medicine rebates and federal pharmacy funding agreements. In addition, they said pharmacy curricula changes and professional development opportunities would also decrease these barriers.

For study limitations, researchers said that 2/3 of pharmacists who responded to the survey self-identified as innovators or early adopters, and so this may have resulted in sampling bias.

In addition, while the sample size of 366 responses was adequate, it was a relatively small number compared with the initial 2149 survey requests and may not provide a full picture.

Researchers said that Australian community pharmacists know contraceptive counseling is good for both public health and for patients. They said pharmacists reported being enthusiastic about expanding their scope of practice for contraceptive care.1

“Community pharmacists provide contraceptive information and counselling but lack the necessary resources and support to be able to consistently provide quality, person-centered care,” researchers concluded.

They said that payment mechanisms, pharmacy-specific professional resources, and training opportunities need additional exploration to provide support for pharmacists to offer high quality, patient-centered contraceptive care.1

References

  1. Buckingham PLM, Hussainy S, Soon J, Norman WV, Bateson D, Mazza D. Improving access to quality contraceptive counselling in community pharmacy: examining the knowledge, attitudes and practices of community pharmacists in Australia. BMJ Sex Reprod Health. 2022 Nov 21:bmjsrh-2022-201623. doi: 10.1136/bmjsrh-2022-201623. Epub ahead of print. PMID: 36410765.
  2. Rebic N, Gilbert K, Soon JA "Now what?!" A practice tool for pharmacist-driven options counselling for unintended pregnancy. Can Phann J 2021; 154:248-55.
  3. Cameron ST, Glasier A, McDaid L, et al. Use of effective contraception following provision of the progestogen-only pill for women presenting to community pharmacies for emergency contraception (Bridge-It): a pragmatic cluster­randomised crossover trial. Lancet 2020;396: 1585-94.
  4. Rodriguez MI, Skye M, Edelman AB, et al. Association of pharmacist prescription and 12-month contraceptive continuation rates. Am J Obstet Gynecol 2021;225:647. e1-647.e9.
  5. Stone RH, Rafie S, Griffin B, et al. Pharmacist self­perception of readiness to prescribe hormonal contraception and additional training needs. Curr Pharm Teach Learn 2020; 12:27-34.