Sexual and reproductive health services from community pharmacists

The role of the community pharmacist has greatly expanded beyond traditional product-focused services to encompass a number of sexual and reproductive health (SRH) services, according to a review in BMJ Open.

“Given the potential feasibility, users’ acceptability and reach, pharmacists are ideally situated to enhance SRH care access,” wrote the authors.

Studies in Medline, EMBASE, CINAHL, Web of Science, Scopus and Cochrane Library from January 2007 to July 2020 were searched.

Most of the 41 studies included in the review were conducted in either the United States (n = 20) or the United Kingdom (n = 13). Overall, 63% of the studies focused on sexually transmitted and bloodborne infections (STBBI), 29% on contraception, 5% on pregnancy, and 2% on sexual dysfunction.

Studies were mostly in specific areas such as chlamydia screening or prescribing of hormonal contraception, while studies in other areas like medical abortion provision, long-acting reversible contraception (LARC) prescribing and vaccine delivery in pregnant women were lacking.

The most common professional pharmacy services provided were screening (39%), prescribing (17%), administration of injections (15%), and provision of medication by pharmacists (15%).

The 2 major SRH areas offered by the pharmacy were treating STBBI (63%) and screening (39%).

Of the studies that evaluated STBBI services, 35% were Chlamydia trachomatis related, 27% concentrated on HIV, 19% on human papillomavirus (HPV), and 19% on hepatitis C virus (HCV).

For chlamydia, users in general reported a high level of satisfaction, citing convenience, location, short wait times, no appointments needed, and a nonjudgmental approach.

For HIV, most studies used rapid point-of-care testing (POCT) with finger-prick blood samples for screening. Pharmacists also are capable of reaching high-risk groups and individuals not previously tested.

For HPV, some pharmacies offered HPV vaccination directly. But in some states in the United States, community pharmacies are not qualified vaccine provider sites for vaccinating age-eligible adolescents, thus limiting the reach to young people.

For HCV, most pharmacies screened via dried blood spot testing (DBST). Pharmacists also consulted or referred patients with reactive tests to specialist care.

For contraception, a prescription service was shown to improve contraception continuation rates because of being significantly more likely to prescribe a 6-month supply than other prescribers. Pharmacists also can enhance access to contraceptive and SRH services through referral to other health care professionals and clinics for follow-up care.

For pregnancy and preconception care, women reported high satisfaction rates for a pharmacist telephone consultation in early pregnancy. Pharmacists could also offer targeted medication reviews to provide preconception education, including folic acid use, medications that may cause fetal harm, and recommended vaccines in pregnancy.

The review findings indicate that pharmacists’ delivery of SRH services was feasible, able to reach vulnerable and high-risk groups, and interventions were highly accepted and valued by users.

However, there were many barriers identified to implementing SRH services, including integration into daily workflow, pharmacist remuneration, cost and reimbursement for patients, and policy regulations.

The authors recommend that future research convey implementation and evaluation of professional pharmacy services for all SRH areas to promote access to these services through community pharmacies and to position pharmacists as SRH providers worldwide.

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Reference

Navarrete J, Yuksel N, Schindel TJ, et al. Sexual and reproductive health services provided by community pharmacists: a scoping review. BMJ Open. 2021 Jul 26;11(7):e047034. doi:10.1136/bmjopen-2020-047034