Table 5

Study descriptions and key findings of studies included in the values and preferences review examining pharmacy access

Study authors and yearCountryPopulationStudy designKey findings
Potential OC users
Gardner et al, 200820USAWomen (and community pharmacists—see below)Time series intervention study (n=214 women)Both women and pharmacists were satisfied with the experience of pharmacist-led interventions for oral contraceptives, contraceptive patches or the contraceptive vaginal ring. Nearly all respondents expressed willingness to continue to see pharmacist prescribers and receive their services from them.
Landau et al, 200629USAWomen aged 18–44 years at risk of unintended pregnancyCross-sectional survey (n=811)68% of women said they would use pharmacy access for hormonal contraceptives if available. 41% of women who were not using any contraception said they would begin using a hormonal contraceptive if pharmacy access were available; this was 47% for uninsured women and 40% for low-income women. 66% of current hormonal contraceptive users said they would like to obtain their method through pharmacy access. 63% agreed that hormonal contraceptives should be available without a prescription if a pharmacist screens a woman first. Support declined to 43% when pharmacist screening was not mentioned. Among those not supporting pharmacy access, concerns focused on a potential lack of screening or information.
Manski et al, 201530USAYoung women aged 14–17Cross-sectional survey (n=348)79% of participants supported pharmacy access to OCs, and 57% reported they would be likely to use OCs available through pharmacy access. Few subgroup differences were noted, except that sexually experienced participants were more likely to both support OTC access and be likely to use it. Suburban teenagers were more likely to support pharmacy access than those from rural and urban areas. The most commonly cited advantage to OTC access was fewer teenage pregnancies (45%). Other common responses were that it would be easier for teenagers to get birth control (22%) and it would be more confidential (14%). Disadvantages cited included teenagers not using condoms to protect against STIs (22%), needing a doctor decide if OCs are safe for them (19%), might have sex at a younger age (18%) and might use OCs incorrectly (18%).
Wilkinson et al, 201837USAYoung women aged 18–19Qualitative study using in-depth interviewsNearly all participants were supportive of California’s new law allowing pharmacist’s prescription of contraception. While participants were satisfied with traditional service providers and valued those relationships, they appreciated the benefit of increased access and convenience of going directly to a pharmacy. Participants expected increased access to contraception in pharmacies would lead to both personal and societal benefits. They expressed concerns regarding parental involvement, as well as confidentiality in the pharmacy environment and with insurance disclosures.
Providers
Gardner et al, 200820USACommunity pharmacists (and women—see above)Time series intervention study (n=26 pharmacists)Both women and pharmacists were satisfied with the experience of pharmacist-led interventions for oral contraceptives, contraceptive patches or the contraceptive vaginal ring.
Hilverding et al, 201725USALicensed pharmacistsCross-sectional survey (n=138)Most pharmacists indicated that oral and transdermal contraceptive methods should be pharmacist initiated (57% and 54%, respectively) through a collaborative practice agreement or state-wide protocol. Increased access to care and convenience for patients were the most frequently identified potential benefits. Time constraints and concerns about increased liability were identified as barriers. Pharmacists said they needed clinical guidelines, continuing professional education and patient education materials to successfully initiate contraceptive therapy regimens.
Landau et al, 200928USAPharmacistsCross-sectional survey (n=2725)The majority of pharmacists were comfortable and interested in providing direct access to hormonal contraception in the pharmacy. Perceived barriers included lack of time, no mechanism of reimbursement for the service and possible resistance from physicians.
Norman et al, 201532CanadaPharmacistsCross-sectional survey (n=146) followed by an optional qualitative interviewOver 80% of participating pharmacists indicated willingness to prescribe hormonal contraceptives. Factors associated with willingness to prescribe included comfort using a protocol to access sexual history, confidence about staff availability and public acceptability, and fewer years in practice. Pharmacists requested training in assessment protocols and liability issues prior to implementation.
Rafie et al, 201133USAStudent pharmacistsCross-sectional survey (n=502)96% of student pharmacists were interested in providing hormonal contraception services to either both minors and adults (53%), adults (41%), or minors (6%). Students felt that patients would benefit from improved access and advice (94.0%). Inadequate pharmacist time was an important barrier in determining whether pharmacists could efficiently and effectively provide OC services, followed by lack of private counselling area in the pharmacy, inadequate patient health information and lack of appropriate incentive structure.
Rafie et al, 201234USAReproductive healthcare providers, including physicians and advanced practice cliniciansQualitative study using structured interviewsMost respondents considered the current prescription-only model of access to hormonal contraception to be too restrictive. Some reported a preference for a pharmacy access model where women could obtain contraceptives directly from a pharmacist, bypassing the clinic visit. Many providers believed that method continuation and compliance would improve with pharmacy access to contraception. The most common concern reported was pharmacist’s refusal to provide services.
Rafie et al, 201635USAReproductive healthcare providers (physicians (mostly gynaecologists), nurse practitioners, certified nurse-midwives, physician assistants and registered nurses)Cross-sectional survey (n=482)Overall, 74% of providers supported pharmacist-initiated access to hormonal contraceptives (OCs, patch and ring), while 45% supported behind-the-counter access (where any pharmacy personnel can ensure restrictions are met and provide contraceptives). Physicians were somewhat more supportive of expanding contraceptive access than mid-level providers, but the differences were not significant.
Vu et al, 201736USAPharmacistsCross-sectional survey (n=121)Following a new law expanding pharmacists’ scope of practice to include directly providing self-administered hormonal contraception to patients pursuant to a state-wide protocol, the majority (73%) of pharmacist respondents said they would likely provide this new service. Respondents reported being comfortable educating patients on short-acting (94%) and long-acting reversible contraception (82%), as well as identifying drug interactions with hormonal contraception (97%). Respondents indicated time constraints (74%), lack of reimbursement (64%) and liability concerns (62%) as barriers to prescribing hormonal contraception.
Other stakeholders
Irwin et al, 201827USAGeneral public commenting in online social discourseRetrospective, cross-sectional, mixed methods analysis of public comments posted in response to articles published by major media outlets on OTC availability of OCsCommenters were generally positive towards pharmacist-prescribed self-administered non-emergency hormonal contraception and cited several benefits, such as increasing access to healthcare, reducing unintended pregnancies and supporting individual autonomy. However, it was acknowledged that these benefits would need to be balanced with potential safety concerns and logistical issues associated with delivering clinical services in a community pharmacy setting.
  • OC, oral contraceptive;OTC, over the counter;STI, sexually transmitted infection.