Contraceptive Care Is Both a Responsibility and Opportunity for Pharmacists

Attendees of the American Pharmacists Association’s Annual Meeting & Exposition (APhA2019) in Seattle, Washington, learned about the evolving role of pharmacists in managing women’s contraceptive care at a presentation on Friday, March 22.

In the session called “Comprehending Contraception: With Prescriptive Power Comes Great Responsibility,” Laura M. Borgelt, PharmD, FCCP, BCPS, at the University of Colorado Skaggs School of Pharmacy in Aurora, and Autumn Stewart-Lynch, PharmD, BCACP, CTTS, associate professor of pharmacy practice at Duquesne University School of Pharmacy in Pittsburgh, Pennsylvania, also discussed patient factors for choosing appropriate contraception, the best ways to communicate with patients about contraception, and educational strategies to support those discussions.

In addition, they spoke about resources for more information for health care providers and patients receiving birth control, and the significance of recent standardized protocols that allow pharmacists to furnish or prescribe hormonal contraceptives without a prescription from another provider.

During the presentations, Borgelt and Stewart-Lynch led interactive discussions using case studies, asking the audience members to discuss the hypothetical situations provided with other pharmacists and pharmacy students sitting near them.

“We are in a new world of opportunity,” Borgelt said about the prescriptive power that pharmacists have in many states, noting that about half of all pregnancies are unintended.

She also reminded the audience members that preventing pregnancy might not be the only benefit to using hormonal contraception, naming, among other factors, improving the menstrual cycle, reducing menstrual pain, and reducing ovarian and endometrial cancers.

Borgelt added that “it is important to use a barrier contraceptive method to prevent [sexually transmitted diseases] or sexually transmitted infections,” noting that cervical cancer may be attributable in some cases to not using a barrier method.

She discussed the different methods of contraception, saying that it is important to work with patients to find out what is best for them. It is also important to offer patients 2 or 3 choices, so that they are not overwhelmed by all the options.

Borgelt also discussed the U.S. Medical Eligibility Criteria for Contraceptive Use that offers 4r different tiers that can help guide which type of contraceptives pharmacists should recommend. These are: no restrictions, so the method can be used; advantages generally outweigh theoretical or proven risks; theoretical or proven risks usually outweigh advantages; or there are unacceptable health risks, in which case the method should not be used.

Stewart-Lynch emphasized that pharmacists must find out what patients’ goals are and the barriers to use before recommending any form of contraception, as well as conducting a physical assessment. Factors to consider include past medical history, other medications that they take, patient preference, and their ability to adhere.

Pharmacists also need to monitor the patients after the fact.

It is also key that “before our patients leave, make sure they know how to use that contraceptive method,” Stewart-Lynch said, using the teach-back method.

She showed 2 videos to the audience to demonstrate how pharmacists can help patients with contraceptive choices. She played the role of the pharmacist, and a colleague played the patient in both. In the first video, the pharmacist made some mistakes with the patient, including pushing her to opt for an intrauterine device, even though the patient sounded like she would not have problem remembering to take a pill each day and was also interested in having children in perhaps a year. In the second video, the pharmacist listened more to the patient’s needs.

Borgelt noted, too, that working with other health care providers is also essential.

“Partnering with providers expands the pie of reproductive access, not necessarily trying to take a slice of it,” she said.

This brave new world of prescribing and advising on contraceptive choices is similar to another area where pharmacists once broke new ground.

“I remember when immunizations came to Pennsylvania, and it was like, ‘you want me to do what?’” Stewart-Lynch said.

Reference

Borgelt LM, Stewart-Lynch A. Comprehending Contraception: With Prescriptive Power Comes Great Responsibility. Presented at: APHA2019. Seattle, Washington; March 22, 2019.