Pharmacists' Role in Managing Contraceptive Care Continues to Evolve

Attendees of the American Pharmacists Association’s Annual Meeting & Exposition (APhA2018) in Nashville, Tennessee, learned about the evolving role of community pharmacists in managing women’s contraceptive care at a continuing-education session.

In the session called “Loosening Controls on Birth Control: Helping Women Get the Care They Need,” Brooke Griffin, PharmD, BCACP, professor of pharmacy practice at Midwestern University Chicago College of Pharmacy in Downers Grove, Illinois, and Autumn Stewart-Lynch, PharmD, BCACP, associate professor of pharmacy practice at Duquesne University School of Pharmacy in Pittsburgh, also discussed the CDC’s evidence-based recommendations for contraceptive management and safety when dispensing or prescribing birth control.

In addition, they discussed educational strategies regarding the safe use of contraceptives, 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.

After their presentations, Griffin and Stewart-Lynch led an interactive discussion using a case study, before opening it up to questions.

Pharmacists in all 50 states have an opportunity to help patients with contraceptives, by providing guidance in terms of selection, use, and monitoring, Stewart-Lynch said.

As of the end of 2017, 5 states had legislation in place allowing pharmacists to furnish or prescribe contraception, according to Stewart-Lynch.

They are California, Colorado, New Mexico, Oregon, and Washington.

“Oregon is the state where pharmacists have been able to provide contraception for the longest period of time,” Stewart-Lynch said. In that state, pharmacists may prescribe and dispense hormonal contraceptive patches and self-administered oral hormonal contraceptives, which is followed by collaborative communication to the woman’s primary care or women’s health provider.

In California, pharmacists may furnish self-administered contraceptives including oral, depot injection, transdermal, and the vaginal ring. There is a “documentation requirement in a shared electronic medical record” to promote communication with the other members of the health care team, Stewart-Lynch said.

As of the end of 2017, legislation was passed in several other states to allow pharmacists to prescribe contraceptives, some through collaborative practice agreements, according to Stewart-Lynch. These are Hawaii, Maryland, Ohio, and Tennessee.

Bills to allow pharmacists to prescribe contraceptives had been introduced in at least 10 other states as of the end of 2017, according Stewart-Lynch.

Meanwhile, the CDC offers Medical Eligibility Guidelines for Contraceptives (MEC), Selected Practice Recommendations (SPR), and Quality Family Planning Services (QFP). The MEC provides guidelines for the safety of hormonal contraceptives under a broad range of conditions, the SPR provides recommendations for managing common birth control situations, and the QFP recommends how to provide family planning services, Griffin said. There is an app for the MEC and SPR, she said.

The MEC is lengthy, but the CDC has “created a supplement which is much more user friendly and can you can use it with every patient who walks in,” Griffin said.

The SPR offers guidance material for practice management issues regarding contraception, such as how to start contraceptives and when a back-up method is suggested. Contraceptive prescribing requires pharmacists to obtain a health history and measure blood pressure. Laboratory studies, a physical exam, and getting a patient’s weight are optional.

The CDC has found that some of these tests are not necessary prior to prescribing contraception and that “women, especially adolescents, may not be comfortable with a pelvic exam, and that can create a barrier to contraceptive access,” Griffin said.

Pharmacists should refer patients to their providers for cervical cancer and sexually transmitted infection screenings. However, these are not medically necessary prior to taking contraceptives.

Reference

Griffin B, Stewart-Lynch A. Loosening Controls on Birth Control: Helping Women Get the Care They Need. Presented at: APHA2018. Nashville; March 16-19, 2018.