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Developing and Piloting a Protocol for Pharmacist Provision and 12-Month Dispensing of Hormonal Contraception in the
Deirdre A Quinn1,2, Lisa S Callegari3,4, Jennifer Chin3
1Center for Healthcare Evaluation, Research, and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. deirdre.quinn@va.gov.
Background:
Many women Veterans using hormonal contraception experience gaps in contraceptive coverage that may result in unintended pregnancy. We designed the Contraception on Demand (COD) program to expand contraceptive access and reduce gaps in coverage in VA by utilizing clinical pharmacist practitioners (CPPs) to provide contraception.
Objective:
The current study describes a two-site demonstration project to evaluate the implementation of COD using the RE-AIM Framework for Implementation and Evaluation (RE-AIM).
Design:
Prospective quality improvement project, July 2021-January 2022.
Participants:
Women Veterans and VA CPPs at VA Pittsburgh and VA Puget Sound.
Interventions:
COD, comprising evidence-based practices including pharmacist provision of hormonal contraception and 12-month contraceptive dispensing.
Main Measures:
Primary outcomes: Reach (e.g., Veterans' interest in pharmacist provision and/or 12-month dispensing); Effectiveness (e.g., receipt of contraception, patient safety, Veteran and pharmacist experience); Implementation (e.g., barriers and facilitators to uptake).
Key Results:
Pharmacists completed 74 COD visits during the study timeframe, 57 of which resulted in a prescription for hormonal contraception (17 new prescriptions, 40 refills) and 6 of which led to the Veteran being referred for LARC placement. Ninety percent of eligible Veterans opted to receive a 12-month supply of their contraceptive method. Veterans described the program as easy, convenient, and sometimes superior to their prior experiences obtaining contraception at VA. Pharmacists reported increased job satisfaction that led to reduced burnout.
Conclusion:
Pharmacist-led contraceptive prescribing and 12-month dispensing are highly feasible to implement within VA's current model and are acceptable to Veterans and pharmacists. These strategies represent a prime opportunity for VA to improve Veterans' access to contraception while meaningfully expanding VA pharmacists' scope of practice.
Clinical Trial Number:
Not applicable.
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