Pharmacist prescribing of hormonal contraceptives: results of the Direct Access study.
OBJECTIVE
To describe implementation of a collaborative drug therapy protocol to screen and counsel women for safe use of hormonal contraceptives prescribed by community pharmacists.


METHODS
Community-based intervention study.


METHODS
Metropolitan Seattle, Wash., from June 2003 to December 2005.


METHODS
26 community pharmacists and 214 women enrollees.


METHODS
Pharmacists identified women at risk of unintended pregnancy and offered to evaluate them to determine whether they could safely use oral contraceptives, contraceptive patches, or the contraceptive vaginal ring. Interested women self-administered medical and contraceptive history questionnaires. Pharmacists measured weight and blood pressure and prescribed hormonal contraceptives according to the protocol guidelines. Study interviewers followed up with women via telephone at 1, 6, and 12 months.


METHODS
Effectiveness of pharmacist interventions was measured by continuation of hormonal methods by women. Feasibility was determined by measuring acceptability and sustainability. Acceptability was measured by interviewing women and pharmacists. Sustainability was measured by evidence of willingness to pay for the services.


RESULTS
195 women (91%) were prescribed hormonal contraceptives by participating pharmacists. A self-administered screening tool and physical measurement of weight and blood pressure enabled pharmacists to evaluate women for safe use of contraceptives. Most women (87%) were experienced users of hormonal contraceptives. More than 80% of women paid for the pharmacists' services out of pocket. After 12 months, 70% of women responding to an interview reported continuing use of hormonal contraceptives. Women reported that they would want to obtain a gynecologic exam within 3-year intervals while taking hormonal contraceptives. Both women and pharmacists were satisfied with the experience. Nearly all respondents expressed willingness to continue to see pharmacist prescribers and to receive other services from them.


CONCLUSIONS
Community pharmacists can efficiently screen women for safe use of hormonal contraceptives and select appropriate products. Women and pharmacists were satisfied with the services, and women were willing to pay for them.
Gardner
Jacqueline S
JS
School of Pharmacy, University of Washington, Seattle. Electronic address: jsgardne@u.washington.edu.
Downing
Donald F
DF
School of Pharmacy, University of Washington, Seattle.
Blough
David
D
School of Pharmacy, University of Washington, Seattle.
Miller
Leslie
L
University of Washington, Seattle.
Le
Stephanie
S
Fred Meyer Pharmacies, Seattle.
Shotorbani
Solmaz
S
International Training and Education Center on HIV (I-TECH), University of Washington, Seattle.
D000279:Administration, Cutaneous; D000282:Administration, Intravaginal; D000328:Adult; D001794:Blood Pressure; D001835:Body Weight; D003157:Community Pharmacy Services / Q000191:economics / Q000458:organization & administration*; D003271:Contraceptive Agents, Female / Q000627:therapeutic use*; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use; D003299:Cooperative Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D010595:Pharmacists; D017410:Practice Guidelines as Topic; D024382:Professional Role; D014861:Washington
D003271:Contraceptive Agents, Female; D003278:Contraceptives, Oral, Hormonal