Pharmacy prescribing is allowed; why isn't it happening?

Objectives Pharmacy-prescribed hormonal contraception is currently authorized in 17 states. Pharmacies could serve as an important access point for historically underserved populations (clients who live in rural areas, are uninsured, do shift-work, or are without a medical home). Yet utilization of these services currently remains limited. We assessed barriers and facilitators of pharmacy prescribing among contraceptive users, pharmacists, and healthcare providers in Utah. Methods We conducted focus groups among contraceptive users (n=14, including English- and Spanish-speaking focus groups), pharmacists (n=6) and healthcare providers (n=6). We coded focus group transcripts using the Consolidated Framework for Implementation Research 2.0 (CFIR). Results Focus group responses clustered around specific implementation barriers including financial barriers (cost for patients, as well as lack of reimbursement for pharmacist’s time); lack of awareness of the service (on the part of patients, pharmacists and healthcare providers); need for updated tools for contraceptive counseling and scheduling; incorrect perceptions of contraceptive complexity among both pharmacists and healthcare providers; and need for pharmacists’ education to conduct contraceptive counseling. Additionally, healthcare providers shared concerns that pharmacy contraceptive clients may not return to healthcare organizations for other health services. Facilitators included clients’ trust in the ability of pharmacists to provide high quality contraceptive care, positive relationships between pharmacists and healthcare providers and pharmacists’ motivation to expand access. Conclusions Both clients and pharmacists expressed a desire for increased utilization of pharmacy prescribing. For pharmacy prescribing to move from a theoretical to an actual access point, significant financial, logistical, technical and educational barriers need to be addressed. Pharmacy-prescribed hormonal contraception is currently authorized in 17 states. Pharmacies could serve as an important access point for historically underserved populations (clients who live in rural areas, are uninsured, do shift-work, or are without a medical home). Yet utilization of these services currently remains limited. We assessed barriers and facilitators of pharmacy prescribing among contraceptive users, pharmacists, and healthcare providers in Utah. We conducted focus groups among contraceptive users (n=14, including English- and Spanish-speaking focus groups), pharmacists (n=6) and healthcare providers (n=6). We coded focus group transcripts using the Consolidated Framework for Implementation Research 2.0 (CFIR). Focus group responses clustered around specific implementation barriers including financial barriers (cost for patients, as well as lack of reimbursement for pharmacist’s time); lack of awareness of the service (on the part of patients, pharmacists and healthcare providers); need for updated tools for contraceptive counseling and scheduling; incorrect perceptions of contraceptive complexity among both pharmacists and healthcare providers; and need for pharmacists’ education to conduct contraceptive counseling. Additionally, healthcare providers shared concerns that pharmacy contraceptive clients may not return to healthcare organizations for other health services. Facilitators included clients’ trust in the ability of pharmacists to provide high quality contraceptive care, positive relationships between pharmacists and healthcare providers and pharmacists’ motivation to expand access. Both clients and pharmacists expressed a desire for increased utilization of pharmacy prescribing. For pharmacy prescribing to move from a theoretical to an actual access point, significant financial, logistical, technical and educational barriers need to be addressed.