Gomez Anu Manchikanti, McCullough Colleen, Fadda Rafaela, Ganguly Brittany, Gustafson Elena, Severson Nicolette, Tomlitz Jacob
Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, USA.
Women Health. 2020 Mar;60(3):249-259. doi: 10.1080/03630242.2019.1635561. Epub 2019 Jul 2.
In 2013, California passed legislation to expand the scope of pharmacist practice, including authorizing pharmacists to prescribe hormonal contraception. Pharmacist-prescribed contraception was largely unavailable across the state in 2017. This study aimed to identify barriers and facilitators to offering this service in California independent pharmacies. To do so, we thematically analyzed qualitative data from structured interviews with 36 pharmacists working in independent pharmacies in 2016-17. We found that pharmacists anticipated general benefits from expanding their roles to prescribe contraception, including increasing health care access and decreasing costs. In contrast, described barriers were concrete, including lack of financial incentives and business risks for independent pharmacies. Specific barriers to prescribing hormonal contraception included time required to screen and counsel women about contraception and concerns that pharmacist-prescribed contraception would increase liability and lead to patients seeking health care less frequently. This study suggests that incentives and barriers identified by the respondents are likely to have varied and unequal impacts, with immediate barriers being potentially prohibitive for pharmacists to prescribe contraception. For independent pharmacies, perceived business risks and lack of insurance reimbursement may outweigh professional support for prescribing contraception, limiting the public health impact of legislation that should increase contraceptive access.
2013年，加利福尼亚州通过立法扩大药剂师的执业范围，包括授权药剂师开具激素避孕药物。2017年，全州范围内基本无法获得药剂师开具的避孕药。本研究旨在确定加利福尼亚州独立药房提供这项服务的障碍和促进因素。为此，我们对2016 - 2017年在独立药房工作的36名药剂师进行结构化访谈，并对定性数据进行了主题分析。我们发现，药剂师预期扩大其开具避孕药的职责会带来诸多普遍益处，包括增加医疗保健机会和降低成本。相比之下，所描述的障碍则较为具体，包括独立药房缺乏经济激励措施和商业风险。开具激素避孕药物的具体障碍包括筛查和为女性提供避孕咨询所需的时间，以及担心药剂师开具的避孕药会增加责任风险并导致患者减少就医频率。本研究表明，受访者所确定的激励措施和障碍可能会产生不同且不平等的影响，直接障碍可能会使药剂师无法开具避孕药。对于独立药房而言，感知到的商业风险和缺乏保险报销可能超过开具避孕药所获得的专业支持，从而限制了本应增加避孕可及性的立法对公共卫生的影响。
