J Am Pharm Assoc (2003). 2022 Jul-Aug;62(4):1296-1303.e2. doi: 10.1016/j.japh.2022.02.013. Epub 2022 Feb 22.
Oral contraceptives and other short-acting reversible contraceptive (SARC) methods such as the patch, vaginal ring, and medroxyprogesterone injections are used by approximately 30% of people using contraception. People may face barriers in obtaining a timely and adequate supply of their SARCs. It is well established that dispensing more than 1-month supply at a time is more convenient for patients, improves continuation, and decreases the risk of unintended pregnancy. Given the potential for public health impact, 20 states, including Massachusetts, have expanded access to a 12-month supply of SARCs.
The goal of this qualitative study was to explore Massachusetts pharmacists' general awareness and specific knowledge of the state's 2017 Act Advancing Contraceptive Coverage and Economic Security in Our State (ACCESS) law, explore barriers to the implementation of the law, and elicit recommendations to improve uptake of this practice.
Semistructured interviews were conducted with a purposeful sample of community pharmacists in Massachusetts between September 2020 and May 2021 using a pretested interview guide. Interviews were audio recorded and professionally transcribed. Data collection ceased when theoretical saturation was achieved. Data were analyzed using modified grounded theory, including code book development and line-by-line and axial coding.
Sixteen pharmacists from diverse practice settings participated in the interviews. All the pharmacists (100%) reported that they had received no training on the ACCESS law, and only 1 pharmacist reported having complete knowledge of the specifics of the law. We identified key themes and subthemes related to pharmacists' concerns about implementation of the law at the system, pharmacy, and patient level, including insurance coverage, communication of new laws, stocking, supply, and misuse by patients.
Addressing the need for pharmacist training and communication regarding new regulations may improve provision of an extended supply of SARC methods.
约有 30%使用避孕措施的人会选择口服避孕药和其他短效可逆避孕方法（SARC），如贴片、阴道环和醋酸甲羟孕酮注射剂。人们在及时获得充足的 SARC 供应方面可能会面临障碍。大量研究证实，一次配给一个月以上的用量，对患者更加方便，能提高避孕方法的持续使用率，并降低意外怀孕的风险。鉴于这对公共卫生可能产生的影响，包括马萨诸塞州在内的 20 个州已经扩大了 SARC 的 12 个月供应渠道。
本定性研究的目的是探讨马萨诸塞州药剂师对该州 2017 年《促进避孕覆盖和保障州内经济安全法案》（ACCESS）的普遍认识和具体了解，探索实施该法案的障碍，并提出改善该实践措施的建议。
2020 年 9 月至 2021 年 5 月，我们采用预测试的访谈指南，对马萨诸塞州不同社区实践环境的药剂师进行了半结构化访谈，使用目的抽样法选取了参与者。访谈进行了录音，并由专业人员进行了转录。当达到理论饱和时，数据收集就停止了。使用改良的扎根理论进行数据分析，包括编码手册的开发以及逐行和轴向编码。
16 名来自不同实践环境的药剂师参加了访谈。所有药剂师（100%）表示他们没有接受过 ACCESS 法案的培训，只有 1 名药剂师报告说他们完全了解该法案的具体内容。我们确定了与药剂师在系统、药房和患者层面实施该法案的关注点相关的关键主题和子主题，包括保险覆盖范围、新法规的沟通、库存、供应以及患者的滥用。
解决药剂师对新法规培训和沟通的需求，可能会改善 SARC 方法的长期供应。
