药师开具避孕药处方与保险覆盖中断的关联。

Association of Pharmacist Prescription of Contraception With Breaks in Coverage.

机构信息

Department of Obstetrics and Gynecology and the Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon.

出版信息

Obstet Gynecol. 2022 May 1;139(5):781-787. doi: 10.1097/AOG.0000000000004752. Epub 2022 Apr 5.

DOI:10.1097/AOG.0000000000004752

PMID:35576337

Abstract

OBJECTIVE

To assess whether pharmacist prescription of combined hormonal contraception is associated with 12-month contraceptive continuation rates or breaks in contraceptive coverage.

METHODS

We conducted a retrospective cohort study of all short-acting, hormonal contraceptive users (pill, patch, ring, injectable) in Oregon's All Payer All Claims database from January 1, 2016, to December 31, 2018. We captured contraceptive use using diagnosis and National Drug Classification codes. We used logistic regression to measure the association between prescription by a pharmacist and 12-month contraceptive continuation rates and breaks in contraceptive coverage. Model covariates included age, rurality, and payer.

RESULTS

Our study sample consisted of 172,325 contraceptive users, of whom 1,512 (0.9%) received their prescriptions from a pharmacist. Pharmacists were significantly more likely than clinicians to prescribe to women between the ages of 25 and 34 years (50.5% vs 36.9%, P<.05), in urban settings (88.4% vs 81.7%, P<.05), and with commercial insurance (89.2% vs 59.5%, P<.05). We found that the rate of 12 months contraceptive continuation was higher among the population receiving a pharmacist prescription (34.3% vs 21.0%, P<.01). In an adjusted model, the odds of contraceptive continuation at 12 months were 61.0% higher for individuals with any pharmacist prescription (adjusted odds ratio [aOR] 1.61, 95% CI 1.44-1.79) compared with those with clinician prescriptions. Over 6 months, most contraceptive users in both groups experienced a break in coverage, defined as a gap of 1-29 days between prescriptions (61.6% vs 61.9%, P=.89). Breaks in contraceptive use were not significantly associated with prescriber type (aOR 1.03, 95% CI 0.90-1.18).

CONCLUSION

Compared with clinician prescriptions, pharmacist prescription of contraception is associated with increased odds of 12-month contraceptive continuation rates. However, the frequency of breaks in contraceptive coverage was similar among pharmacist and clinic-based prescribers.

FUNDING SOURCE

Arnold Ventures.

摘要

目的

评估药剂师开具复方激素避孕药与 12 个月避孕续用率或避孕覆盖中断的关系。

方法

我们对俄勒冈州所有支付者所有索赔数据库中 2016 年 1 月 1 日至 2018 年 12 月 31 日期间所有短期激素避孕药（药丸、贴剂、环、注射剂）使用者进行了回顾性队列研究。我们使用诊断和国家药物分类代码来捕捉避孕措施的使用情况。我们使用逻辑回归来衡量药剂师处方与 12 个月避孕续用率和避孕覆盖中断之间的关联。模型协变量包括年龄、农村性和支付方。

结果

我们的研究样本包括 172325 名避孕使用者，其中 1512 名（0.9%）从药剂师处获得处方。药剂师开具处方的妇女中，25 至 34 岁的妇女比例明显高于临床医生（50.5%比 36.9%，P<.05），在城市环境中的比例也明显高于临床医生（88.4%比 81.7%，P<.05），且商业保险的比例也明显高于临床医生（89.2%比 59.5%，P<.05）。我们发现，接受药剂师处方的人群中 12 个月避孕续用率更高（34.3%比 21.0%，P<.01）。在调整模型中，与有临床医生处方的人相比，任何药剂师处方的个体在 12 个月时避孕续用的几率高 61.0%（调整后的优势比[aOR]1.61，95%CI 1.44-1.79）。在 6 个月内，两组中大多数避孕使用者都经历了覆盖中断，定义为处方之间间隔 1-29 天（61.6%比 61.9%，P=.89）。避孕使用中断与处方医生类型无显著关联（aOR 1.03，95%CI 0.90-1.18）。