Mixed methods systematic review of pharmacist-administered injectable contraception: Insights from patients, pharmacists, and other healthcare professionals.

Abstract

Background: The role of the pharmacist in reproductive health and contraception management continues to expand. Examination of the perspectives of patients, pharmacists, and other healthcare professionals can highlight both the benefits and challenges associated with pharmacist-administration of injectable contraception.

Objectives: The objective of this systematic review was to assess the feasibility, applicability, and satisfaction of patients, pharmacists, and other healthcare professionals regarding pharmacist-administered injectable contraception.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a search of Medline and Embase databases, from inception through June 3, 2024, was conducted using a predefined search strategy to capture relevant records. Initial records were screened based on pre-specified inclusion criteria focusing on patient, pharmacist, and other healthcare professional outcomes related to the pharmacist-administration of injectable contraceptives. After deduplication and screening, three independent reviewers extracted data, with any disagreements resolved through discussion by a fourth reviewer. Risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized studies and the Appraisal Tool for Cross-Sectional Studies. A convergent integrated mixed-methods approach was utilized to analyze both qualitative and quantitative data.

Results: Five cross-sectional studies and one randomized controlled trial were included. Pharmacists were interested in administering injectable contraceptives and reported that implementation would positively impact patient access and convenience. Quantitative analysis demonstrated that pharmacists felt confident and capable in this role and expressed the need for further training and resources. Qualitative analysis highlighted patient satisfaction for the convenience and accessibility, specifically in rural areas. Barriers included insufficient training, lack of infrastructure, mixed acceptance among other healthcare professionals, reimbursement, and regulatory frameworks.

Conclusion: Pharmacist-administered injectable contraception appears to be beneficial, accessible, and convenient for patients while aligning with pharmacists' capabilities and professional roles. Barriers should be addressed when considering implementation. Future research should aim to broaden the evidence-based research across different regions and explore long-term outcomes.