Pharmacist-prescribed contraception using clinical protocols: A review of the gray literature

Abstract

Background

Many women face barriers to starting and continuing contraception due to difficulties in accessing primary care. Pharmacist-prescribed contraceptives have emerged as a strategy to improve access. This approach offers an additional pathway for women to access contraceptive care, with benefits such as lower costs, shorter wait times, and extended hours.

Objectives

This review aims to analyze clinical protocols used by community pharmacists to prescribe and continue hormonal contraceptives and evaluate their quality.

Study design

This review utilized gray literature since protocols are often not formally published. The search involved four processes: searching a gray literature database, using Google, reviewing health agency websites, and consulting international experts. Records were included if they met the definition of a clinical protocol, were for community pharmacist prescribing or continuation of hormonal contraception, and were written in English. Grounded Theory was used for analysis. Quality appraisal was performed using the Appraisal of Guidelines for Research and Evaluation II tool.

Results

Thirty clinical protocols were identified from the USA (n = 23), Canada (n = 2), the UK (n = 2), New Zealand (n = 1), and Australia (n = 2). Pharmacists were authorized to prescribe and continue contraceptives in 27 protocols and continue contraceptives only in three. Key requirements included age restrictions, measurement of blood pressure and body mass index, review by a health professional, patient self-completed screening tools, and use of best-practice guidelines. The lowest-scoring domains in the quality assessment were “Editorial Independence,” “Applicability,” and “Rigor of Development.”

Conclusions

The review provides insights into the current international landscape of pharmacist-prescribed contraception and highlights key components of clinical protocols. It offers valuable information for policymakers to support the development of frameworks for pharmacist-prescribed contraception globally.