DOCTOR'S VIEW ARCHIVE
According to a news release from the University of Washington's School of Pharmacy, 8 Seattle-area pharmacies are collaborating in a study to provide birth control (oral contraceptives, contraceptive patches, or vaginal rings) to 300 women without first requiring that they visit a clinic or physician. The objective is to test the feasibility of pharmacists prescribing hormonal contraceptives. For the last 6 years, pharmacists in Washington State have been able to prescribe the "morning after" pill.
Although the new study is designed to dispense birth control without a doctor's prescription, the process is not without checks and balances. Women must provide answers to 23 specific questions designed to disclose contraindications to their using hormonal contraceptives. The pharmacist will decide whether and what to prescribe. The initial prescription will only be for three cycles (months) after which the women must return to the pharmacy for additional evaluation including remeasurement of their blood pressure and weight. The women may then be prescribed another ten cycles of birth control.
Comment: Some headlines described this as "non-prescribed birth control." In actuality, the protocol has been carefully designed by the University of Washington School of Pharmacy and the UW Department of Obstetrics and Gynecology. The birth control will be prescribed but it will just not require a prior trip to a clinic or physician. The admirable goal of this Seattle program is to make birth control more accessible to more women in the community
Barbara K. Hecht,
Frederick Hecht, M.D.
Medical Editors, MedicineNet.com
- Birth Control
- Oral Contraceptives, Birth Control Pills
Pharmacist Prescribers Increase Access to Effective Contraceptives
March 19, 2004 -- Pharmacists and technicians in eight Seattle-area pharmacies -- four Bartell Drugs branches and four Fred Meyer stores -- are collaborating in a study to provide oral contraceptives, contraceptive patches, or vaginal rings to women without the requirement of a clinic or physician visit.
The Direct Access study's objective is to test the feasibility of pharmacists prescribing hormonal contraceptives. It is being conducted by investigators from the UW Departments of Pharmacy and Obstetrics and Gynecology, as well as from the local pharmacies. Women aged 18-45 are recruited through shelf-talkers, brochures, and posters, and in conjunction with emergency contraception consultations at the study pharmacies.
Women complete a self-screening form containing 23 questions chosen to rule out contraindications to hormonal contraceptive use, including current pregnancy. The pharmacists, working within collaborative drug therapy agreements developed with Dr. Leslie Miller of the Public Health Seattle/King County Family Planning Clinics, assist women in self-screening for appropriate hormonal contraceptive use and make the decisions about whether and what to prescribe. The initial prescription is for three cycles, after which the woman must return to the pharmacy for blood pressure and weight re-measurement. If neither is elevated beyond guidelines, the pharmacist may prescribe another ten cycles for a total of one year.
In recent years the provision of birth control has been "unbundled" from cancer screening by many family planning agencies, including Planned Parenthood, the World Health Organization, and local health departments. This has allowed non-physician prescribers to have greater flexibility in providing effective contraception in non-clinical settings. Consultation with women includes recommendations that they seek clinical care for pelvic and breast exams and Pap smears at regular periodic intervals, and STD screening as needed.
Pharmacist service fees and contraceptives are paid for by the women themselves, or by their insurance plans. Many plans will cover the products, and Uniform Medical Plan, through the assistance of Director of Pharmacy Donna Marshall, will cover pharmacists' fees as well as products for their members. Discussions are in progress to sign up other health insurance carriers to participate in the project. Through collaboration with Northwest Pharmaceutical Services' (NWPS) Joe Fazio, pharmacists are able to bill their services online to cooperating health plans.
The Direct Access Study is sponsored by the National Institute of Child Health and Human Development (NICHD) through a four-year grant for $851,604. A study Advisory Committee enjoys representation from the WA State Health Department, DSHS, Planned Parenthood of Western Washington, the American College of Obstetricians and Gynecologists, the Office of the WA Insurance Commissioner, WSMA, WSPA, WSBOP, the Northwest Women's Law Center, PATH, two health insurers and community health centers.
Source: Press release written by Dan Downing and issued by the University of Washington School of Pharmacy, March 19, 2004.