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- Title
Willingness of Pharmacists to Prescribe Medication Abortion in California.
- Authors
Cohen, Cathren; Hunter, Lauren A.; Beltran, Raiza M.; Serpico, Jaclyn; Packel, Laura; Ochoa, Ayako Miyashita; McCoy, Sandra I.; Conron, Kerith J.
- Abstract
Key Points: Question: Are pharmacists in California willing to prescribe medication abortion? Findings: In this cross-sectional survey study of 316 California community pharmacists, 193 of 280 (69%) were willing to prescribe medication abortion if permitted by law, but only 139 of 288 (48%) were confident in their knowledge and 115 of 285 (40%) were confident in their ability to do so. Despite greater willingness and confidence to prescribe hormonal birth control, only 144 of 308 pharmacists (47%) worked in pharmacies that provided these prescriptions; those who worked at pharmacies that did not provide these prescriptions reported knowledge or training, staffing or time, and payment for services as barriers. Meaning: These findings suggest that most pharmacists in California would be willing to prescribe medication abortion if legally permitted to do so; however, training and attention to pharmacy-level barriers may be needed. This cross-sectional study surveys attitudes toward reproductive health services and medication abortion; the availability of pharmacist-prescribed, self-administered hormonal contraceptives; and pharmacy-level contraceptive implementation obstacles from licensed community pharmacists in California. Importance: Nearly half of US states have restricted abortion access. Policy makers are exploring pathways to increase access to abortion and reproductive health care more broadly. Since 2016, California pharmacists could prescribe hormonal birth control, providing an opportunity to learn about the implementation of pharmacist-provided reproductive health care. Objective: To explore the feasibility of broadening pharmacist scope of practice to include prescribing medication abortion. Design, Setting, and Participants: A cross-sectional online survey was conducted from October 11 to December 20, 2022, among a convenience sample of California licensed community pharmacists to examine their attitudes toward, knowledge of, and confidence in prescribing hormonal birth control and reports of pharmacy-level practices. Main Outcomes and Measures: Descriptive analyses and log-binomial regression models were used to compare medication abortion and contraceptive provision attitudes by pharmacist and pharmacy characteristics. Results: Among the 316 pharmacists included in the analysis who worked at community pharmacies across California (mean [SD] age, 40.9 [12.0] years; 169 of 285 [59.3%] cisgender women; and 159 of 272 [58.5%] non-Hispanic Asian individuals), most (193 of 280 [68.9%]) indicated willingness to prescribe medication abortion to pharmacy clients if allowed by law. However, less than half were confident in their knowledge of medication abortion (139 of 288 [48.3%]) or their ability to prescribe it (115 of 285 [40.4%]). Pharmacists who indicated that providing access to hormonal birth control as a prescribing provider was important (263 of 289 [91.0%]) and were confident in their ability to prescribe it (207 of 290 [71.4%]) were 3.96 (95% CI, 1.80-8.73) times and 2.44 (95% CI, 1.56-3.82) times more likely to be willing to prescribe medication abortion and to express confidence in doing so, respectively. Although most pharmacists held favorable attitudes toward hormonal birth control, less than half (144 of 308 [46.8%]) worked in a pharmacy that provided prescriptions for hormonal birth control, and 149 who did not reported barriers such as lack of knowledge or training (65 [43.6%]), insufficient staff or time to add new services (58 [38.9%]), and lack of coverage for services (50 [33.6%]). Conclusions and Relevance: The findings of this cross-sectional survey study of California pharmacists suggest that most pharmacists were willing to prescribe medication abortion. However, future efforts to expand pharmacists' scope of practice should include training to increase knowledge and confidence in prescribing medication abortion. Pharmacy-level barriers to hormonal birth control prescription, such as insurance coverage for pharmacist effort, should also be addressed, as they may serve as barriers to medication abortion access.
- Subjects
CALIFORNIA; CROSS-sectional method; STATISTICAL models; HEALTH services accessibility; LIFESTYLES; COMMUNITY health services; INSURANCE; RESEARCH funding; STATISTICAL sampling; LOGISTIC regression analysis; NON-medical prescribing; CONFIDENCE; DESCRIPTIVE statistics; ABORTIFACIENTS; PROFESSIONS; ODDS ratio; RACE; ATTITUDES toward abortion; RELIGION; CONTRACEPTION; DATA analysis software; CONFIDENCE intervals; PHARMACISTS' attitudes; MEDICAL practice; ABORTION; EMERGENCY contraceptives; SELF-perception
- Publication
JAMA Network Open, 2024, Vol 7, Issue 4, pe246018
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.6018