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| Helping pharmacy & health communities improve access to Emergency Contraception (EC) |
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Models for EC PharmaciesThere are significant “system” differences in how states and provinces in the US and Canada allow pharmacists to initiate emergency contraception (EC). These characteristics are important because they ultimately determine how easy it is for pharmacists to participate and thus, from a programmatic point of view, how widespread the system becomes. This section looks at nine states in the US (Alaska, California, Hawaii, Maine, Massachusetts, New Hampshire, New Mexico, Vermont and Washington) and three Canadian provinces (British Columbia, Quebec and Saskatchewan) that currently allow women direct pharmacy access to EC. In all states and provinces, pharmacists providing EC must follow guidelines or protocols. In three cases, New Mexico, British Columbia and Quebec, the pharmacist is the prescriber and initiates EC in conformance with guidelines or a protocol issued by the State or Provincial regulatory board. In New Mexico this is the State Board of Pharmacy, and in Canada, it is the QC or BC College of Pharmacists. In six states, Alaska, Hawaii, Massachusetts, New Hampshire, Vermont and Washington, the pharmacist must locate a prescriber to co-sign a collaborative agreement to initiate EC. In Hawaii, only physicians have prescribing authority so physicians must authorize all protocols with pharmacists. Prescribers in Washington, Alaska, Maine, New Hampshire and Vermont include both MDs and advanced practice nurses, so a larger class of health care professionals may sign protocols with pharmacists. In California, pharmacists can either locate a prescriber to co-sign a collaborative agreement to initiate EC OR work under the statewide protocol approved by the Board of Pharmacy and Medical Board to furnish EC. There are other types of system characteristics that affect ease of pharmacist participation and, therefore, how many pharmacies will provide EC services. This includes Board approval or notification about the EC protocol. Having to notify the Board and receive notification back adds an extra step that may not seem like much, but for busy pharmacists it can serve as an additional disincentive to participate. In some states protocols have an automatic two-year expiration date that can make the system more difficult to maintain. Regulations for follow-up with prescribers, or the EC’s patient designated physician or primary health care provider, tend to be vestiges of collaborative agreements that apply to other types of patient specific protocols. Most, if not all systems, stress voluntary referrals to physicians and clinics for ongoing contraceptive care and other services. Most EC systems have some type of training requirement. The Canadian systems specify a three-hour program. Washington has no technical requirement, but most WA pharmacists participate under a standardized board approved protocol that requires completion of training. Alaska, Hawaii and California have very general training requirements. The trend in training in some states, including California, is to simplify options for pharmacists. California passed legislation specifying 1 hr CE training. Pharmacist Provision of EC in the United States: System CharacteristicsPrinter
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