Pharmacist-prescribed contraception using clinical protocols: A review
of the grey literature
Victoria Anne Chisari 1, Helen Benson 2, Shalom Charlie Benrimoj 3,
Therese Foran 4, Sarah Dineen-Griffin 5, Kylie Williams 2
Affiliations Expand
PMID: 40451565 DOI: 10.1016/j.contraception.2025.110979
Free article
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.
Keywords: Clinical protocols; Contraceptive agents; Female; Hormonal
contraception; Nonmedical prescribing; Pharmacists.
Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.