Barriers and facilitators for pharmacists prescribing emergency contraception under statewide protocol

Background Pharmacists can prescribe levonorgestrel and ulipristal acetate emergency contraception (EC) under statewide protocol in California. The objective of this study was to determine barriers and facilitators for pharmacists prescribing EC. Methods For this qualitative study, we conducted semi-structured individual interviews with 18 pharmacists and pharmacy technicians practicing in pharmacies across California. We operationalized the Practical, Robust Implementation and Sustainability Model (PRISM) implementation science framework to develop the interview guide and inform the thematic analysis. The interview questions explored barriers and facilitators to implementation of pharmacist prescribing of EC. Results Several themes emerged around barriers and facilitators to service implementation in the PRISM domains of Intervention, External Environment, Implementation and Sustainability Infrastructure, and Recipients. Though participants had experience with over-the-counter sales of levonorgestrel EC, they had limited experience prescribing EC and with ulipristal acetate. Reported barriers include difficulty incorporating an additional service into workload without payment or additional human resources, lack of patient demand possibly due to absence of public awareness, lack of physician prescribing of EC, management approval required, and being unaware of the protocol. Participating pharmacists reported being motivated to prescribe EC to benefit patients and provide clinical services. Other reported facilitators included support from their local communities, opportunities created by the statewide protocol, training opportunities, pharmacy team-based care, and providing patient-centered care. Conclusions Multilevel contextual barriers and facilitators exist to implementing pharmacist prescribing of EC that could be addressed in a multicomponent implementation intervention. These findings may help guide implementation strategies, thus increasing patient access to EC.