Table 2 Pharmacy contraceptive prescribing focus groups mapped to CFIR
CFIR construct | Key concepts within the construct | Representative quote(s) |
|---|---|---|
Innovation domain | ||
 Complexity | • The risk involved in contraception is sometimes overrepresented • It can be overwhelming for pharmacists to learn the contraceptive counseling process • Concern about liability if prescribed for a patient who is not a good fit for a certain method | Yes, there are definite risks to birth control; there are risks to a lot of things that are sitting on the counter [...] It just feels birth control’s been targeted in a way that maybe Tylenol hasn’t, you know. And how many people overdose on Tylenol as a percentage of people taking Tylenol versus like people who end up with a stroke out of the birth control pills? -Provider |
 Adaptability | • The state-required process to become eligible can be cumbersome | Having patients be empowered to screen themselves, understand where they’re at themselves, is overall better for health care in general just because they themselves are more educated on their conditions moving in so that we’re more fit to help them -Pharmacist |
Outer setting domain | ||
 Financing | • Need reimbursement for pharmacists’ counseling time • Uninsured patients cannot afford some options | As far as some barriers to providing contraceptive care [...] The majority of the patients I did prescribe birth control for were without insurance or were between insurances, so that immediately reduced the availability of certain ones for instance, NuvaRing, patches, things like that, they definitely go up in cost -Pharmacist |
 Policies and laws | • Required visits to providers are a barrier • Parental consent laws limit access for clients under 18 • State requirements for pharmacist prescribing take time but are worthwhile | The birth control still works for me, so going to the office [to comply with the law requiring yearly physician follow-up] and paying that copay is a little bit of a barrier. Pretty soon, when I won’t have health insurance anymore, then it’ll be a complete stop. I won’t even be able to go to a provider and get that prescription -Client As far as the how easy it is in law for us to do, it is a little bit tricky. We have to maintain the two hours of continuing education. You have to enroll, but it was super nice that there’s those forms, like the questionnaires that are already built out and readily available for us. I feel like it’s somewhere in the middle between easy and hard to do, but it does take a little bit of effort -Pharmacist |
 Partnerships and connections | • Desire for integrated EHRs for provider/pharmacist communication • Desire to build trust between providers and pharmacists | Yeah. I know in our practice when we collaborate with our physicians [...] the physicians really do like the services that we bring to the table. In fact, they go out of their way to make sure that they’re reaching out to us on different things when they know that they can trust us and that we are there to help them out. I think ultimately that kind of relationship can be developed even within the retail setting and the physician providers, too -Pharmacist |
 Local conditions | • Students have trouble accessing contraception • Lack of sex ed • Lack of transportation • Desire for education about contraceptive options • Desire for client-led decision making • Need for better advertisement of pharmacy as an access point for contraception | Barriers come in many forms. Cost is often one, but even with that barrier being taken care of, at the end of the day, the big thing was if people don’t know about it, they can’t utilize it. I think that’s the first big barrier we need to overcome for pharmacy providing contraception -Client |
 Local attitudes | • Clients appreciate the convenience of pharmacy-prescribing • Some do not view their pharmacies as a place for education • Some clients prefer pharmacists to providers for contraceptive conversations • Pharmacists are limited in providing the full range of methods • Some providers worry lost opportunity to address other women’s health needs | I think that this is a wonderful idea just for people that fit in my demographic. You know, I’ve been on birth control my entire life. I’m friggin’ busy. I don’t have time to remember to go to the doctor. Sometimes I’m showing up to get milk. I’m like, oh crap, I’m out of my blood pressure medicine, too. I think this would be potentially great for just 30 -, and 40-year-old women that are friggin’ busy. And it’s smooth sailing. We’ve been on the same pill for that last decade. I just need a refill -Client Then, I think I’d also be more comfortable talking to a pharmacist because it’s their job to administer different kinds of medication and I feel like if they see so many different things that they probably would not be very judgmental -Client |
Inner setting domain | ||
 Access to knowledge and information | • Pharmacists unaware of ability to prescribe • Primary care providers unaware of which pharmacies offer this service • Pharmacists find the continuing education modules helpful but would like more information • Medical Eligibility Criteria is helpful | We have not implemented this program either at our [pharmacy]. Part of it is just even the information for pharmacies to know that this is out there and available and what training and resources are out there to help them implement this kind of a program. I think that would go a long way to getting more pharmacies up and on board with it -Pharmacist |
 Culture > recipient-centeredness | • Clients feel pharmacists might be more person-centered than providers • Pharmacists and providers want to improve access for clients • Pharmacists are concerned about client privacy | And patients will be waiting for months on end to get in [to see provider] just for a birth control visit. That’s absurd. They should have access birth control much faster than that -Provider I think that our whole purpose is doing what’s in the best interest of our patient and expanding care. I think we can all agree that this [pharmacy prescribing] is a fantastic idea. It’s just getting all the pieces in place so that it’s safe for our patients and that it’s a smooth process when they go in -Provider |
 Structural characteristics | • Need for private counseling space • Some pharmacy cultures/policies do not allow time for counseling sessions • Provision of vaccines in pharmacies created systems that can be used for other services | I don’t usually bring this one up, but I do think that we continually talk about time being a barrier [...]. The way that our model works, we will allow labor to be earned like it would be for a prescription, but—for the time of a visit for something like this, but until you get to a level of services that allows you to then add an extra pharmacist so that there’s two pharmacists on some days where you can schedule appointments during overlap or something. You’ve got to get to a level of services that—high level that allows for that -Pharmacist |
Individual domain | ||
 Innovation recipients (patient need) | • Lack of healthcare access • Complicated patient needs Affordability • Desire for a female pharmacist • Lack of awareness of pharmacy prescribing • Need for walk-in appointments • Desire for privacy • Need for multiple languages • Shame around contraception | I like the idea of the drugstore. First because, when I was younger, I used to be ashamed to visit the doctor; whereas in the drugstore, it’s a lot easier to go, talk and be seen -Client So, for me, an ideal situation would be that the person spoke Spanish and was able to understand me. In general, I have realized that we, Latin people, tend to speak a lot; so, it would be very good if they could give you comprehensive information. You would feel good with that -Client I think [ideal situation] would be without an appointment. It’s the easiest and the most practical. They are there to assist us and to solve our questions in a much faster way than to make an appointment with a gynecologist. We know they are there for us in a much faster way -Client |