The feasibility of contraceptive injections at the community pharmacy

Abstract

Purpose: The progestogen-only intramuscular injectable Depo-Provera^® (depot medroxyprogesterone acetate) is an effective contraceptive method, but users need to attend a clinic every 12–13 weeks for a repeat injection from a doctor/nurse. This limits convenience of the method and may affect continuation rates. We conducted a pilot study to examine the feasibility and acceptability of users receiving the subcutaneous form of the contraception injection from pharmacists in the community pharmacy setting.

Materials and methods: Existing users of Depo-Provera^®, who wished to switch to the subcutaneous preparation with the same active ingredient (Sayana Press^®) were invited to attend 1 of 11 community pharmacies for up to three repeat injections, given by a pharmacist. Evaluation consisted of (i) self-administered questionnaires of women and (ii) interviews with participating pharmacists, at study exit on their respective experiences.

Results: Global unavailability of the product during the study adversely affected recruitment and retention. 50 women were recruited. Only 48 injections were delivered at the pharmacy out of a possible 150 (34%). About 26 participants received no injections at the pharmacy and only seven (14%) participants received all three injections at the pharmacy. Participants reported mixed experiences, with some welcoming the intervention but others experiencing difficulty with pharmacist availability. Pharmacists were enthusiastic about this expansion of their role, and did not view their availability as a barrier to service delivery.

Conclusions: Delivery of the subcutaneous contraceptive injectable from a community pharmacy may be feasible but availability of sufficient numbers of pharmacists trained in this technique is necessary for a robust model of service delivery.

Chinese abstract

目的：单纯孕激素可肌内注射的醋酸甲羟孕酮注射液（长效醋酸甲孕酮）是一种有效的避孕方法, 但用户需要每12-13周就诊一次, 以便医生/护士重复注射。 这限制了方法的便利性并可能影响持续率。我们进行了一项试验研究, 以探讨社区药房药剂师皮下注射避孕针的可行性和用户的可接受性。材料和方法：对甲孕酮现有用户, 希望更换具有相同的活性成分的皮下制剂(Sayana Press^Ⓡ）被邀请到11个社区药房中的1个, 由药剂师提供三次重复注射。

评价包括：（一）女性自评问卷和（二）就个人经历同参与的药剂师面谈。结果：研究期间产品无法全球提供对招募和保留产生了不利影响。共招募了50名女性。可能的150次注射药房仅提供了48次。大约有26名参与者并没有在药房注射, 而只有7名（14%）参与者接受了3次注射。参与者有着不同的经历, 一些欢迎干预, 而另外一些在药剂师注射可行性方面遇到了困难。药剂师对自身作用的拓展感到非常高兴, 并不认为他们提供服务的可行性是一种障碍。结论：从社区药房皮下注射避孕药可能是可行的, 但是提供足够数量的受过这种技术培训的药剂师是强有力服务模式的必要条件。

Keywords:

• Contraception
• community pharmacy
• contraceptive injection
• subcutaneous injection

Additional information

Funding

Pfizer Ltd.

Pfizer10.13039/100004319WI184313This study was funded by an independent investigator-initiated research grant from Pfizer Ltd., makers of Sayana Press^®.The PhD of the first author was funded by an unrestricted grant from HRA Pharma.