Pharmacist direct dispensing of mifepristone for medication abortion in Canada: a survey of community pharmacists

Enav Z Zusman; Sarah Munro; Wendy V Norman; Judith A Soon

doi:10.1136/bmjopen-2022-063370

Pharmacist direct dispensing of mifepristone for medication abortion in Canada: a survey of community pharmacists

BMJ Open. 2022 Oct 7;12(10):e063370. doi: 10.1136/bmjopen-2022-063370.

Authors

Enav Z Zusman^{1

2}, Sarah Munro^{2

3

4}, Wendy V Norman^{5

6}, Judith A Soon^{1

4}

Affiliations

¹ Collaboration for Outcomes Research and Evaluation, The University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada.
² Department of Obstetrics and Gynaecology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada.
³ Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care, Vancouver, British Columbia, Canada.
⁴ Department of Family Practice, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
⁵ Department of Family Practice, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada wendy.norman@ubc.ca.
⁶ Public Health, Environments and Society, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK.

Abstract

Introduction: Pharmacists were acknowledged as the most appropriate healthcare professional to dispense mifepristone for medication abortion shortly after the prescription therapy became available in January 2017 in Canada.

Objective: We aimed to identify the facilitators and barriers for successful initiation and ongoing dispensing of mifepristone among community pharmacists across Canada.

Study design: We surveyed community pharmacists from urban/rural practice settings across Canada by recruiting from January 2017 to January 2019 through pharmacist organisations, professional networks, at mifepristone training courses and at professional conferences. The Diffusion of Innovations theory informed the study design, thematic analysis and interpretation of findings. We summarised categorical data using counts and proportions, χ² tests, Wilcoxon rank-sum and proportional odds logistic regression.

Results: Of the 433 responses from dispensing community pharmacists across 10/13 Canadian provinces and territories, 93.1% indicated they were willing and ready to dispense mifepristone. Key facilitators were access to a private consultation setting (91.4%), the motivation to increase accessibility for patients (87.5%) and to reduce pressure on the healthcare system (75.3%). The cost of the mifepristone/misoprostol product was an initial barrier, subsequently resolved by universal government subsidy. A few pharmacists mentioned liability, lack of prescribers or inadequate stock as barriers.

Conclusions: Pharmacist respondents from across Canada reported being able and willing to dispense mifepristone and rarely mentioned barriers to stocking/dispensing the medication in the community pharmacy setting. The removal of initial regulatory obstacles to directly dispense mifepristone to patients facilitated the provision of medication abortion in the primary care setting.

Keywords: Medical abortion; PRIMARY CARE; PUBLIC HEALTH; Pharmacy practice; REPRODUCTIVE MEDICINE; SEXUAL MEDICINE.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Abortion, Induced*
Canada
Female
Humans
Mifepristone / therapeutic use
Misoprostol* / therapeutic use
Pharmacists
Pregnancy
Surveys and Questionnaires

Substances

Misoprostol
Mifepristone