Community pharmacists could inject subcutaneous contraceptives, according to a pilot study from the University of Edinburgh, published in the European Journal of Contraception & Reproductive Health Care. However, the study identified several barriers including anxiety on the part of the pharmacists.
The authors invited 50 users of intramuscular medroxyprogesterone acetate, who wanted to switch to a subcutaneous depot given every 13 weeks, to attend one of 11 community pharmacies for up to three repeat injections. Pharmacists delivered only 34 per cent of the possible 150 injections.
Twenty-six participants received no injections at the pharmacies and only seven received all three. Fifty-four per cent of participants chose not to continue after one or two injections. Subcutaneous medroxyprogesterone acetate was unavailable for five months during the study and 17 patients withdrew during this time, while three women elected to self-inject following a licence change.
Some participants said that the service was excellent and should be routinely available. Eleven participants had only positive comments but seven women using larger, chain pharmacies commented that when they phoned to make an appointment, staff did not know about the service and were unsure what advice to offer.
This was a particular problem at the beginning of the project, but persisted. Some participants also experienced problems attending when a trained pharmacist was available, especially in the larger pharmacy groups.
Three women expressed concerns about the pharmacist’s ability to inject, commenting that they seemed anxious and unfamiliar with the injection. Many pharmacists admitted this, saying that their anxiety arose because administration involved “breaking the skin” and “they were giving contraception … the stakes were very high”. The research team had not anticipated this.
Nevertheless, pharmacists felt providing contraceptive services improved access and would reduce pressure on GPs. About half were “wholly pleased” to develop the service. “Delivery of subcutaneous contraceptive injectables from a community pharmacy may be feasible,” the authors conclude, “but availability of sufficient numbers of pharmacists trained in this technique is necessary for a robust model of service delivery.”