Contraception on Demand

Last updated 2024-08-21T17:52:43Z

Contraception on Demand (COD) offers VA facilities the opportunity to expand contraceptive access for Veterans, improve Veteran experiences with reproductive healthcare at VA, and expand VA clinical pharmacists' scope of practice and job satisfaction. The practice is easy to adopt and implement and is achievable at very low cost to the individual facility and an estimated cost savings for the health system at large.

Origin:

May 2020, Pittsburgh VA Medical Center-University Drive, Seattle VA Medical Center

Adoptions:

2 successful, 2 in-progress

Awards and Recognition:

Diffusion of Excellence Promising Practice, VHA Shark Tank Winner

Partners:

Clinical Pharmacy Practice Office, Pharmacy Benefits Management Services, Women’s Health

Overview

The problem

Consistent contraceptive use is the most effective way to prevent unwanted pregnancy; however, gaps in contraceptive coverage due to access issues or prescription refill delays are major barriers to consistent use. VA offers all FDA-approved contraceptive methods but generally limits dispensing for prescriptions to a 3-month supply and requires Veterans to r ... Consistent contraceptive use is the most effective way to prevent unwanted pregnancy; however, gaps in contraceptive coverage due to access issues or prescription refill delays are major barriers to consistent use. VA offers all FDA-approved contraceptive methods but generally limits dispensing for prescriptions to a 3-month supply and requires Veterans to request contraception through their primary care provider (PCP), which can be a barrier to access due to limited appointment availability, insufficient time during appointments, and limited knowledge among some PCPs about contraceptive methods. Ensuring contraceptive access for all Veterans has become even more important given that safe and legal abortion to end unwanted pregnancy has become less accessible in many states where women Veterans reside. Improving contraceptive access and reducing refill gaps or delays is critical to support Veterans’ reproductive health and autonomy. See more

Images

Number of reproductive-age women Veterans by VA health care system (Image credit: Siobhan Mahorter, MPH)

Files

Published research by members of our team describing the potential impact of 12-month contraceptive prescribing in VA Judge-Golden et al 2019_Financial Implications of 12-month dispensing of oral contraceptive pills in the Veterans Affairs Health Care System

The solution

Primary care clinical pharmacy practitioners (CPPs) were trained to conduct patient-centered contraceptive counseling and prescribe hormonal contraception using a shared-decision model; local approval to order and dispense 12-month supplies was secured. Veterans accessed the program via multiple pathways (e.g., direct calls, provider referral, pharmacy outre ... Primary care clinical pharmacy practitioners (CPPs) were trained to conduct patient-centered contraceptive counseling and prescribe hormonal contraception using a shared-decision model; local approval to order and dispense 12-month supplies was secured. Veterans accessed the program via multiple pathways (e.g., direct calls, provider referral, pharmacy outreach). COD consults were scheduled and CPPs provided contraceptive counseling via telephone. They prescribed all short-acting methods and provided counseling and referrals for long-acting reversible contraceptive (LARC) methods (IUDS and implants). Expanding pharmacist-led prescribing and 12-month dispensing increases access to essential reproductive health services, meaningfully expands CPPs’ role in reproductive healthcare, and supports Veterans’ reproductive autonomy. See more

Files

One-page summary of the Contraception on Demand demonstration project Contraception on Demand One Page Summary

Published conference abstract describing preliminary results from the Contraception on Demand demonstration project Quinn et al 2022_Contraception on Demand in VA

The results

COD CPPs completed 74 consults during the study timeframe. Of those, 57 Veterans received prescriptions for hormonal contraception (17 new prescriptions, 40 refills of existing prescriptions) and 6 Veterans were referred for LARC placement. The remaining Veterans who didn’t receive a prescription were referred to primary care for either (1) safety concerns r ... COD CPPs completed 74 consults during the study timeframe. Of those, 57 Veterans received prescriptions for hormonal contraception (17 new prescriptions, 40 refills of existing prescriptions) and 6 Veterans were referred for LARC placement. The remaining Veterans who didn’t receive a prescription were referred to primary care for either (1) safety concerns related to the Veterans’ current or preferred contraceptive method or (2) menopause evaluation (to determine the appropriateness of ongoing hormonal contraceptive use).

Among the 40 Veterans receiving refills and therefore eligible for 12-month dispensing, 90% opted to receive a 12-month supply; of those 47% had a prescription copay, demonstrating that copay status did not appear to be a major deterrent to electing 12-month dispensing.

We also assessed the safety of pharmacists prescribing by collecting data on Veterans’ possible and/or absolute contraindications to contraceptive methods. There were zero instances of pharmacists prescribing contraceptives that were contraindicated based on patient interview and past medical history. In fact, in 9 cases, project CPPs identified absolute contraindications to the Veterans’ current contraceptive method and offered counseling on contraceptive options that were safer based on the Veteran’s personal health profile. One Veteran shared “[the pharmacist] asked me very in-depth questions that I usually don’t get asked for birth control … this was much better [than previous experiences getting contraception at VA] because I usually have to squeeze in my birth control request, and we don’t talk about it all that much”.
Evaluation data from our 6-month study period suggest that pharmacist provision meaningfully expands contraceptive access for Veterans: participants shared “I was offered options that I hadn’t known about before” and “being able to get your birth control … without going through all the hoopla is like having a pocket pharmacist for your womanly needs”. In addition to benefitting Veterans, Contraception on Demand also benefitted VA clinical pharmacists, meaningfully expanding their scope of practice and increasing job satisfaction. COD CPPs shared: “this was a really good learning opportunity for us to become better, more well-rounded pharmacists” and “advocating for women and advocating for pharmacy, that we can do more than most people think we do, is a great reason to continue offering this service”. See more

Images

Results from the Contraception on Demand demonstration project (July 2021 - January 2022) (Image credit: Shannon Mitchell, MSW, MPH)

Veteran and Pharmacist Feedback on Contraception on Demand

Diffusion tracker

Does not include Clinical Resource Hubs (CRH)

PA: Pittsburgh VA Medical Center-University Drive (Pittsburgh) WA: Seattle VA Medical Center (Seattle)

PA: Lebanon VA Medical Center (Lebanon) VISN 20 Clinical Resource Hub (Remote)

There are no unsuccessful adoptions for this innovation.

Implementation

Timeline

Pre-Implementation

• Identify local clinical pharmacy specialist(s) interested in providing hormonal

contraception.

• Identify local pharmacy and primary care/women’s health champions.

• Secure local pharmacy approval for 12-month dispensing (this step includes

having site ADPAC change the drug file to allow for 12 months)

• Work with informatics to import and activate “Contraception on Demand” CPRS

note templates for initial and follow-up consults.

• Ensure CPPs complete training in patient-centered contraceptive counseling and

hormonal contraceptive prescribing (including competency assessment)

• Establish workflow processes (e.g., quarterly pharmacy outreach to patients due

for a refill, scheduling Veterans referred by provider, scheduling Veterans who

call or walk in, process for curbside WH consults)
Implementation

• Inform pharmacy (including ADPAC, clinical, outpatient dispensing), women’s

health, and primary care providers and stakeholders when program is active.

• Market the program to Veterans and providers
Sustainment

• Schedule regular presentations to primary care and women’s health provider

teams

• Continue outreach to Veterans due for refills

Departments

Gynecology
Marketing
Pharmacy
Information technology
Primary care
Women Veteran care

Core Resources

Resource type	Resource description
PEOPLE	One local physician champion One clinical pharmacy specialist (0.2 FTE) One clinical informatics staff member (most of this person's work will occur in the pre-implementation stage) One project coordinator (e.g., physician, CPP, pharmacy technician, medical support assistant, health or research trainee, or other interested staff member; 0.2 FTE)
PROCESSES	Training for CPPs on patient-centered contraceptive counseling and hormonal contraceptive prescribing
TOOLS	Support/buy-in from local pharmacy leadership is critical to ensure protected time for pharmacist training and facilitate local pharmacy inventory updates.

Optional Resources

Resource type	Resource description
PEOPLE	One or more pharmacy technicians or medical support assistants to support scheduling Veterans eligible for refills Public Affairs assistance to develop local marketing strategies and produce facility- or healthcare system-specific marketing materials

Support Resources

Resource type	Resource description
PEOPLE	Team member consultation
PROCESSES	Workflow consultation Ongoing data collection and evaluation
TOOLS	Pharmacist training materials Implementation guide (includes: standard operating procedure, CPRS note templates, sample marketing strategy and marketing materials, pharmacist competency quiz)

Risks and mitigations

Risk	Mitigation
Pharmacist comfort & skill with contraceptive prescribing	With appropriate training on (a) the pharmacology and mechanisms of action of each contraceptive method on the VA formulary and (b) how to conduct patient-centered contraceptive counseling, there is minimal risk associated with this practice. Pharmacist provision of hormonal contraception is SAFE (see results section above).
Veterans with complex medical history	Designating a local women's health provider (e.g., physician or mid-level provider) who can be available to consult with pharmacists (e.g., via MSTeams messaging or in-person precepting) provides pharmacists with a clear plan of action when a Veteran's medical or medication history is particularly complex. Referring the Veteran to women's health for follow-up is another option if real-time curbside assistance isn't available.

Risk

Mitigation

Pharmacist comfort & skill with contraceptive prescribing

With appropriate training on (a) the pharmacology and mechanisms of action of each contraceptive method on the VA formulary and (b) how to conduct patient-centered contraceptive counseling, there is minimal risk associated with this practice. Pharmacist provision of hormonal contraception is SAFE (see results section above).

Veterans with complex medical history

Designating a local women's health provider (e.g., physician or mid-level provider) who can be available to consult with pharmacists (e.g., via MSTeams messaging or in-person precepting) provides pharmacists with a clear plan of action when a Veteran's medical or medication history is particularly complex. Referring the Veteran to women's health for follow-up is another option if real-time curbside assistance isn't available.

Contact

Comment

Comments and replies are disabled for retired innovations and non-VA users.

VA User (Pharmacist) Innovation owner posted 2022-10-26T19:10:09Z

It was an honor to be a part of implementing this program and serving our Women Veterans!

VA User (REGISTERED NURSE) posted 2022-10-17T16:01:26Z

Very proud of our VAPHS and Seattle teams for contributing to the access of safe contraception options for our Veterans.

VA User (Psychologist) posted 2022-10-06T09:02:01Z

Thank you for this wonderful program!

VA User (REGISTERED NURSE) edited 2022-10-05T16:56:14Z

As a female veteran, of child bearing age, this sounds like a great program!

VA User (Nurse Residency Coordinator) posted 2022-10-05T15:25:12Z

I am very happy to see this; expanding access to care to our Veterans!

VA User (Physician) posted 2022-09-15T23:59:02Z

Glad to see this is happening!

VA User (Psychologist) posted 2022-09-15T15:48:29Z

so pleased that we are offering this to insure access to all Veterans with minimal barriers. Reproductive health is HEALTH.

VA User (Physician) Innovation adopter posted 2022-09-13T15:52:16Z

I am a primary care provider at the VA Puget Sound Seattle Division, and this innovation has been incredibly helpful for our veterans, giving them timely, seamless access to contraception while at the same time reducing workload for PCPs by leveraging the skills and expertise of the interprofessional team!

Email

Email ContraceptionOnDemand@va.gov with questions about this innovation.

About

Origin story

In July 2019, research by members of our team on the financial and reproductive health implications for the VA of implementing a 12-month dispensing option for hormonal contraception (namely, cost savings for VA and a reduction in unintended pregnancy among women Veterans) garnered a lot of media attention. The VAPHS clinical pharmacy supervisor (Amy Plumley ... In July 2019, research by members of our team on the financial and reproductive health implications for the VA of implementing a 12-month dispensing option for hormonal contraception (namely, cost savings for VA and a reduction in unintended pregnancy among women Veterans) garnered a lot of media attention. The VAPHS clinical pharmacy supervisor (Amy Plumley, PharmD) reached out to a member of the research team (Sonya Borrero, MD, MS) to say "I think we have the local flexibility to do this in Pittsburgh, how can we try it out?" Dr. Borrero and Dr. Deirdre Quinn assembled a team with representatives from pharmacy, research, and women's health and began planning a demonstration project with colleagues at VA Puget Sound ... and the rest is history!

Original team

Sonya Borrero

Co-Director, Advanced Fellowship in Women's Health, VA Pittsburgh

Deirdre Quinn

Core Investigator, Center for Health Equity Research and Promotion, VA Pittsburgh

Brandon Herk

Clinical Pharmacy Practitioner, VA Pittsburgh

Beth Desanzo

Clinical Pharmacy Practitioner, VA Pittsburgh

Meghan McLinden

Clinical Pharmacy Practitioner, VA Pittsburgh

Amy Plumley

Clinical Pharmacy PACT Supervisor, VA Pittsburgh

Sarah Merriam

Attending Physician, Primary Care, VA Pittsburgh

Sheila Tunney

Public Affairs Officer, VA Pittsburgh

Lora McBrearty

Informatics, VA Pittsburgh

Mark Thompson

Informatics Nurse, VA Pittsburgh

Maria Mor

Director, CHERP Biostatistics and Informatics Core, VA Pittsburgh

Lucy Speerhas

Chief of Pharmacy, VA Pittsburgh

Deborah Dinardo

Women's Health Medical Director, VA Pittsburgh

Nicole McCune

Women Veterans Program Manager, VA Pittsburgh

Lisa Callegari

Attending Physician, OB/GYN, VA Puget Sound

Jaime Heissler

Pharmacy Clinical Supervisor, VA Puget Sound

Carolyn Gardella

Attending Physician, Chief of Gynecology, VA Puget Sound

Emily Ashbaugh

Women's Health Medical Director, VA Puget Sound

Hollye Bondurant

Clinical Pharmacy Practitioner, VA Puget Sound

Jennifer Chin

Research Associate, VA Puget Sound

Siobhan Mahorter

Research Health Science Specialist, VA Puget Sound

Diane Nguyen

Informatics Nurse, VA Puget Sound

Tammy Begasse

Public Affairs Officer, VA Puget Sound

Elizabeth Evans

Medical Support Specialist, VA Puget Sound

Ali Icenogle

Clinical Pharmacy Resident, VA Puget Sound

Jennifer Mecca

Clinical Pharmacy Specialist, VA Puget Sound

Maria Montecupo

Pharmacy Technician, VA Pittsburgh

Laura Johnson

Pharmacy Technician, VA Pittsburgh

Laura Danovich

Pharmacy Technician, VA Pittsburgh

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Contraception on Demand

Origin:

Adoptions:

Awards and Recognition:

Partners:

Tags:

Overview

The problem

Images

Files

The solution

Files

The results

Images

Diffusion tracker

Successful adoptions (2)

In-progress adoptions (2)

Unsuccessful adoptions (0)

Implementation

Timeline

Pre-Implementation

Implementation

Sustainment

Departments

Core Resources

PEOPLE

PROCESSES

TOOLS

Optional Resources

PEOPLE

Support Resources

PEOPLE

PROCESSES

TOOLS

Risks and mitigations

Contact

Comment

Email

About

Origin story

Original team

Search tags