Pharmacist prescribed hormonal contraceptives in New York State: Is there a need and an interest?

BACKGROUND: Hormonal contraceptives are a popular option for pregnancy prevention and other indications and require a prescription. Since 2013, 24 states have given pharmacists legal authority to initiate self-administered hormonal contraceptives, allowing for direct pharmacy access (DPA). New York State (NYS) did not allow for DPA of any hormonal contraceptives during the survey period, but passed a bill in 2023 allowing pharmacists to dispense hormonal contraceptives in accordance with a nonpatient-specific order. OBJECTIVES: This study aimed to characterize the experiences, perceptions, and knowledge of access to and DPA to hormonal contraceptives. METHODS: A survey was developed to gather responses to demographic- and opinion-related questions and administered online using the Pollfish survey platform. Participants were women between the ages of 16 and 44 years who lived in NYS. To ensure geographic representation, at least one response was gathered from each of the 27 NYS congressional districts. Chi-square tests were used to assess differences in hormonal contraceptive use by patient demographics. RESULTS: Most of the 500 respondents reported past (76.2%) or current/planned (76.8%) use of hormonal contraceptives. Older age (P = 0.033) and higher income (P = 0.0016) were associated with significantly greater rates of use. The most common challenges when visiting a provider for birth control included needing to schedule an appointment and wait times at the provider. Almost three-quarters of respondents (72.6%) were not aware that pharmacists could initiate contraceptives in other states, and 74.2% reported feeling comfortable with a pharmacist prescribing and dispensing hormonal contraceptives. CONCLUSION: Contraceptive initiation by pharmacists would be acceptable to most respondents, but there is room for increased acceptance based on patient education and experience. DPA to hormonal contraceptives may eliminate some of the barriers identified in this survey.

Racial, Age, and Regional Disparities in Maternal Mortality in the USA, 1999-2020.

BACKGROUND: The health and well-being of mothers are essential for a thriving and prosperous society, yet maternal mortality remains a pressing public health problem in the USA. We aimed to examine the US trends in maternal mortality from 1999 to 2020 based on age, race/ethnicity, and census region. METHODS: Data from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research were used to identify maternal mortality cases. Temporal trends were analyzed using Joinpoint regression. Annual percentage changes, average annual percentage changes, and 95% confidence intervals were calculated. RESULTS: The maternal mortality rate in the USA increased from 1999 to 2013, but has stabilized since then until 2020 (APC = - 0.1; 95% CI: - 7.4, 2.9). However, there have been recent increases among Hispanics at a rate of 2.8% per year (95% CI: 1.6, 4.0) from 1999 to 2020. The rates stabilized among non-Hispanic Whites (APC = - 0.7; 95% CI: - 8.1, 3.2) and non-Hispanic Blacks (APC = - 0.7; 95% CI: - 14.7, 3.0). Maternal mortality rates increased among women aged 15-24 years at a rate of 3.3% per year (95% CI: 2.4, 4.2) since 1999, among women aged 25-44 years at a rate of 22.5% per year (95% CI: 5.4, 34.7), and among women aged 35-44 years at a rate of 4% per year (95% CI: 2.7, 5.3). Regional disparities existed, with rising rates in the West at a rate of 13.0% per year (95% CI: 4.3, 38.4), and stable rates in the Northeast (APC = 0.7; 95% CI: - 3.4, 2.8), Midwest (APC = - 1.8; 95% CI: - 23.4, 4.2), and South (APC = - 1.7; 95% CI: - 7.5, 1.7). CONCLUSIONS: While maternal mortality rates in the USA have stabilized since 2013, our analysis reveals significant disparities by race, age, and region. Therefore, it is essential to prioritize efforts to improve maternal health outcomes across all population subgroups to achieve equitable maternal health outcomes for all women.