Contraception on Demand
Last updated
Share PrintContraception 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 a 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:
7 successful, 3 in-progress
Awards and Recognition:
Diffusion of Excellence Promising Practice, VHA Shark Tank Winner
Partners:
Clinical Pharmacy Practice Office, Office of Primary Care, Pharmacy Benefits Management Services, Women’s Health
Recent Updates
Overview
The problem
Images
Above:
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
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
- This guide outlines necessary steps for pre-implementation planning, successful implementation, and ongoing program maintenance and provides tools for project setup, pharmacist training and assessment, Veteran outreach, and data collection. Contraception on Demand Implementation Guide
The results
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 contraindicated contraceptives based on patient interview and past medical history. In fact, in nine 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 by meaningfully expanding their scope of practice and increasing their 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
Above:
Results from the Contraception on Demand demonstration project (July 2021 - January 2022) (Image credit: Shannon Mitchell, MSW, MPH)
Above:
Veteran and Pharmacist Feedback on Contraception on Demand
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Timeline
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Pre-Implementation
• Identify local clinical pharmacy specialist(s) interested in providing hormonalcontraception• Identify local pharmacy and primary care/women’s health champions• Secure local pharmacy approval for 12-month dispensing (this step includeshaving site ADPAC change the drug file to allow for 12 months)• Work with informatics to import and activate “Contraception on Demand” CPRSnote templates for initial and follow-up consults• Ensure CPPs complete training in patient-centered contraceptive counseling andhormonal contraceptive prescribing (including competency assessment)• Establish workflow processes (e.g., quarterly pharmacy outreach to patients duefor a refill, scheduling Veterans referred by provider, scheduling Veterans whocall or walk in, process for curbside WH consults) -
Implementation
• Inform pharmacy (including ADPAC, clinical, outpatient dispensing), women’shealth, 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 providerteams• Continue outreach to Veterans due for refills
Departments
- Gynecology
- Marketing
- Pharmacy
- Information technology
- Primary care
- Women Veteran care
Core Resources
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Optional Resources
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Support Resources
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Risks and mitigations
| Risk | Mitigation |
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| 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.
Email ContraceptionOnDemand@va.gov with questions about this innovation.
About
Origin story
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
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
Elizabeth Evans
Medical Support Specialist, 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
It was an honor to be a part of implementing this program and serving our Women Veterans!
Very proud of our VAPHS and Seattle teams for contributing to the access of safe contraception options for our Veterans.
Thank you for this wonderful program!
As a female veteran, of child bearing age, this sounds like a great program!
I am very happy to see this; expanding access to care to our Veterans!
Glad to see this is happening!
so pleased that we are offering this to insure access to all Veterans with minimal barriers. Reproductive health is HEALTH.
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!