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Open Access Publications from the University of California

Scholarly Works (7 results)

  • Multimedia
Symposium 2025 (2025)

Background:

Mifepristone is used for both medication abortion and medical management of early pregnancy loss (EPL). In 2023 the FDA REMS for mifepristone was modified, allowing pharmacies to become certified to dispense mifepristone. This modification facilitated medication abortions via additional providers, and telehealth, which studies have shown is equally safe and effective compared to in-person medication abortion care. Despite the evidence supporting medication abortion without an in-person clinic visit and the ability of pharmacies to dispense these medications, this is not yet a routine part of abortion care. It is unknown how many pharmacies are certified to order, stock, and dispense mifepristone.

 

Description:

This project aims to understand the number of San Diego pharmacies that are able to dispense mifepristone. In addition, among pharmacies not dispensing, we assessed interest in being able to dispense mifepristone.

Study team members called all retail pharmacies in San Diego. The team member asked standardized questions to understand if the contacted pharmacy could dispense mifepristone. Further, for independent retail pharmacies that are not certified, the study team member asked if they were interested in becoming certified to dispense mifepristone. Once we found pharmacies currently dispensing mifepristone, we requested approval to add them to the Medication Abortion Pharmacies website directory (https://medicationabortionpharmacies.com), where clinicians and patients can identify participating pharmacies. We also identified independent retail pharmacies that are not currently certified and encouraged the use of a grant through the Pharmacists CARE initiative (https://birthcontrolpharmacist.com/advocacy-initiatives/care/) to increase the number of pharmacies dispensing mifepristone in San Diego.

Lessons learned or expected outcomes:

Of the 176 licensed pharmacies in San Diego County, 22 (12.5%) pharmacies were excluded from the sample size given they were found to be closed-door or specialty pharmacies that would not be expected to dispense mifepristone. Of the 154 eligible retail pharmacies, we were able to reach a staff member at 149 (96.8%) pharmacies and found that 33 (22.1%) are certified, 1 (0.7%) was in the process of becoming certified, and 115 (77.2%) are not certified and thus unable to dispense the medication. Of the 115 pharmacies not certified, 35 qualified as independent retail pharmacies. Of these 35 pharmacies, 16 (45.7%) were interested in becoming certified.

 

Recommendations/next steps:

Independent pharmacies interested in becoming mifepristone providers will be contacted again in 3-6 months to determine if they are certified to dispense mifepristone and will be added to the Medication Abortion Pharmacies website. Ultimately, the goal is to decrease barriers for clinicians prescribing mifepristone, improve patient access to medication abortion, and increase flexibility for patients undergoing a medication abortion or medical management of EPL.

  • 1 supplemental PDF
  • Article
  • Peer Reviewed
UC San Diego Previously Published Works (2022)
Integrating a pharmacist into a hemodialysis unit significantly reduced medication discrepancies and medication-related problems over time.Medication reconciliation for the Centers for Medicare and Medicaid Services End-Stage Renal Disease Quality Incentive Program can be optimally performed by a dialysis pharmacist.
    Cover page: Impact of Medication Reconciliation by a Dialysis Pharmacist
    • Article
    • Peer Reviewed
    UC Davis Previously Published Works (2020)

    Objective

    To describe the implementation and results of a proactive patient outreach project to offer self-administered, depot medroxyprogesterone (DMPA) subcutaneous (SC) to interested patients at a California safety-net clinic following expanded state Medicaid coverage.

    Study design

    We contacted non-pregnant patients at an urban, safety-net hospital-based primary care clinic who had been prescribed DMPA intramuscular (IM) in the past year to gauge interest in self-administered DMPA-SC. Interested patients received a prescription for DMPA-SC and a telehealth appointment with a clinic provider to learn self-injection. We recorded patient interest in DMPA-SC, completed appointments, and completed first injections. We conducted initial outreach in May, 2020 and recorded appointment attendance and completed injections through August, 2020.

    Results

    Of 90 eligible patients (age 17-54), we successfully contacted and discussed DMPA-SC with 70 (78%). Twenty-six (37%) patients expressed interest in DMPA-SC and scheduled telehealth appointments to learn to self-administer the medication. Fifteen (58%) of those interested (21% of the total) successfully self-injected DMPA-SC. Of the 44 (63%) patients not interested in DMPA-SC, the three most common reasons were fear of self-injection (n = 23 [52%]), wanting to stop DMPA (n = 11 [25%]), and satisfaction with DMPA-IM (n = 6 [14%]).

    Conclusion

    There is interest in and successful initiation of self-administered DMPA-SC among patients at an urban safety net hospital-based primary care clinic who have used DMPA-IM in the last year.

    Implications

    Our data provide evidence for the interest and successful first injection rate after offering self-administered DMPA-SC to patients on DMPA-IM. Expanding coverage of self-administered DMPA-SC could increase patient-centeredness and accessibility of contraception as well as reduce patient anxiety around COVID-19 transmission without losing contraceptive access.
      Cover page: An implementation project to expand access to self-administered depot medroxyprogesterone acetate (DMPA)
      • Article
      • Peer Reviewed
      UCLA Previously Published Works (2020)
      Prescription hormonal contraceptive methods are vital to prevention of unplanned pregnancies. New legislation among 23 states has expanded access to contraception. In California, a 2017 law requires pharmacists to dispense year-long supplies of contraception and insurance plans to cover it upon patients' request. This study assesses pharmacist knowledge of this new law 6 months after enactment. From July to November 2017, a random selection of 600 community pharmacies were called requesting a pharmacist (n = 532, 88.7% response). Pharmacists were asked if they had heard of the new law, if they would dispense a year-long supply to cash-pay, privately or publicly insured patients, and what they perceived as obstacles to dispensing year-long supplies. Awareness of this law was assessed through these surveys. Most pharmacists responded they would dispense year-long supplies to cash-pay patients, regardless of knowledge of the new law (81% of "knew", 70% of "did not know", p = 0.1046). The top two perceived obstacles were insurance reimbursement (55.8%) and store policy (13.4%). Despite a new law requiring insurance coverage of a year-long supply of prescription birth control, most pharmacists were unaware at six months after the policy went into effect. Of those who were aware, the majority did not clearly understand it. Compliance among insurance plans is unknown. There was no implementation plan or awareness campaign for the new law.
        • Article
        • Peer Reviewed
        UC Berkeley Previously Published Works (2022)

        Objectives

        In the United States, numerous states have enabled pharmacists to prescribe hormonal contraception. Little research focuses on the perspectives of potential users of this service in rural communities. This study sought to describe awareness of, interest in, acceptability of, and support for pharmacist-prescribed contraception in a rural California county.

        Study design

        We conducted a community-based survey in 2019-20 in Tulare County, California. Researchers partnered with community members to design, implement, and analyze the survey. We recruited respondents who were ages 15 to 44 and assigned female sex at birth, using passive community-based approaches, social media advertisements, and social networks. Analyses focused on 177 respondents with a potential future need for contraception.

        Results

        Thirty-one percent of respondents were aware that pharmacists could prescribe hormonal contraception in California, with more accurate knowledge among older respondents (p = 0.015). After receiving brief educational information about pharmacist-prescribed contraception, respondents expressed high levels of support and acceptability: they perceived pharmacist-prescribed contraception to be safe, time saving, and more convenient. Respondents were more comfortable talking about contraception with traditional contraceptive care providers compared to asking pharmacists questions about contraception. Fifty-seven percent were somewhat or very interested in obtaining contraception from a pharmacist, with higher levels of interest among those who preferred to use a different method.

        Conclusion

        Awareness of pharmacist-prescribed contraception in a rural California community was low, though people are supportive of and interested in utilizing this service. This research suggests that increased availability of pharmacist-prescribed contraception could support individuals' reproductive self-determination and address gaps in access.

        Implications

        Despite limited awareness of pharmacist-prescribed contraception, interest in using and community support for this service was high in a rural California community. This analysis suggests that increased availability of pharmacist-prescribed contraception could support reproductive self-determination and address access barriers, particularly for people whose contraceptive needs are not currently being met.
          Creative Commons 'BY-NC-ND' version 4.0 license
          • Article
          • Peer Reviewed
          UC Davis Previously Published Works (2021)

          Objective

          To estimate effectiveness and acceptability of medication abortion with mifepristone dispensed by pharmacists.

          Methods

          We conducted a prospective cohort study at eight clinical sites and pharmacies in California and Washington State from July 2018 to March 2020. Pharmacists at participating pharmacies underwent a 1-hour training on medication abortion. We approached patients who had already been evaluated, counseled, and consented for medication abortion per standard of care. Patients interested in study participation gave consent, and the clinician electronically sent a prescription to the pharmacy for mifepristone 200 mg orally, followed 24-48 hours later by misoprostol 800 micrograms buccally. Participants were sent web-based surveys about their experience and outcomes on days 2 and 14 after enrollment and had routine follow-up with study sites. We extracted demographic and clinical data, including abortion outcome and adverse events, from medical records. We performed multivariable logistic regression to assess the association of pharmacy experience and other covariates with satisfaction.

          Results

          We enrolled 266 participants and obtained clinical outcome information for 262 (98.5%), of whom two reported not taking either medication. Of the 260 participants with abortion outcome information, 252 (96.9%) and 237 (91.2%) completed day 2 and 14 surveys, respectively. Complete medication abortion (primary outcome) occurred for 243 participants (93.5%, 95% CI 89.7-96.1%). Four participants (1.5%, 95% CI 0.4-3.9%) had an adverse event, none of which was serious or related to pharmacist dispensing. In the day 2 survey, 91.3% (95% CI 87.1-94.4%) of participants reported satisfaction with the pharmacy experience. In the day 14 survey, 84.4% (95% CI 79.1-88.8%) reported satisfaction with the medication abortion experience. Those reporting being very satisfied with the pharmacy experience had higher odds of reporting overall satisfaction with medication abortion (adjusted odds ratio 2.96, 95% CI 1.38-6.32).

          Conclusion

          Pharmacist dispensing of mifepristone for medication abortion is effective and acceptable to patients, with a low prevalence of adverse events.

          Clinical trial registration

          ClinicalTrials.gov, NCT03320057.
            Cover page: Medication Abortion With Pharmacist Dispensing of MifepristoneCreative Commons 'BY-NC-ND' version 4.0 license
            • Article
            • Peer Reviewed
            UC Davis Previously Published Works (2021)

            Background

            The U.S. Food and Drug Administration (FDA) restricts dispensing of mifepristone for medication abortion to certified health care providers at clinical facilities, thus prohibiting pharmacist dispensing. Allowing mifepristone dispensing by pharmacists could improve access to medication abortion.

            Objective

            To assess the feasibility of pharmacists dispensing mifepristone to patients who have undergone evaluation for eligibility and counseling for medication abortion by a clinician.

            Methods

            Before providing a study training on medication abortion, we administered baseline surveys to pharmacists who participated in a multisite mifepristone-dispensing intervention. The survey assessed medication abortion knowledge-using a 15-item score-and perceptions about the benefits and challenges of the model. We administered follow-up surveys in the study's final month that also assessed the pharmacists' satisfaction and experiences with mifepristone dispensing. To investigate the association of the study intervention with the pharmacists' knowledge, perceptions, and experiences dispensing mifepristone, we conducted multivariable linear regression analyses using generalized estimating equation models, accounting for clustering by individual.

            Results

            Among the 72 pharmacists invited from 6 pharmacies, 47 (65%) completed the baseline surveys, and 56 (78%) received training. At the study's end (mean 18 months later), 43 of the 56 pharmacists who received training (77%) completed the follow-up surveys. At follow-up, 36 (83%) respondents were very or somewhat satisfied with mifepristone dispensing, and 24 (56%) reported experiencing no challenges dispensing mifepristone. Four (6%) of the 72 pharmacists invited objected to participating in mifepristone dispensing. In regression analyses, average knowledge scores, perceived ease of implementation, and level of support for the pharmacist-dispensing model were higher at follow-up (P < 0.001).

            Conclusion

            Most pharmacists were willing to be trained, dispensed mifepristone with few challenges when given the opportunity, were satisfied with the model, and had higher knowledge levels at follow-up. Our findings support removal of FDA's restriction on pharmacist dispensing of mifepristone.
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