THE IMPACT OF A DIRECT PHARMACY ACCESS POLICY ON WOMEN’S ACCESS TO HORMONAL CONTRACEPTIVES IN INDIANA
Background/Objective: Several states have implemented Direct Pharmacy Access (DPA) policies, allowing pharmacists to prescribe hormonal contraceptives. Previous work has examined pharmacist and patient perceptions of this service, but none have comprehensively evaluated the impact on access to care. Therefore, the objective of this study was to assess the impact of DPA policies on women’s access to hormonal contraceptives by comparing access between three groups: 1) women in Indiana (i.e., a state without DPA), 2) women in a state with DPA, but not using DPA, and 3) women in a state with DPA, using DPA.
Methods: A perceived access scale was created based on Levesque et al.’s model of access to care, which includes five dimensions: 1) approachability, 2) acceptability, 3) availability and accommodation, 4) affordability, and 5) appropriateness. After pilot-testing the scale, items were reduced using exploratory and confirmatory factor analysis. The final scale included 31 items using a five-point Likert response format and was included in a survey containing sociodemographic measures. The pilot and final surveys were distributed via Amazon’s MechanicalTurk. Eligibility criteria for the final survey included being a woman, aged 18 to 44 years, having lived in Indiana or a state that has a DPA policy and having been interested in using hormonal contraceptives within the past year. Linear regression (alpha=0.05) was used to determine the relationship between dimensional access, group, education, income and age.
Results: Factor analysis revealed six factors, five of which mapped to the dimensions from Levesque’s model. The sixth factor measured privacy. When controlling for education, income, and age, women not using DPA, whether in Indiana or a state with a DPA policy, reported significantly higher levels of approachability (p<0.001, p<0.001 respectively), acceptability (p<0.001, p<0.001 respectively), availability and accommodation (p<0.001, p=0.009 respectively), affordability (p<0.001, p<0.001 respectively), and appropriateness (p<0.001, p<0.001 respectively) access than women who used direct pharmacy access. Women using DPA reported significantly lower levels of privacy access than those not using DPA in a state with a DPA policy (p=0.004) when controlling for education, income and age. However, 78.9% of women who used DPA agreed DPA made obtaining hormonal contraceptives easier. The majority who had never used DPA were previously unaware of DPA (81.1% in DPA states, 86.2% in Indiana) but felt it would improve access (82.8%, 80.0% respectively).Discussion/Conclusion: Understanding the effects of DPA policies on women’s access can inform future policies and support implementation of DPA. Women using DPA reported the lowest levels of access; poorer access may have motivated these women to seek alternatives to access contraceptives, and therefore be drawn to DPA. Currently, few states require insurance to pay for pharmacists’ assessment and/or the medication, such as would be paid for if a patient received hormonal contraceptives from a physician, which leaves patients to shoulder the cost. The persistence of lower levels of access across all six dimensions among those using DPA may be influenced by imperfect policy implementation and failure to legislatively enable the sustainability of this service rather than pharmacists’ ability to improve women’s access to hormonal contraceptives.