Pharmacist-prescribed contraception using clinical protocols: A review of the gray literature
Bibliographic record
Abstract
BACKGROUND: Many women face barriers to starting and continuing contraception due to difficulties in accessing primary care. Pharmacist-prescribed contraceptives have emerged as a strategy to improve access. This approach offers an additional pathway for women to access contraceptive care, with benefits such as lower costs, shorter wait times, and extended hours. OBJECTIVES: This review aims to analyze clinical protocols used by community pharmacists to prescribe and continue hormonal contraceptives and evaluate their quality. STUDY DESIGN: This review utilized gray literature since protocols are often not formally published. The search involved four processes: searching a gray literature database, using Google, reviewing health agency websites, and consulting international experts. Records were included if they met the definition of a clinical protocol, were for community pharmacist prescribing or continuation of hormonal contraception, and were written in English. Grounded Theory was used for analysis. Quality appraisal was performed using the Appraisal of Guidelines for Research and Evaluation II tool. RESULTS: Thirty clinical protocols were identified from the USA (n = 23), Canada (n = 2), the UK (n = 2), New Zealand (n = 1), and Australia (n = 2). Pharmacists were authorized to prescribe and continue contraceptives in 27 protocols and continue contraceptives only in three. Key requirements included age restrictions, measurement of blood pressure and body mass index, review by a health professional, patient self-completed screening tools, and use of best-practice guidelines. The lowest-scoring domains in the quality assessment were "Editorial Independence," "Applicability," and "Rigor of Development." CONCLUSIONS: The review provides insights into the current international landscape of pharmacist-prescribed contraception and highlights key components of clinical protocols. It offers valuable information for policymakers to support the development of frameworks for pharmacist-prescribed contraception globally.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.044 | 0.141 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.025 | 0.032 |
| Science and technology studies | 0.001 | 0.003 |
| Scholarly communication | 0.005 | 0.007 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".