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Research Article: Expanding community pharmacists’ scope of practice in relation to contraceptive counselling and referral: a protocol for a pragmatic, stepped-wedge, cluster randomised trial (ALLIANCE)

Date Published: 2023-08-31

Abstract:
Introduction Improving access to effective contraception has the potential to reduce unintended pregnancy and abortion rates. Community pharmacists could play an expanded role in contraceptive counselling and referral to contraceptive prescribers particularly when women are already attending community pharmacy to obtain emergency contraceptive pills (ECPs) or to have medical abortion (MA) medicines dispensed. The ALLIANCE trial aims to compare the subsequent uptake of effective contraception (hormonal or intrauterine) in women seeking ECP or MA medicines, who receive the ALLIANCE community pharmacy-based intervention with those who do not receive the intervention. Methods and analysis ALLIANCE is a stepped-wedge pragmatic cluster randomised trial in Australian community pharmacies. The ALLIANCE intervention involves community pharmacists delivering structured, patient-centred, effectiveness-based contraceptive counselling (and a referral to a contraceptive prescriber where appropriate) to women seeking either ECPs or to have MA medicines dispensed. Women participants will be recruited by participating pharmacists. A total of 37 pharmacies and 1554 participants will be recruited. Pharmacies commence in the control phase and are randomised to transition to the intervention phase at different time points (steps). The primary outcome is the self-reported use of effective contraception at 4?months; secondary outcomes include use of effective contraception and the rate of pregnancies or induced abortions at 12?months. A process and economic evaluation of the trial will also be undertaken. Ethics and dissemination Ethical approval has been obtained from the Monash University Human Research Ethics Committee (#34563). An explanatory statement will be provided and written consent will be obtained from all participants (pharmacy owner, pharmacist and women) before their commencement in the trial. Dissemination will occur through a knowledge exchange workshop, peer-reviewed journal publications, presentations, social media and conferences. Trial registration number ACTRN12622001024730.

Introduction:
Preventing unintended pregnancy is an important public health imperative and a key focus of Australia’s National Women’s Health Strategy 2020–2030. 1 In Australia, 40% of women experience an unintended pregnancy during their lifetime, and one in three of these results in abortion. 2 3 The cost of an unintended pregnancy in Australia was estimated to be $A7.2?billion in 2020, with 56% of total costs borne either directly or indirectly on the woman experiencing the unintended pregnancy. 2 Where contraception has not…

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