Feasibility of a contraceptive-specific electronic health record system to promote the adoption of pharmacist-prescribed contraceptive services in community pharmacies in the United States

Objective: Pharmacists in over half of the United States can prescribe contraceptives; however, low pharmacist adoption has impeded the full realization of potential public health benefits. Many barriers to adoption may be addressed by leveraging an electronic health records (EHR) system with clinical decision support tools and workflow automation. We conducted a feasibility study to determine if utilizing a contraceptive-specific EHR could improve potential barriers to the implementation of pharmacist-prescribed contraceptive services. Materials and Methods: 20 pharmacists each performed two standardized patient encounter simulations: one on the EHR and one on the current standard of care paper-based workflow. A crossover study design was utilized, with each pharmacist performing encounters on both standardized patients with the modality order randomized. Encounters were timed, contraceptive outputs were recorded, and the pharmacists completed externally validated workload and usability surveys after each encounter, and a Perception, Attitude, and Satisfaction (PAS) survey created by the research team after the final encounter. Results: Pharmacists were more likely to identify contraceptive ineligibility using the EHR-based workflow compared to the paper workflow (p=0.003). Contraceptive encounter time was not significantly different between the two modalities (p=0.280). Pharmacists reported lower mental demand (p=0.003) and greater perceived usefulness (p= 0.029) with the EHR-based workflow compared to the paper modality. Discussion and Conclusion: Pharmacist performance and acceptance of contraceptive services delivery were improved with the EHR workflow. Pharmacist-specific contraceptive EHR workflows show potential to improve pharmacist adoption and provision of appropriate contraceptive care.

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Methods
Twenty US-based pharmacists with active pharmacy licenses and patient care experience were recruited through social media. Each pharmacist completed two standardized contraceptive patient encounters in sequence (referred to here as Patient 1 and Patient 2). To minimize selection bias, an impartial third-party moderator used randomizer software (https://app.studyrandomizer.com) to assign each pharmacist a number between 1-20 and the two study arms were created by dividing the participants into odd and even groups according to the randomized number. . Participants in the odd-numbered group began with the paper-based workflow, while those in even-numbered group began with the EHR workflow.

Encounters were timed and contraceptive outputs were recorded by the moderator in an excel spreadsheet using the pharmacist's randomized number and indicating the encounter as Patient 1 or Patient 2. The contraceptive outputs were verified on the paper and electronic medical record documents by the study team. The pharmacists completed externally validated workload and usability surveys after each encounter on paper forms which were photographed and then mailed to the study team using pre-paid packaging. The forms contained the pharmacist's randomized number and the corresponding encounter, Patient 1 vs Patient 2. The study team transcribed the results into the excel spreadsheet.

The study team created a Perception, Attitude, and Satisfaction (PAS) survey which was administered to each study participant after the final encounter. The survey was administered electronically by the third party moderator and the results were visible to the study team and transcribed into an excel spreadsheet using the pharmacist's randomized number.

The results from the excel spreadsheet were uploaded to R software version 4.2.2 for statistical analysis.