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.   --