2025 Southeastern Residency Conference

Title: Contraception on Demand, Increasing Patient Access to Contraceptives Within the Gulf Coast Veterans Health Care System
 
Authors: Annelle L. Drake, Hayley R. McCarron, Tiffany D. Jagel
 
Background: In 2018, approximately 9% of the Veteran population was female and is expected to increase to 17% by 2040. The general population has a 6% chance of developing Post-Traumatic Stress Disorder (PTSD) at some point in their lives, but female Veterans have a 13% chance. PSTD increases the risk of gestational diabetes, preeclampsia, preterm births, prolonged hospitalizations surrounding delivery, and increases the risk of rehospitalization. Beginning in 2021 at the VA clinics in Puget Sound and Pittsburgh, Clinical Pharmacy Practitioners (CPPs) started the Contraception on Demand program that was later awarded the VHA Shark Tank Diffusion and Excellence Promising Practice. Their CPPs then saw 74 Veterans in 6 months and counseled Veterans on contraceptive options. Veterans were able to receive either a 3-month supply of a new contraceptive or a 12-month supply of their established contraception. 77% of patients agreed to some form of contraception, and 90% of the eligible Veterans elected to receive a 12-month supply. Data also suggested that a 12-month supply would save $87.12 per patient per year, while improving patient outcomes. On March 11, 2024, the diffusion of Contraception on Demand to the Gulf Coast Veterans Health Care System (GCVHCS) was approved.
 
Methods: A list was compiled from within the GCVHCS, and patients who were eligible were offered a clinic visit with a PACT Clinical Pharmacy Specialist to discuss a 12-month supply of contraception. Data was captured and analyzed on the percentage of patients who agree to an appointment, those who transition to a 12-month supply, reasons for denial, and other pharmacist interventions. In addition, data was captured on the referrals for IUDs, contraindications identified, and the percentage of patients who switched to a different form of contraception. The “PharmD Tool” within CPRS was utilized to track any additional pharmacist interventions.
 
Results: Of 320 patients with active prescriptions for contraception, 214 (66.88%) were eligible for enrollment. 144 (67.29%) patients agreed to have an appointment scheduled, 4 (1.87%) agreed to schedule an appointment but were not contacted by scheduling assistants, 45 (21.03%) Veterans declined the appointment offer, and 21 (9.81%) Veterans were mailed letters after three unsuccessful attempts to contact. The most common reason for declining an appointment was a lack of interest. Of the 144 Veterans who agreed to an appointment, 118 (81.94%) agreed to transition to a 12-month supply of their contraceptive. 16 (11.11%) Veterans declined transitioning. 10 (6.94%) patients did not attend their appointments. During these appointments, 29 additional interventions were captured via the PharmD tool within the electronic health record. One of the most frequent intervention made was discontinuing estrogen-containing oral contraceptives, which occurred during 9 appointments. The other most frequent intervention was conducting a Veteran's annual suicide screening questionnaire, which occurred during 9 appointments as well. Other interventions included medication reconciliation, contraceptive counseling, dispensing of pregnancy tests, referrals to specialists, and recruitment to primary care clinics for disease state management.
 
Conclusion: Overall, female Veterans were interested in receiving a 12-month supply and expressed great satisfaction with the implementation of Contraception on Demand. One unforeseen limitation to implementing Contraception on Demand related to the expiration date of the stock at the Central Mail Order Pharmacy used by the GCVHCS. Through identifying contraindications to estrogen-containing contraceptives, stroke risks were reduced and safety improved. By converting to a 12-month supply, between 468-1,404 refill requests were eliminated for the upcoming year, depending on whether Veterans were prescribed a 1-month or a 3-month supply on their original prescription. This reduction improves Veteran's access to medication, reduces potential lapses in care due to delays in mail, and saves Veteran's time from having to request refills from the VA.