VA Birth Control on Demand

Abstract

Veterans with the capacity for pregnancy who utilize Veterans Affairs (VA) healthcare are a vulnerable population with unmet contraceptive needs despite access to existing VA health services. As the largest integrated healthcare system in the country, there is an opportunity to implement and evaluate novel evidence-based interventions to improve contraceptive access within the VA. Two examples of innovative strategies include pharmacist prescription of contraception and 12-month dispensing of prescription contraception. Several states have demonstrated that pharmacist provision of hormonal contraception is safe, feasible, and satisfactory to both patients and pharmacists. Furthermore, data demonstrate that 12-month dispensing of short-acting contraception increases adherence and continuation. We conducted and evaluated a demonstration project examining pharmacist prescription of hormonal contraception and 12-month dispensing at two sites within the VA healthcare system. While we found high patient and pharmacist satisfaction, improved patient safety, and ongoing interest in participation in the program, we also identified numerous implementation challenges including low uptake of services and lack of sufficient staffing. These findings can inform efforts to implement these interventions to increase access to contraception at other sites in the VA and in other integrated healthcare systems.