(1164) Assessing Barriers, Facilitators, and Confidence in Ability to Provide Maternal Health Services in Community Pharmacies in South Carolina

Objectives: Maternal morbidity is a public health issue that disproportionately affects mothers in rural areas. In 2020, 14.5% of South Carolina’s population resided in rural areas of the state. Community pharmacy staff in rural areas tend to be the most accessible healthcare providers and are uniquely positioned to assist in improving South Carolina’s maternal morbidity rate. The 2022 South Carolina Pharmacy Access Act gave licensed pharmacists the ability to prescribe self-administered methods of contraception to patients without physician prescriptions, which expanded the pharmacist scope of practice regarding maternal health. However, few routinely offer maternal health services. Therefore, the objective of this study was to identify pharmacist and pharmacy technician knowledge, confidence, and perceived barriers and facilitators to implementation of maternal health services in the community pharmacy setting.

Methods: A cross-sectional survey was administered electronically via Qualtrics to pharmacists and pharmacy technicians across the state of South Carolina in February 2023. For this study, “maternal health” was defined as care in the following time periods: contraception, preconception and fertility, prenatal, and postnatal. A sample of pharmacists and pharmacy technicians were randomly selected and invited to participate in this survey. Participants were required to be licensed in the state of South Carolina as a pharmacist or registered as a pharmacy technician and practice in a rural area designated as those with Rural-Urban-Commuting-Area [RUCA] codes of 4-10. Each participant received a $75 e-gift card. Descriptive statistics were reported for demographic items including respondent and pharmacy characteristics. Exploratory factor analysis was conducted using principal components and varimax rotation for the perceived barriers and facilitators scales. Cronbach’s alpha was used to assess reliability. Mean scale scores were calculated for the confidence, barriers, and facilitators subscales. One-way analysis of variance (ANOVA) was used to assess differences in perceived barriers and facilitators by demographic characteristics including sex, rurality, parental status, role, and pharmacy type.

Results: A total of 176 respondents completed the survey, with 123 (69.9%) being pharmacists and 51 (29%) pharmacy technicians. Respondents displayed less knowledge in the hormonal contraception, preconception and fertility care, and postnatal domains. Respondents demonstrated the greatest confidence in providing contraception services with a mean of 3.33 (SD 0.69). Respondents were least confident in preconception and fertility with a mean of 2.75 (SD 0.83). Exploratory factor analysis indicated that barriers and facilitators domains each held three factors. Factors in the barriers domain were pharmacy factors, external factors, and patient factors. Factors in the facilitators domain were pharmacy factors, community support, and access & convenience. The Cronbach’s alpha scores for these factors ranged from 0.642-0.823. Significant differences were found in perceived barriers and facilitators to maternal health services by the demographic characteristics of sex, rurality, role, and pharmacy type. Male (p < 0.001) and rural (p < 0.001) respondents were more likely to perceive greater patient factor barriers. Pharmacists were more likely than technicians to perceive greater pharmacy factor (p < 0.001) and external factor (p < 0.001) barriers, while technicians were more likely to perceive community support as a greater facilitator than pharmacists (p=0.010). Finally, chain pharmacy respondents were more likely to report greater pharmacy factor barriers (p=0.027), while independent pharmacy respondents were more likely to report pharmacy factors as facilitators (p=0.002). Independent pharmacy respondents were more likely than other pharmacy respondents to report access and convenience as a facilitator (p=0.005).

Conclusions: While pharmacists are the most accessible provider of healthcare in rural areas, many barriers exist that prevent implementation of maternal health services. Strategies are needed to increase knowledge and confidence, and overcome barriers, to increase pharmacist capability to administer maternal health services in the community pharmacy setting.