Should We Offer Preconception Services in Community Pharmacies?

Why is preconception care important?

Roughly 4 million pregnancies occur in the United States annually.¹ A common misconception is that preconception care is only a health care need when there is an intention to become pregnant. However, because nearly half of all pregnancies in the United States are unplanned, most birth defects occur within the first 3 months of pregnancy, and nearly one-fifth of pregnant women in in the United States receive no prenatal care before the end of their first trimester, preconception care is a serious population health issue deserving of attention.^2-4

Why should pharmacists consider being involved?

Although preconception care is recommended to be routinely provided to all women of reproductive potential, gaps exist. With an estimated 90% of Americans living within 5 miles of a community pharmacy, community pharmacists have been proposed as an ideal provider of selected preconception care services to help fill these gaps and support preconception care initiatives.^5,6

Where do we even start?

My PGY-1 community pharmacy residency was an incredible year filled with many great experiences that truly helped sculpt my professional practice during my first year as a pharmacist. One of the requirements was to develop and implement a research project; the topic chosen was preconception care. In full disclosure, I did not know much about it when I started the project and quickly found I had more questions than answers. However, I rapidly realized how deserving it is of continued attention.

Our primary objective was to perform a needs assessment using modified evidence-based core indicators:

The above parameters were assessed with the use of a 1-page patient survey, retrospective chart review, and vaccine database review.^3,7

Of the 110 patients who were asked to complete the survey, 99 patients took the survey and were included in the study for analysis. More than 75% of the patient population reported being sexually active and only about 50% of participants indicated they used some form of contraception, highlighting a large proportion of the population with the potential to become pregnant, as well as for unplanned pregnancy.

96% of study participants were found to have at least one health concern that could adversely affect a pregnancy if she were to become pregnant. The majority of study participants reported at least one of the following:

• Abnormal BMI
• Missing documentation of at least one assessed vaccination
• No form of daily multivitamin that contained folic acid

Additionally, roughly half of survey participants were on at least one medication with potentially teratogenic effects.

Not only was preconception care need established across the majority of survey participants, but needs were found to span multiple preconception care parameters as well as differing demographics. However, despite the demonstrated need, 78.8% of the survey participants indicated they were not interested in receiving more information on preconception care. Therefore, pharmacists must play an active role in identifying and educating eligible patients.

Are you ready to begin implementing preconception care services within the community pharmacy setting?

If the answer is yes — and I hope it is — what are the next steps?

In identifying these concerns, we hoped that the results could be used in developing new clinical services to support preconception care needs.

Pharmacists already provide non-dispensing services via multiple service models, therefore preconception care services may be built within existing frameworks.^6,8,9,10 This support can include:

• Screening for preconception parameters
• Optimizing pharmaceutical care plans for adequate disease state management
• Counseling for prescription and over-the-counter (OTC) products to assist in family planning
• Prescription contraception via statewide protocol or collaborative practice agreement (depending on state/scope of practice)

As we continue to learn more about the need for and how preconception care fits into community pharmacy practice, I leave you with one final question:

Where might preconception care services fit within your pharmacy workflow and how might you implement these types of services to better the health of the patients you serve?

References

For the original research article, please visit: https://www.ncbi.nlm.nih.gov/pubmed/31010784

1. Centers for Disease Control and Prevention. Births and natality. Available at: https://www.cdc.gov/nchs/fastats/births.htm; March 31, 2017. 
2. Centers for Disease Control and Prevention. Preconception health and healthcare. Available at: https://www.cdc.gov/preconception/index.html; February 13, 2017. 
3. Johnson K, Posner SF, Biermann J, et al. Recommendations to improve preconception health and health caredUnited States. A report of the CDC/ATSDR Preconception Care Work Group and Select Panel on Preconception Care. MMWR Morb Mortal Wkly Rep. 2006;55(RR06):1e23.
4. Korenbrot CC, Steinberg A, Bender C, Newberry S. Preconception care: a systematic review. Matern Child Health J. 2002;6(2):75e88.
5. Frederick J. By the numbers: how community pharmacists measure up. Drugstore News;March 13, 2015. Available from:http://www.drugstorenews. com/article/numbers-how-community-pharmacists-measure. 
6. DiPietro NA, Bright DR. Medication therapy management and preconception care: opportunities for pharmacist intervention. Inov Pharm. 2014;5(1):141.
7. Frayne DJ, Verbiest SV, Chelmow D, et al. Health system measures to advance preconception wellness: consensus recommendations of the Clinical Workgroup of the National Preconception Health and Health Care initiative. Obstet Gynecol. 2016;127:863e872.
8. DiPietro Mager NA. Fulfilling an unmet need: roles for clinical pharmacists in preconception care. Pharmacotherapy. 2016;36(2): 141e151.
9. El-Ibiary SY, Raney EC, Moos MK. The pharmacist’s role in promoting preconception health. J Am Pharm Assoc. 2014;54:e288ee303.

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About the Author

Mollie Reidenbach, PharmD is a clinical care coordinator with SpartanNash, a chain community pharmacy primarily based in Michigan, embedded within a physician group to provide medication therapy support for both their patients and providers.