Use of path analysis to predict changes to community pharmacy and GP emergency hormonal contraception (EHC) provision in England

Abstract

Objectives:
In 2014/2015, 46% of community pharmacies were commissioned by local authorities to provide emergency hormonal contraception (EHC) free without prescription in England. Commissioning EHC services influences EHC prescribing from General Practice (GP)—greater community pharmacy provision reduces GP prescribing. This study aimed to examine predictors of GP and pharmacy EHC activity, describing them using path analysis. From this, commissioners and policy-makers may understand ways to influence this.

Study design:
Cross-sectional study of routinely recorded data, obtained through freedom of information requests to local authorities.

Setting:
Community pharmacies and general practices in England, UK.

Participants:
All local authorities in England were included in the study (147 areas). The study population were all girls, adolescents and women aged 12–55. Of the 147 areas, data from 80 local authorities were obtained covering an eligible female population of 9?380?153.

Primary and secondary outcome measures:
Correlation between community pharmacy and GP EHC activity.

Results:
Data from 80 local authorities were analysed, representing 60% of the eligible female population in England. A significant negative correlation was found between rates of community pharmacy provision and GP prescribing (-0.458, p<0.000). Community pharmacy provision and the proportion of pharmacies commissioned were significantly correlated (0.461, p<0.000). A significant correlation was found between increased deprivation and community pharmacy provision (0.287, p=0.010). Standardised total effects on GP prescribing were determined from path analysis including community pharmacy provision (ß=-0.552) and proportion of pharmacies commissioned (ß=-0.299). If all community pharmacies were commissioned to provide EHC, GP EHC prescriptions could decrease by 15%.

Conclusion:
Community pharmacy EHC provision has a significant influence on GP EHC prescribing. Increasing the proportion of commissioned community pharmacies should have a marked impact on GP workload. The methodology affords the possibility of examining relationships surrounding other commissioned service activity across different settings and their impact on linked care settings.