Designing a national hormonal contraceptive service: a blueprint for access
Jan 2024 - June 2024
Project team: Nicoletta Nobble (Design researcher and myself)
Client
Project challenge
Before the project commenced we had two major data points / reason for further investigation:
Project approach
We facilitated a comprehensive design research and service design process focused on creating a patient-centered approach to hormonal contraception that removes unnecessary barriers while ensuring appropriate clinical oversight with staff and patients.
We engaged 17 Pharmacy staff across 4 states (pharmacy managers, Operating managers and technicians. With a mix of Pharmacy service volumes (store tiers). All Pharmacies were in high SVI zones. Census track social vulnerability index ratings >0.7 (scale of 0 to 1)*. Mix of urban, suburban, a rural in each state. We facilitated design research activities with Pharmacists including:
We conducted patient research with 26 prospective patients (14 Medicaid, 12 Cash pay). Across a mix of demographics, ages, experiences
with hormonal contraception, incl. 1 transgender patient. We uncovered the value of contraceptives today - how it fits into patient lives, and the associated benefits and barriers to accessing it. We gauged openness and needs for a hormonal contraceptive offering.
Project outcomes and outputs
The redesigned service model empowers pharmacists to deliver comprehensive hormonal contraception care through structured eligibility consultations, clinical assessments including blood pressure measurements, and personalized prescribing with tailored counseling when appropriate. Our work bridged current capabilities with future requirements by providing detailed program recommendations informed by both patient expectations and team member insights. Our research insights are grounded in a holistic evaluation of past work and one-on-one engagement with patients.
The design encompasses the complete patient journey—from scheduling and arrival at the pharmacy through the consultation experience—while defining the necessary tools, workflows, and operational changes required for successful implementation. This holistic approach ensures a seamless experience for patients while establishing practical frameworks that enable pharmacy teams to confidently deliver this expanded service offering.
This service is currently live.
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Click this link to view
Research Project outputs:
Research insights and service recommendations span key service journey phases:
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Accessing hormonal contraception may vary over one’s lifetime; frequency and prescriptive authority follows this variance
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Hormonal contraception decision-making is back and forth
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Project team: Nicoletta Nobble (Design researcher and myself)
Client
Pharmacy in the USA
Project challenge
- 46 million U.S. individuals with ovaries aged 15-49 are sexually active and not seeking to become pregnant.
- More than 19 million of these individuals in the United States lack meaningful access to birth control within their communities; contraceptive deserts and significant disparities in care exist in America
- 28 states and the District of Columbia. allow pharmacists to provide contraceptive care
Before the project commenced we had two major data points / reason for further investigation:
- There was an initial pilot service launched in Idaho in 2020 with limited results
- In the state of Oregon (where 46% of pharmacies offer this service), ~10% of patients obtained birth control from a pharmacy
Project approach
We facilitated a comprehensive design research and service design process focused on creating a patient-centered approach to hormonal contraception that removes unnecessary barriers while ensuring appropriate clinical oversight with staff and patients.
We engaged 17 Pharmacy staff across 4 states (pharmacy managers, Operating managers and technicians. With a mix of Pharmacy service volumes (store tiers). All Pharmacies were in high SVI zones. Census track social vulnerability index ratings >0.7 (scale of 0 to 1)*. Mix of urban, suburban, a rural in each state. We facilitated design research activities with Pharmacists including:
- State-based focus groups discussing a pharmacist-led hormonal contraception offering and administering pharmacy services more generally. Including some of the perceived pain points and key barriers to effectively delivering the service.
- Reactions to, and feedback to high-level happy path patient experience.
We conducted patient research with 26 prospective patients (14 Medicaid, 12 Cash pay). Across a mix of demographics, ages, experiences
with hormonal contraception, incl. 1 transgender patient. We uncovered the value of contraceptives today - how it fits into patient lives, and the associated benefits and barriers to accessing it. We gauged openness and needs for a hormonal contraceptive offering.
Project outcomes and outputs
The redesigned service model empowers pharmacists to deliver comprehensive hormonal contraception care through structured eligibility consultations, clinical assessments including blood pressure measurements, and personalized prescribing with tailored counseling when appropriate. Our work bridged current capabilities with future requirements by providing detailed program recommendations informed by both patient expectations and team member insights. Our research insights are grounded in a holistic evaluation of past work and one-on-one engagement with patients.
The design encompasses the complete patient journey—from scheduling and arrival at the pharmacy through the consultation experience—while defining the necessary tools, workflows, and operational changes required for successful implementation. This holistic approach ensures a seamless experience for patients while establishing practical frameworks that enable pharmacy teams to confidently deliver this expanded service offering.
This service is currently live.
Click this link to view
Research Project outputs:
Research insights and service recommendations span key service journey phases:
Accessing hormonal contraception may vary over one’s lifetime; frequency and prescriptive authority follows this variance
Hormonal contraception decision-making is back and forth
Hormonal Contracaption consultation recommendations
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Ensure a standardized protocol offers comprehensive guidance, ideally employing built-in logic. The protocol should serve three primary functions: eliminating ambiguity for team members (TMs) in both what to prescribe and how to follow-up, ensuring a consistently high level of holistic care across patient backgrounds, and mitigating the potential for bias among TMs. Consider a digital solution with a built-in rules engine to support these functions, alleviating potential liability concerns. Ensure any state-specific follow-up needs/restrictions (e.g., refills, repeat assessment, time horizon for PCP follow-up, etc.) are flagged.
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Consider hands-on and continuous training to instill confidence in (TMs) who may be more apprehensive about the services. Some state-specific legal requirements may require additional hands-on training. Ensure additional resources, further training modules, and opportunities for continuous learning and knowledge refresh beyond the initial training are available to TMs online and as job aids, fostering a supportive environment where TMs build prescriptive confidence over time.
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Ensure stores offering the service have adequate space for consultations. For stores without private rooms today, explore ways to enhance privacy and comfort with essential amenities such as privacy/sound barriers, seating for patients who will receive BP readings, hardware to capture the consultation, and (if applicable) access to a nearby restroom for pregnancy tests. Implement and notify patients of regular cleaning schedules for the space, especially if it is shared with other services.
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Prioritize Spanish-language support in the service. Ensure Spanish-language outreach, scheduling, and assessment is available. Consider how virtual care, bilingual techs, or remote bilingual pharmacists can close care gaps in areas where there are language gaps, ensuring accessibility and inclusivity in service delivery for communities most likely to take advantage of this service.
Hormonal Contraception Service Blueprint
Combines both the future state service aspirations with the existing day-to-day WAG processes and systems to depict the possible current state service offering. The blueprint was created with the following inputs;
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Patient research
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TM research
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Desk research (existing research)
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Competitive analysis
- Stakeholder engagement
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