(P116) Overcoming Pennsylvania’s Collaborative Practice Regulation Barriers to Forge Pharmacy Partnerships for Expanded STI Services

Project: Allegheny County Health Department (ACHD) in Pittsburgh, Pennsylvania has only one STD/HIV clinic and is not readily accessible by foot or public transit. In late 2021, ACHD sought to expand STI/HIV screening and treatment access through a pilot partnership with the University of Pittsburgh School of Pharmacy and Hilltop Pharmacy, a highly trafficked community pharmacy. This partnership includes 1) implementation of an at-home self-collection program where testing kits are obtainable online and 2) expanding access for treatment and test-kit access at Hilltop Pharmacy. However, Pennsylvania’s restrictive pharmacy collaborative practice regulations presented challenges.

Issue: Current Pennsylvania pharmacy laws are logistically challenging and not reflective of modern health care realities. Collaborative practice laws permit pharmacists to manage patients’ drug therapy by adjusting a drug’s strength, frequency, or route of administration; however, pharmacists may not prescribe (PA Code § 27.302). ACHD overcame this with a standing order for treatment of STI/HIV patients at the pharmacy and co-developed a protocol with Hilltop Pharmacy and the University to support clinical decision-making (Figure 1).

Results: Through stakeholder meetings, standing orders were developed that included a protocol for patient evaluation, patient education, documentation, and treatment selection. Notably, the protocol allows patients to receive prompt treatment at Hilltop Pharmacy, if eligible. Standing orders and protocols from other states (IA and CO) were used as templates. Challenges included triaging medically complex patients, covering uninsured patients, communication of test results, and documenting treatment into the statewide disease surveillance system.

Lessons Learned: Standing orders and protocols from other states provide a precedent for practice expansion for community pharmacists. Standing orders and protocols were co-developed through collaborative discussions with all three partners and pharmacists in other states. The University facilitated these discussions and helped connect all stakeholders. Since these services target individuals who may not seek care in clinical settings, it was important to aim for broad accessibility. Practice implications include quicker time to treatment in a less stigmatized setting, increased access to testing kits, the ability to reach patients who may not seek care traditional medical settings, and leveraging of pharmacists’ expertise to improve outcomes in the community.