Work

Implementation and mixed method evaluation of a unique midwife-prescribed, pharmacist-administered routine antenatal Anti-D prophylaxis model in pregnant people

Year: 2025

Type: article

Abstract: BACKGROUND: Routine antenatal anti-D prophylaxis, an injected blood product, reduces the risk of rhesus (D) sensitisation in rhesus negative pregnancies. One New Zealand district implemented this service through a unique model using midwives to prescribe and community pharmacists to administer and manage anti-D. AIM: To describe the model and its implementation and ascertain uptake, cost, acceptability to service users and stakeholders, and potential improvements. METHODS: An audit compared uptake from October 1, 2021 to May 31, 2023 with the eligible population. A cross-sectional survey of service users, midwives, pharmacists and staff supporting the service delivery was conducted in 2023. A cost analysis was undertaken. RESULTS: At least one dose of anti-D was administered in 300 of 522 eligible pregnancies (57 %), although this was significantly lower in those with Māori ethnicity (35 %, p = 0.008 versus European ethnicity), or increased parity. Uptake increased over time. All groups surveyed highly preferred (74-86 %) the existing model over alternatives. Service users would highly recommend (95 %) the pharmacy they attended to others eligible for anti-D. Pharmacists were very satisfied with the service and ease of administration but experienced challenges, e.g. service users presenting without the required blood test first and insufficient staffing. Midwife-pharmacist communication was sometimes rated poorly. Courier and pharmacy costs were 3 % and 10 % of the total cost, respectively. CONCLUSION: Anti-D prescribed by midwives and administered by community pharmacists is convenient for service users, low cost, and the preferred model for service users, midwives and pharmacists. Uptake needs to increase and focus on equity.

Source: Research in Social and Administrative Pharmacy

DOI: 10.1016/j.sapharm.2025.04.004

Authors: Dr Natalie Gauld, Amanda Hinks, Runzhe Gao, Talalelei Teu, Dr Dhana Gounder

Institutions: University of Auckland, Counties Manukau District Health Board, Research & Evaluation Office

Language: English

Topic: Blood groups and transfusion

Subfield: Hematology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,880