E063 Discussion of contraception and family planning in the lupus clinic

Abstract

Abstract Background/Aims Females with a diagnosis of systemic lupus erythematosus (SLE) have a higher risk of adverse pregnancy outcomes. Many medications used to treat SLE are teratogenic. Contraception counselling and discussion around family planning are essential to reduce pregnancy risks. This service evaluation aimed to evaluate the appropriateness of contraceptive advice given to females of childbearing age with SLE in accordance with international guidelines and assess patient adherence to recommendations provided. Methods A retrospective evaluation of electronic medical records was undertaken. All females with a diagnosis of SLE seen in the preceding 12 months were identified. Any who were menopausal or trying to conceive were excluded. Based on BSR and EULAR guidance, five standards relating to contraceptive advice were assessed, primarily focusing on frequency of contraceptive discussions and the level of adherence to recommendations provided. For analysis of the established parameters, patients were stratified into different clinic groups; tertiary lupus clinic, vs. general clinic and whether the consultation was clinician or nurse led. Results 42 females aged 16-55 were identified. 39/42 (93%) of patients had discussions regarding contraception and conception. 39/39 (100%) of females were recommended appropriate contraception methods. Only 3/42 (7.1%) received written information on family planning. Adherence to contraceptive advice was low. Only 10/39 (25.6%) of patients recommended non-barrier contraception were complying with advice. 29/42 (69%) patients were on teratogenic medication. 8/29 (27.6) were using long acting reversible contraceptives (LARC). Of those who were not, 2/29 (6.8%) were not sexually active, 1/29 (3.4%) relied on their partner’s vasectomy, 3/29 (10.3%) had alternative contraception preference and in 15/29 (51.7%) the reasons were unclear. Conception and family planning advice was given in all clinics, however those attending the tertiary lupus clinic were significantly more likely to receive follow up advice on contraception and conception advice compared to those attending general clinics (U = 44, P < 0.001). There was no difference between the frequency of nurse or clinician led advice. Conclusion Contraceptive advice in line with current guidelines is being delivered routinely in lupus clinics. There appears to be barriers to the uptake of LARC. To better understand this, exploration of patient experiences of contraception and conception discussions is underway. Disclosure K. Mashida: None. R. Benson: None. A. Redfern: None. C. Burton: None. Z. Mclaren: None.