Faculty Of Sexual And Reproductive Healthcare Research Articles

An evaluation of remote algorithm-assisted consultations for the safe prescribing of progesterone-only pills in a digital setting

Abstract Introduction This study aimed assessed the prescribing quality of progesterone-only pills (POP) to determine whether online asynchronous algorithmic assisted consultations alone could help women or whether enhanced remote consultations still need to be performed. Our digital service follows Faculty of Sexual and Reproductive Healthcare FSRH clinical guidance, patients who have conditions that fall in category of UKMEC 3 and 4 would be signposted to other methods.1,2 The service works by patients completing an online consultation which is supported by algorithm-assisted consultations. The algorithm is written by doctors and pulls out the relevant information for the clinician to suggest whether it safe to prescribe. Asynchronized consultations using algorithms can identify patients for whom POP is not suitable to prescribe. As this is safe and scalable, it has the potential to improve access to contraception for women. For those women where technology identifies that POP is not suitable, there is still an important place for remote interaction to ensure that women are able to make an informed and safe contraceptive choice. Aim To review patients who met a Faculty of Sexual and Reproductive Healthcare (FSRH) exclusion for POP to determine adherence to FSRH clinical guidance on signposting these patients to in-person services where appropriate,1.2 and to review patients’ medical records, who were initially declined POP after completing an online consultation to identify the outcome and potential pathway improvement. Methods A retrospective case-note review of 362 patients, who met a FSRH exclusion criteria for POP, using a large digital sexual health service for POP (Cerelle, Cerazette, Norgeston, Noriday) between 1.3.21-25.5.22. Those patients who were not prescribed POP were then identified, to see how they were managed; how many were signposted to the clinic and how many were managed remotely and subsequently prescribed POP. The data underwent descriptive statistical analysis. Ethical approval was not required as this was a service evaluation. Results Of the 362 patients who met the FSRH exclusion criteria (100% female, aged 18-51), 288 (80%) patients were declined from POP treatment and signposted to in-persons services, 74 (20%) were prescribed POP after clinician review. Of the 288 who were initially declined POP, 110 (38%) patients sought further advice with a clinician remotely, resulting in 83 being prescribed POP and 27 being declined. Overall clinicians correctly followed guidance for 99% (284/288) of POP consultations who met the FSRH exclusion criteria.2 Of these 4 patients reported potential exclusion criteria for POP and were prescribed. Upon reflection, clinicians felt the potential exclusion criteria could have been explored further before prescribing. Discussion/Conclusion Asynchronous consultations bring lots of efficiencies, assists clinicians in triaging and managing the majority of patients. We’ve developed a pathway where patients can undertake a further discussion with a clinician remotely, which resulted in provision of remote contraception. This is convenient for patients and has the potential or may ease pressure off in-person services.

How to relate progestogen-only pill guidance to clinical practice

The Clinical Effectiveness Unit (CEU) of the Faculty of Sexual and Reproductive Healthcare (FSRH) regularly updates and develops national UK clinical guidelines relating to contraception. The updated FSRH progestogen-only pills (POPs) guideline was published in August 2022 and gives an overview of all POPs available in the UK. This article will highlight what is new or important in the guideline and how to relate the recommendations to clinical practice.

How to relate progestogen-only pill guidance to clinical practice

A new guideline for the use of progestogen-only pills has been published. Claire Nicol explains how this relates to clinical practice The Clinical Effectiveness Unit (CEU) of the Faculty of Sexual and Reproductive Healthcare (FSRH) regularly updates and develops national UK clinical guidelines relating to contraception. The updated FSRH progestogen-only pills (POPs) guideline was published in August 2022 and gives an overview of all POPs available in the UK. This article will highlight what is new or important in the guideline and how to relate the recommendations to clinical practice.

Safeguarding and telemedical abortion services

### Key messages On 21 March 2020, in response to the coronavirus COVID-19 outbreak, the Royal College of Obstetricians and Gynaecologists (RCOG), the Royal College of Midwives (RCM), the Faculty...

Spotlight on… contraception

Spotlight on… contraception

Common questions on emergency and postcoital contraception

There are a number of key questions that must be asked when considering the method of emergency or postcoital contraception to use. Alison J Vaughan examines these when choosing from the three treatments available in the UK Copper IUD (CU-IUD), Levonorgestrel (LNG-EC), Ulipristal Acetate Emergency Contraception (UPA-EC) are the three methods of emergency contraception (EC) available in the UK. CU-IUD is the most effective method and must be offered to all women requesting emergency contraception and that offer documented in the record. UPA is more effective than LNG but the efficacy of UPA can be affected by on-going contraception, so is not always the ideal method for all women (see Figure 1 ). A consultation for EC offers the opportunity to discuss on going contraception and sexual health. Comprehensive evidence-led guidance can be found in the EC clinical guideline, published by the Clinical Effectiveness Committee of Faculty of Sexual and Reproductive Healthcare (FSRH) in 2017.

New combined hormonal contraception guideline and its impact on prescribing practice

The Clinical Effectiveness Unit of the Faculty of Sexual and Reproductive Healthcare (FSRH) regularly develops and updates national clinical guidelines. The most recent updated guideline on combined hormonal contraception details the new evidence and suggests recommendations for clinical practice based on this evidence. This guideline will influence clinical and prescribing practice within the speciality of sexual and reproductive health and primary care. This article will critically analyse the impact this updated guideline will have on prescribing practice and will evaluate how the implementation of the recommendations will be influenced by the multidisciplinary team.

Insights from outside BJOG

Insights from outside BJOG

Insights from outside BJOG

Insights from outside BJOG

Insights from outside BJOG

Insights from outside BJOG

Insights from outside BJOG

Insights from outside BJOG

Emergency contraception

Emergency contraception is used to prevent unwanted pregnancy in women following unprotected sexual intercourse, including contraceptive failure. The primary healthcare team has an important role in the provision of emergency contraception. Other providers include sexual health clinics, pharmacies and emergency departments. Three methods are used in the UK: levonorgestrel oral emergency contraception, ulipristal oral emergency contraception, and the copper intrauterine device. In 2017 the Faculty of Sexual and Reproductive Healthcare (FSRH) produced guidance on emergency contraception and quick starting regular contraception. This article will provide an approach to counselling patients about emergency contraception, and practice pointers from the FSRH guidelines. Case studies will be used for illustration.

Insights from outside BJOG

Insights from outside BJOG

Update on the use of emergency contraception

In March 2017, the Faculty of Sexual and Reproductive Healthcare (FSRH) issued a new guideline on emergency contraception. This article provides an overview of the current approach to managing emergency contraception to help busy clinicians tailor the most appropriate method to each individual.

Contraception for adolescents (American Academy of Pediatrics)

Choosing the right contraceptive and getting reliable sexual health advice is important for adolescents as they have their first sexual experiences and their attitudes towards sex begin to form. In...

FSRH launches a national training programme for nurses

The Faculty of Sexual and Reproductive Healthcare (FSRH) has voted to widen its membership to include nurses, paving the way for the development of a new national qualification for nurses working in sexual health

Contraceptives: a guide to product selection

AbstractContraception remains one of the most cost-effective public health measures to reduce rates of maternal and infant mortality. General practitioners (GPs) who provide contraceptive counselling should be able to discuss every eligible contraceptive method for the specific woman. In addition to contraceptive counselling, the GP can address other sexual and reproductive health issues, including the prevention of sexually transmitted infections at the same visit, providing a holistic approach. The World Health Organization (WHO) has online tools available to aid in contraceptive choice. The WHO Medical Eligibility Criteria for Contraceptive Use (WHO MEC) provides evidence-based recommendations to ensure that patients are medically fit to use a particular method and can safely select the most appropriate method of contraception. The Faculty of Sexual and Reproductive Healthcare (FSRH) of the Royal College of Obstetricians and Gynaecologists and the National Institute for Health and Clinical Effectivenes...

Role of ultrasound scanning in community contraceptive and reproductive health clinics

Background The role of ultrasound scanning (USS) in the community setting of contraception and reproductive health (CRH) has not yet been clearly established. Abacus Clinics use ultrasound scans prior to referral for abortion where gestation is uncertain and for location of an intrauterine device/intrauterine system (IUD/IUS). Objective To audit the indications for USS performed in Abacus Clinics and to determine a minimum acceptable number of annual scans for each clinician. Methods A retrospective review of case notes was performed for a period of 3 months. Results The majority of women (36; 64%) had a scan to determine gestation prior to referral for abortion. In 12 (21%) women the scan was performed for location of an IUD/IUS. Two (4%) women had a scan for both indications. Only six (11%) women did not comply with the indications listed above but all were related to gestation or IUD/IUS use. In 16 women the scan significantly influenced decision-making regarding referral to the appropriate abortion service provider. The number of scans performed by individual doctors varied between two and 12. Conclusions The use of USS prevented unnecessary referrals to hospital and delays in clients' care. The number of scans each clinician performed was small and the indications for future USS were only slightly changed. The new special skills module in ultrasound developed by the Faculty of Sexual and Reproductive Healthcare(FSRH) (formerly the Faculty of Family Planning and Reproductive Health Care) aims to set new standards and should improve training.