Prescription Of Contraceptives Research Articles

Prevalencia de prescripción conjunta incorrecta de fármacos anticonvulsivantes y anticonceptivos hormonales Colombia, 2014

<p><strong>Objetivo:</strong> determinar la prevalencia de prescripción conjunta de fármacos antiepilépticos para identificar formulación incorrecta que podría afectar la efectividad de los anticonceptivos hormonales en un grupo de mujeres afiliadas al Sistema General de Seguridad Social en Salud de Colombia.</p><p><strong>Materiales y métodos:</strong> estudio de corte transversal, en el que se seleccionaron registros de mujeres de 15 a 45 años que recibían al menos un fármaco antiepiléptico, entre el 1 y el 31 de marzo de 2014, en una base de datos poblacional de dispensación de medicamentos de un operador logístico en Colombia, para población perteneciente al régimen contributivo y subsidiado en el Sistema General de Seguridad Social en Salud de Colombia. Se evaluaron el tipo de anticonceptivo hormonal y de fármaco antiepiléptico. Se utilizó estadística descriptiva.</p><p><strong>Resultados:</strong> de un total de 2092 pacientes usuarias de fármacos antiepilépticos, se identificaron 89 (4,3 %) casos que tenían por lo menos un antiepiléptico y un anticonceptivo simultáneamente. En 48 mujeres (54 %) se encontró formulación incorrecta de métodos de planificación, como el uso de fármacos antiepilépticos inductores enzimáticos e inyectables combinados (20 casos), el uso de anticonceptivos orales combinados de bajas dosis de estrógenos (16 casos), de progestinas orales (10 casos), y el uso de antiepilépticos no inductores enzimáticos y anticonceptivos orales combinados y dosis altas de estrógenos (2 casos).</p><p><strong>Conclusiones:</strong> un importante número de mujeres usuarias de medicamentos antiepilépticos utiliza métodos hormonales de anticoncepción, y cerca de la mitad de ellas tenían una prescripción anticonceptiva incorrecta, lo que podría resultar en embarazos no deseados o incremento del riesgo de enfermedad tromboembólica.</p>

Oral contraceptive exposure in newly pregnant women not linked to birth defects

University of California, San Francisco School of Pharmacy, told Pharmacy Today. “If a woman mistakenly continued using oral contraceptives during the early part of pregnancy, it didn’t increase the risk of birth defects.” Using Danish health registries, the researchers studied four exposure groups and found that prevalence of major birth defects—about 25 per 1,000 births—was consistent across each group. Nearly 70% of the mothers stopped using oral contraceptives more than 3 months before pregnancy; 21% never used oral contraceptives; 8% used oral contraceptives until 0 to 3 months

Unfettered Access to Reliable Contraception: Pharmacist Prescription Derails a Definitive Solution

In this commentary, the Chief Executive Officer of the American Congress of Obstetricians and Gynecologists describes how pharmacist prescription of oral contraceptives exchanges one barrier for an...

Oregon pharmacists begin prescribing hormonal contraceptives

O pharmacists now have prescribing authority for oral and patch contraceptives after a woman completes a self-screening risk assessment questionnaire and receives a blood pressure screening. The new statute, which was signed into law in July 2015, became effective in January. Since November 2015, many pharmacists throughout the state have completed the 5-hour online certification course, developed by Oregon State University College of Pharmacy with guidance from the Oregon Board of Pharmacy.

Trends in direct-to-consumer advertising of prescription contraceptives

ObjectiveDespite much speculation about the role of direct-to-consumer advertising (DTCA) in increasing demand for prescription contraceptives in the United States, there is little published research on this topic. We sought to quantify the prevalence and magnitude of DTCA for prescription contraceptives over the last decade. Study designUsing cross-sectional data from January 2005 through December 2014, we performed descriptive analyses on trends in DTCA expenditure for prescription contraceptives. We also quantified the amount of DTCA according to contraceptive method category and individual brand. ResultsDuring the study period, pharmaceutical companies spent a total of US$1.57 billion in the United States on DTCA of prescription contraceptives. Annual expenditure for contraceptive DTCA reached a peak value of US$260 million in 2008, with a progressive decline to a nadir of US$69 million by 2013. Of the contraceptive methods, oral contraceptive pills (OCPs) have been the most heavily promoted, with Yaz (drospirenone/ethinyl estradiol) — the most advertised brand — accounting for US$347 million of cumulative DTCA expenditure. However, DTCA spending on OCPs peaked in 2007 and was overtaken in 2012 by the DTCA of long-acting reversible contraceptives (LARCs), the contraceptive method now receiving the largest amount of DTCA promotion. ConclusionsDTCA is a major form of promotion for prescription contraceptives. Recent trends in DTCA expenditure indicate a shift from promotion of the OCPs to the LARCs. DTCA's effect on provider and patient utilization of various contraceptive methods has yet to be determined. ImplicationsThis study provides the first quantitative evaluation of DTCA of prescription contraceptive methods and reveals DTCA's importance as a form of promotion. Recent DTCA trends indicate increased promotion of LARCs, coinciding with greater uptake of LARC methods by patients and prescribers.

Instrumental variable analysis as a complementary analysis in studies of adverse effects: venous thromboembolism and second-generation versus third-generation oral contraceptives.

A potentially useful role for instrumental variable (IV) analysis may be as a complementary analysis to assess the presence of confounding when studying adverse drug effects. There has been discussion on whether the observed increased risk of venous thromboembolism (VTE) for third-generation oral contraceptives versus second-generation oral contraceptives could be (partially) attributed to confounding. We investigated how prescribing preference IV estimates compare with conventional estimates. Women in the Clinical Practice Research Database who started a second-generation or third-generation oral contraceptive from 1989 to 2013 were included. Ordinary least squares and two-stage least squares regression were used to estimate risk differences in VTE. Cox regression and IV for Cox proportional hazards regression were used to calculate hazard ratios (HR). The instrument used was the proportion of prescriptions for third-generation oral contraceptives by the general practitioner in the year preceding the current prescription. All analyses pointed in the direction of an increased VTE risk for third-generation oral contraceptives. The adjusted HR from the conventional Cox regression was 1.62 (95% confidence interval 1.16-2.27) and the fully adjusted HR from the IV Cox regression was 3.45 (95% confidence interval; 0.97-11.7), showing a larger risk and wider confidence intervals in the IV analysis. The similarity in direction of results from the IV analyses and conventional analyses suggests that major confounding is unlikely. IV analysis can be a useful complementary analysis to assess the presence of confounding in studies of adverse drug effects in very large databases.

Contraceptive Provision to Adolescent Females Prescribed Teratogenic Medications.

Rates of adult women receiving contraceptive provision when simultaneously prescribed a known teratogen are alarmingly low. The prevalence of this behavior among pediatric providers and their adolescent patients is unknown. The objective of this study was to describe pediatric provider behaviors for prescribing teratogens concurrently with counseling, referral, and/or prescribing of contraception (collectively called contraceptive provision) in the adolescent population. A retrospective review was conducted examining visits in 2008-2012 by adolescents aged 14 to 25 years in which a known teratogen (US Food and Drug Administration pregnancy risk category D or X) was prescribed. The electronic medical records were queried for demographic information, evidence of contraceptive provision, and menstrual and sexual histories. The data were analyzed using standard statistical methods. Within 4172 clinic visits, 1694 females received 4506 prescriptions for teratogenic medications. The most commonly prescribed teratogens were topiramate, methotrexate, diazepam, isotretinoin, and enalapril. The subspecialties prescribing teratogens most frequently were neurology, hematology-oncology, and dermatology. Overall, contraceptive provision was documented in 28.6% of the visits. Whites versus nonwhites and older versus younger girls were more likely to receive contraceptive provision. The presence of a federal risk mitigation system for the teratogen also increased the likelihood of contraceptive provision. Our data demonstrate female adolescents prescribed teratogens receive inadequate contraception provision, which could increase their risk for negative pregnancy outcomes. Although the presence of a federal risk mitigation system appears to improve contraceptive provision, these systems are costly and, in some instances, difficult to implement. Efforts to improve provider practices are needed.

An observational study of the impact of the 2014 XX Commonwealth Games on the sexual and reproductive health services in Glasgow, Scotland.

Background: Large sporting events have raised concerns about the effect on the sexual and reproductive health (SRH) of visiting and resident populations to the host city and increased demand on SRH services. However, there is little evidence to support these concerns. The aim of this study is to investigate if the 2014 XX Commonwealth Games had an effect on the service demands of a Glasgow city-wide integrated SRH service. Methods: Electronic patient records, city-wide pharmacy data and case note review was used to assess aspects of SRH; this included overall attendance at integrated services, clinic and community emergency contraception prescriptions, victims of sexual assault, acute sexually transmissible infections (STIs), post exposure prophylaxis after sexual exposure (PEPSE) prescriptions, condom distribution and termination of pregnancy. Results: There was a significant decrease in core sexual health attendances, total acute STIs and emergency hormonal contraception prescriptions. There was no change in PEPSE prescriptions or the number of reported sexual assaults throughout the city. Conclusions: This study found no evidence that the 2014 XX Commonwealth Games placed any increased demand on the local SRH services, and showed no increase in STIs, emergency hormonal contraception prescriptions or sexual assaults. These findings will help service planning in host cities hosting future large sporting events.

Brief Behavioral Intervention to Improve Adolescent Sexual Health: A Feasibility Study in the Emergency Department.

Although emergency department (ED) visits offer an opportunity to deliver brief behavioral interventions to improve health, provision of ED-based interventions targeting adolescent sexual health is uncommon. The objectives for this study were to evaluate the feasibility and preliminary effects of a novel sexual health service intervention for adolescents. In this cross-sectional feasibility study, sexually active patients aged 14 to 19 years presenting to a Midwestern pediatric ED were recruited to receive an intervention to improve sexual health. The intervention, based on motivational interviewing (MI), included agenda setting, exploration of behaviors, a decisional balance exercise, tailored feedback, and provision of personalized health services (including condoms, prescription for emergency contraception, urine testing for Chlamydia trachomatis and Neisseria gonorrheae, and referral to the hospital-affiliated adolescent clinic). Data were collected before and after intervention administration and at a 3-month follow-up telephone interview. Surveys assessed sexual risk behaviors, satisfaction with the intervention, health care use, and demographics. Feasibility criteria were (1) subject-rated interventionist fidelity to MI principles (Likert scale 1 [strongly agree] to 4 [strongly disagree]), (2) subject satisfaction (Likert scale 1 [not at all] to 5 [very]), and (3) session duration (minutes, recorded by the interventionist). A secondary outcome was the proportion of subjects who completed at least 1 health service. Services provided at the adolescent clinic were determined by an electronic medical record review. Comparisons of responses between sex subgroups were analyzed using Χ test. From August to November 2012, 69 adolescents were approached, 66 (96%) completed the screening survey, and 24 (37%) reported previous sexual activity. Of those, 20 (83%) agreed to participate. The mean (SD) age was 16.2 (1.4) years; 60% were female. Most (78%) reported that the interventionist maintained high fidelity to MI principles and most (80%) were very satisfied with the intervention. Mean (SD) intervention length was 15.7 (2.2) minutes. Most subjects (65%) accepted 1 or more health services, including 42% who completed clinic follow-up. In the ED or the referral clinic, the following services were provided to the subjects: condoms (n = 11), emergency contraception prescription (n = 5), C. trachomatis/N. gonorrheae testing (n = 4), hormonal birth control provision (n = 2), and human immunodeficiency virus testing (n = 3). Fifteen subjects (75%) were reached for the 3-month follow-up, and condom use was maintained by 67% of those reporting sexual activity. This study demonstrated the feasibility and potential utility of an MI-based service navigation intervention to connect youth with point-of-care services as well as resources for ongoing sexual health needs.

Trends of contraception among ladies of local population in Pakistan; why, how, when and what?

Objective:To analyze trends of use of methods of contraception along with study of impact of various demographic and social factors on contraception in Peshawar, Pakistan.Methods:A cross-sectional descriptive study with random purposive sampling was conducted at Combined Military Hospital Peshawar, from Mar 2015-Nov 2015. Self-designed questionnaire with demographic details and questions pertinent to contraceptive practices was utilized as study instrument. Females reporting to concerned hospital for contraceptive advice and prescription were distributed with questionnaire and written informed consent form. Formal approval was taken from ethical committee of hospital. Data was analyzed via descriptive analysis (SPSS-21), qualitative data was expressed as frequencies and percentages; quantitative as mean±standard deviation (SD). Main outcome variable i-e contraceptive device used; was cross-tabulated with independent variables.Results:Response rate was 53.2% (n-426). Usage of contraceptive device was as follows; 51.2% Nil, 9.4% barriers, 22.3% oral/injectable hormones, 13.4% IUCDs, 3.8% sterilization. There was a strong relationship between type of contraceptives used and age (p<0.001), client’s education (p<0.001), husband’s education (p<0.001), number of children (p<0.001), religion (p0.013), socioeconomic class (p<0.001), and religious beliefs about use of contraceptives (p<0.001). More Muslims considered contraception irreligious than non-Muslims (p 0.02). There was no significant impact of husbands’ pressure to not to use contraceptives on type of contraception practised (p 0.114).Conclusion:Contraceptive devices are under-utilized in the study participants. Multidisciplinary approach should be applied to enhance client education, awareness and counseling to utilize these devices more appropriately and regularly.

Assessing the Moral Coherence and Moral Robustness of Social Systems: Proof of Concept for a Graphical Models Approach.

This paper presents a proof of concept for a graphical models approach to assessing the moral coherence and moral robustness of systems of social interactions. "Moral coherence" refers to the degree to which the rights and duties of agents within a system are effectively respected when agents in the system comply with the rights and duties that are recognized as in force for the relevant context of interaction. "Moral robustness" refers to the degree to which a system of social interaction is configured to ensure that the interests of agents are effectively respected even in the face of noncompliance. Using the case of conscientious objection of pharmacists to filling prescriptions for emergency contraception as an example, we illustrate how a graphical models approach can help stakeholders identify structural weaknesses in systems of social interaction and evaluate the relative merits of alternate organizational structures. By illustrating the merits of a graphical models approach we hope to spur further developments in this area.

Prescription Birth Control Access Among U.S. Women at Risk of Unintended Pregnancy.

Access to contraception is a vital component of preventing unintended pregnancies. This study was conducted to assess the prevalence of and factors associated with U.S. women's difficulty accessing prescription contraception (pill, patch, or ring). We performed a nationally representative survey of adult women at risk of unintended pregnancy (aged 18-44, not pregnant or seeking pregnancy, sexually active, not sterilized) using a probability-based web panel. In November to December 2011, 2046 women completed the survey. Weighted proportions were calculated and logistic regression was used to identify covariates associated with difficulty obtaining or refilling prescription contraception. A total of 1385 (68%) women had ever tried to get a prescription for hormonal contraception. Among this population, 29% reported ever having problems obtaining a prescription or refills. In multivariable regression, uninsured (vs. privately insured) and Spanish-speaking (vs. English-speaking) women were significantly more likely to report difficulties; women with a high school degree and those with some college (vs. a college degree or higher) were significantly less likely to report difficulty. Difficulties included cost barriers or lack of insurance (14%), challenges obtaining an appointment or getting to a clinic (13%), the clinician requiring a clinic visit, exam, or Pap smear (13%), not having a regular doctor/clinic (10%), difficulty accessing a pharmacy (4%), and other reasons (4%). One-third of adult U.S. women who have ever tried to obtain prescription contraception reported access barriers. While the Affordable Care Act may resolve some of these issues, these data indicate that additional factors may still need to be addressed.

Chronic Conditions Needn't Preclude Contraception

Women with chronic conditions may face excess risk for adverse pregnancy outcomes. To explore contraceptive use among women with selected medical conditions (e.g., breast cancer, diabetes, hypertension), researchers analyzed a nationwide healthcare claims database to identify privately insured women (age range, 15–44) with and without such conditions and assessed claims indicating use of prescription contraceptives during fiscal year 2011 (including …

A Qualitative Study of Prescription Contraception Use: The Perspectives of Users, General Practitioners and Pharmacists.

BackgroundThe oral contraceptive pill (OCP) remains the most popular form of prescription contraception in many countries, despite adherence difficulties for many. Uptake of long acting reversible contraceptives (LARCs), which are less reliant on user adherence, remains low. The aim of this study was to explore the experiences of, and attitudes towards, prescription contraception amongst samples of contraception users, general practitioners (GPs) and pharmacists.Methodology and FindingsWe conducted a qualitative study using semi-structured interviews with 18 contraception users, 18 GPs and 9 pharmacists. The study took place in Galway, Republic of Ireland between June and September 2014. Thematic analysis was used to analyse the data. Overall, contraception users were more familiar with the OCP, and all the women interviewed began their prescription contraception journey using this method. All participants identified episodes of poor adherence throughout the reproductive life course. The identified barriers for use of LARCs were lack of information, misconceptions, lack of access and high cost. In contrast, GPs believed that adherence to the OCP was good and stated they were more likely to prescribe the OCP than other methods, as they were most familiar with this option. Barriers to prescribing LARCSs were time, cost to practice, training and deskilling. Pharmacists also believed that adherence to the OCP was generally good and that their role was limited to dispensing medication and providing information when asked.Discussion and ConclusionThere are contrasting perspectives between contraception service providers and contraceptive users. Training for healthcare providers is required to support informed contraceptive choice and adherence. It is necessary to address the practice barriers of cost and lack of time, to promote better communication around adherence issues and prescription contraception options. There is a need for more easily-accessible public health information to promote awareness on all methods of prescription contraception.

Délivrance par l’infirmière de la contraception orale suite à une prescription médicale initiale aux mineurs et aux non-assurés sociaux dans les centres de planification et d’éducation familiale du Val-de-Marne

Since 2012in France, nurses are allowed to renew the medical prescription of oral contraceptives (OC). To support this plan, a service protocol in family planning centers allows nurse delivery of OC. This is a pilot feasibility study. After a medical prescription of OC, the nurse is authorized to deliver OC for 3months after a nursing interview. The duration of the nursing follow-up is determined by the physician. A total of 244nurses interviews of 170women were conducted between January 2012and July 2013. All women have benefited from a delivery of contraceptives by the nurse. Analysis shows that 40interviews (16%) had one or more abnormal criteria. Of these, more than a quarter found poor tolerance of contraception and/or the appearance of gynecological symptoms (27%) or unprotected sex with a new partner (25%). In these cases, an orientation to the physician was more frequent (85% versus 62%, P=0.005) and faster (median 33days versus 90days, P<0.001) than if the nurse interview was normal. Our study shows the feasibility of delivery protocol of oral contraception by nurses following an initial prescription by the physician.

Contracepção Hormonal segundo a Ótica do Estudante de Medicina: Mais um Desafio para o Ensino Médico Brasileiro?

RESUMO Introdução Desde a década de 1960, vêm-se utilizando anticoncepcionais orais como forma efetiva de contracepção. De modo a uniformizar e guiar a prescrição de tais medicamentos em situações especiais, a Organização Mundial da Saúde (OMS) lançou o guia Critérios de elegibilidade para o uso de contraceptivos. Objetivo Este estudo objetiva avaliar os conhecimentos de internos de Medicina de uma universidade a respeito da prescrição de anticoncepcionais hormonais de acordo com o Guia da OMS. Métodos Foi realizado um estudo transversal, descritivo, com alunos do quinto e sexto anos de Medicina de uma universidade em Goiânia (GO) por meio da aplicação de um questionário com perguntas técnicas sobre indicações e contraindicações de determinados métodos contraceptivos em situações especiais. Foi realizada análise univariada, e os dados foram dispostos em tabelas de frequência. Resultados Responderam ao questionário 92% dos acadêmicos, dos quais 72% afirmaram se sentir aptos a prescrever anticoncepcionais hormonais (ACH). Os acertos variaram de 3%, na prescrição correta em hipertensas leves, a 27%, em mulheres com cefaleia leve sem sinais focais. Conclusão A maioria dos alunos se sentia apta a prescrever contraceptivos hormonais, mas grande parte deles apresenta conhecimento inconsistente quando colocada em situações especiais presentes na prática clínica. Considerando-se que o interno dentro em breve ingressará no mercado de trabalho, propõe-se uma revisão do plano de ensino de forma a dar mais ênfase ao tema em questão.

Contraception Delivery in Pediatric and Specialist Pediatric Practices

Study ObjectiveTo characterize pediatricians' knowledge, attitudes, and self-efficacy around contraception. DesignCross-sectional survey. SettingUnited States. ParticipantsNational sample of pediatricians. InterventionsAssessment of behaviors of providing contraception. Main Outcome MeasuresReproductive health practice score. ResultsTwo hundred twenty-three usable surveys were received, from 163 contraceptive prescribers and 60 nonprescribers. The mean reproductive health practice score was 43.1 (SD, 8.2; total possible score, 84). Prescribers differed in their mean reproductive health score (46.0; SD, 7.0) from nonprescribers (34.0; SD, 4.5; P < .001). Prescribers vs nonprescribers differed in their attitude and efficacy in providing contraception. More prescribers believed it was their responsibility to ask about patients' need for birth control, were confident in their ability to prescribe contraception options, and provided contraception to minors despite parental disapproval. Neither group was confident in their ability to place intrauterine devices or believed that the literature supports intrauterine device placement in adolescents. Only efficacy was related to prescribing contraception in a multivariate regression analysis (odds ratio, 1.7; P < .001). ConclusionIn this study, we showed that most pediatricians are contraception prescribers but the overall reproductive health score was low for prescribers and nonprescribers. The odds of prescribing contraception increased with higher self-efficacy scores rather than knowledge alone. Many prescribers and nonprescribers would not prescribe birth control if parents disapproved and do not believe it is their responsibility to assess patients' need for birth control. In addition very few pediatricians have training in long-acting reversible contraception, despite being the recommended method for adolescents.

Improving Awareness and Outcomes Related to Venous Thromboembolism.

Improving Awareness and Outcomes Related to Venous Thromboembolism.

AKT question relating to contraception prescribing

AKT question relating to contraception prescribing

AKT answer relating to contraception prescribing

AKT answer relating to contraception prescribing