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Accessibility of Pharmacist-Prescribed Contraceptives in Utah. Obstet Gynecol 2021; 138:871-877. [PMID: 34735383 PMCID: PMC8594517 DOI: 10.1097/aog.0000000000004594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess pharmacy participation in and accessibility of pharmacist-prescribed contraception after legislation effective in the state of Utah in 2019. METHODS A secret-shopper telephone survey was used to assess participation in pharmacist-prescribed contraception. Geospatial analysis was used to map the distribution of participating pharmacies by population characteristics. RESULTS Of all operating Class A retail pharmacies in Utah, 127 (27%) were providing pharmacist-prescribed contraception 1 year after implementation of the Utah standing order. Oral contraceptive pills were widely accessible (100%); however, other allowed methods were not (vaginal ring 14%; contraceptive patch 2%). Consultation fees and medication costs varied widely. Participating pharmacies were mainly concentrated in population centers. Assuming access to a personal vehicle, urban areas with a high percentage of Hispanic people (Utah's largest minority race or ethnicity group) have access to a participating pharmacy within a 20-minute driving distance. However, access in rural areas with a high percentage Hispanic or other minority were limited. We identified 235 (40%) census tracts with a high proportion of Utah's residents living below the poverty line or of minority race or ethnicity who also had low access to pharmacist-prescribed contraception. CONCLUSIONS Although the pharmacy-based model is intended to increase access to contraception, practical availability 1 year after the authorization of pharmacist-prescribed contraception in Utah suggests that this service does not adequately serve rural areas, particularly rural areas with a high proportion of minorities and those living below the federal poverty line.
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Uhm S, Chen MJ, Cutler ED, Creinin MD. Twelve-month prescribing of contraceptive pill, patch, and ring before and after a standardized electronic medical record order change. Contraception 2020; 103:60-63. [PMID: 33098853 DOI: 10.1016/j.contraception.2020.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/01/2020] [Accepted: 10/12/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the proportion of 12-month contraceptive pill, patch, and ring prescriptions before and after an institution-wide change of default electronic medical record facility orders to dispensing 12-month supply. STUDY DESIGN This retrospective pre-post study compares outpatient contraception prescriptions from August 10, 2019 through April 9, 2020 obtained from our institutional electronic medical record prescription database. On December 10, 2019, we facilitated a change in the default orders for dispensing self-administered hormonal contraceptives from one-month to 12-months. We evaluated the primary outcome of 12-month supply prescriptions during the four months before and after the change. We also compared 12-month supply prescriptions for pills, patch, and ring by prescriber specialty and location. RESULTS The dataset included 4897 distinct evaluable prescriptions for the pill, patch, or ring, with an overall increase in 12-month prescriptions from 260/2437 (10.7%) to 669/2460 (27.2%) after the order change (p < 0.001). Twelve-month pill prescriptions increased from 238/2250 (10.6%) to 607/2250 (27.0%) (p < 0.001), patch prescriptions from 6/40 (15.0%) to 21/44 (47.7%) (p = 0.002), and ring prescriptions from 16/147 (10.9%) to 41/165 (24.8%) (p = 0.001). Twelve-month prescriptions increased after the order change among all provider types at the medical center campus (194/594 [32.7%] to 329/623 [52.8%], p < 0.001). At community clinics, non-obstetrics/gynecology providers increased 12-month prescriptions after the order change (58/1616 [3.6%] to 327/1612 [20.3%], p < 0.001), but obstetrics/gynecology providers did not (8/227 [3.5%] to 13/225 [5.8%], p = 0.27). CONCLUSION Providers more frequently prescribed a 12-month supply of contraceptive pills, patches, and rings after a change in the default dispensing quantity in electronic medical record orders. IMPLICATIONS Institution-wide changes to the electronic medical record default facility order settings can increase 12-month supply contraceptive prescriptions. As a 12-month prescription order represents only one step of many in obtaining a 12-month contraception supply, additional research is required to elucidate and remove other potential barriers.
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Affiliation(s)
- Suji Uhm
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA
| | - Melissa J Chen
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA
| | - Erika D Cutler
- Department of Pharmacy Services, University of California, Davis, Sacramento, CA, USA
| | - Mitchell D Creinin
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA.
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Martins SL, Hellerstedt WL, Mason SM, Brady SS. Pregnancy Prevention on the Fly: An Exploratory Study of Contraceptive Lapse Among Young Women Traveling Internationally. J Womens Health (Larchmt) 2019; 28:951-960. [PMID: 31184981 DOI: 10.1089/jwh.2018.7371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: International travel is increasingly popular, and women comprise half of all outbound travel from the United States (almost 46 million trips in 2017). The implications of international travel for women's reproductive health are not fully clear due to lack of data on travelers' contraceptive use. Methods: Women attending a U.S. university (n = 340) completed a cross-sectional survey in 2016-2017 about their sexual and reproductive health during recent international travel. Participants were 18-29 years old (mean: 21.1) and had a history of male sex partners. We calculated the prevalence of contraceptive lapse-nonadherence (e.g., missed pill) or having sex without contraception-by individual and travel-related characteristics and evaluated multivariable correlates of lapse using modified Poisson regression and prevalence ratios (PRs). Results: Prevalence of contraceptive lapse was 29% overall and especially high among pill users (50%). Multivariable correlates of lapse were the following: using the pill (PR 4.51, 95% confidence interval [CI] 2.57-7.94) compared to other or no contraception; trip duration of >30 days versus 1-7 days (PR 2.02, 95% CI 1.14-3.57); having trouble communicating with a male partner about contraception (PR 1.79, 95% CI 1.16-2.75); a high perceived impact of language barriers (PR 1.77, 95% CI 1.02-3.08); and perceiving local access to abortion as difficult (PR 1.67, 95% CI 1.22-2.27). There was a trend toward increased lapse prevalence among participants who had difficulty maintaining their contraceptive schedule while traveling across time zones (PR 1.38, 95% CI 1.00-1.91). Conclusions: During international travel, prevalence of contraceptive lapse varied by young women's chosen contraceptive method as well as travel-specific factors. Pretravel counseling by clinicians can help women anticipate contraceptive challenges and reduce the likelihood of unintended pregnancy.
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Affiliation(s)
- Summer L Martins
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Wendy L Hellerstedt
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Susan M Mason
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Sonya S Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
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Murphy J, Eustace N, Sarma KM, Molloy GJ. Habit Strength and Adherence to Oral Contraceptives: the Role of Time- and Place-Based Cues. Int J Behav Med 2019; 25:431-437. [PMID: 29856008 DOI: 10.1007/s12529-018-9729-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Non-adherence to the oral contraceptive pill (OCP) has been reported by almost half of OCP users. As the efficacy of the OCP requires daily adherence, poor adherence often leads to unplanned pregnancies in women who depend on this method of contraception. This study aims to investigate the association between habit strength and time- and place-based cues in the context of adherence to the OCP. METHODS A cross-sectional questionnaire of 245 current OCP users with a mean age of 22.41 years (SD = 4.78) and a range of 18-52 years was conducted. The Self-Report Behavioural Automaticity Index was employed to measure habit strength. The Medication Adherence Report Scale was used and modified to refer to OCP non-adherence specifically. Additional measures were employed to assess the use of time- and place-based cues. Data were analysed using correlational analyses. RESULTS Stronger habit strength was associated with better adherence to the OCP (r = - 0.25, p < .001). Having a fixed time of day to take the OCP was associated with habit strength and OCP adherence. Having a fixed place to store the OCP was associated with habit strength but not with OCP adherence. CONCLUSIONS Time- and place-based cues are likely to be an important part of any intervention design to support adherence and strengthen the habit of taking the OCP. It is recommended that future replications include longitudinal study designs and analyses.
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Affiliation(s)
- Jane Murphy
- School of Psychology, NUI Galway, Galway, Ireland
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Martins SL, Mason SM, Hellerstedt WL, Brady SS. Risk of Contraceptive Lapse and New Sexual Partnership Among Female University Students Traveling Internationally. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2018; 50:173-180. [PMID: 30118153 DOI: 10.1363/psrh.12075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT International travel is common and may influence women's sexual and reproductive health through myriad pathways. Existing studies focus on travelers' risk of acquiring STDs, but not their pregnancy prevention behaviors. Further, it is unclear whether sexual and reproductive health outcomes observed for female travelers are associated with travel itself, because few studies compare travelers with nontravelers. METHODS An online survey was conducted in 2016-2017 among females attending a U.S. university who reported a history of sex with men; the sample comprised 340 students who had traveled internationally in the past three months (travelers) and 170 who intended to travel in the next three months (pretravelers). Multivariable modified Poisson regression models assessed associations between travel status and two outcomes during travelers' recent trip or a period of similar duration for pretravelers: contraceptive lapse (incorrect or inconsistent use of any method) and new sexual partnership. RESULTS Travelers and pretravelers reported similar levels of contraceptive lapse (29% and 32%, respectively) and new sexual partnerships (17% and 12%). Multivariable analysis confirmed that travelers were no more likely than pretravelers to have contraceptive lapses, but indicated that they were more likely to report a new male partner (relative risk, 1.7). Most participants (80%) had a regular source of sexual and reproductive health care; 42% of travelers had seen a health care provider in preparation for their trip. CONCLUSION If the findings are corroborated by additional research, they may suggest a role for health care providers in students' pretravel period.
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Affiliation(s)
- Summer L Martins
- Doctoral student, Division of Epidemiology and Community Health, University of Minnesota School of Public Health
| | - Susan M Mason
- Assistant professor, Division of Epidemiology and Community Health, University of Minnesota School of Public Health
| | - Wendy L Hellerstedt
- Associate professor, Division of Epidemiology and Community Health, University of Minnesota School of Public Health
| | - Sonya S Brady
- Associate professor, Division of Epidemiology and Community Health, University of Minnesota School of Public Health
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MacGregor EA, Guillebaud J. The 7-day contraceptive hormone-free interval should be consigned to history. BMJ SEXUAL & REPRODUCTIVE HEALTH 2018; 44:bmjsrh-2017-200036. [PMID: 29945924 DOI: 10.1136/bmjsrh-2017-200036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 05/04/2018] [Accepted: 05/04/2018] [Indexed: 06/08/2023]
Abstract
AIM This review summarises the available data on the disadvantages of the 7-day contraceptive-free interval (CFI) of combined oral contraceptives (COCs), in contrast to shorter CFIs or continuous use - including flexible regimens - and provides recommendations for practice. METHODS Relevant papers were identified by Medline and PubMed. The final reference list was generated on the basis of relevance to the review, with priority given to systematic reviews and randomised controlled trials. RESULTS There is considerable inter- and intra-individual variation in the absorption and metabolism of COCs. Even with perfect use, the loss of endocrine suppression during the standard 7-day CFI allows follicular development with the risk of escape ovulation in a vulnerable minority. This risk increases in typical users whenever the CFI is prolonged: late restarts are a common reason for pill omissions. Shortening or eliminating the CFI improves contraceptive efficacy using the lowest doses available, without evidence to date of compromised safety. CONCLUSIONS There is no scientific evidence to support a 7-day CFI and it should be replaced either by a continuous flexible regimen, or extended regimens with a shortened CFI, prescribed first-line. In women preferring a monthly 'bleed', a 4-day CFI similarly provides a greater safety margin when pills are omitted.
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Affiliation(s)
- E Anne MacGregor
- Barts Health NHS Trust, London, UK
- Barts and the London School of Medicine and Dentistry, Centre for Neuroscience & Trauma, London, UK
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Eustace N, Sarma KM, Murphy J, Molloy GJ. Conscientiousness and adherence to the oral contraceptive pill: a cross-sectional analysis of the facets of conscientiousness. PSYCHOL HEALTH MED 2018. [DOI: 10.1080/13548506.2018.1450518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Neidin Eustace
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Kiran M. Sarma
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Jane Murphy
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Gerard J. Molloy
- School of Psychology, National University of Ireland Galway, Galway, Ireland
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Chabbert-Buffet N, Jamin C, Lete I, Lobo P, Nappi RE, Pintiaux A, Häusler G, Fiala C. Missed pills: frequency, reasons, consequences and solutions. EUR J CONTRACEP REPR 2017; 22:165-169. [DOI: 10.1080/13625187.2017.1295437] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Nathalie Chabbert-Buffet
- Department of Obstetrics and Gynaecology, APHP Tenon Hospital, Pierre and Marie Curie University, Paris, France
| | | | - Iñaki Lete
- Department of Obstetrics and Gynaecology, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Paloma Lobo
- Department of Obstetrics and Gynaecology, Infanta Sofía University Hospital, San Sebastián de los Reyes, Madrid, Spain
| | - Rossella E. Nappi
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, Research Centre for Reproductive Medicine, Gynaecological Endocrinology and Menopause, IRCCS San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Axelle Pintiaux
- Department of Obstetrics and Gynaecology, Citadelle Hospital, University of Liège, Liège, Belgium
| | - Günther Häusler
- Department of Gynaecology and Gynaecological Oncology, Vienna General Hospital, Vienna, Austria
| | - Christian Fiala
- Gynmed Outpatient Clinic for Pregnancy and Family Planning, Vienna, Austria
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Reminders make people adhere better to a self-help sleep intervention. HEALTH AND TECHNOLOGY 2016; 7:173-188. [PMID: 29201588 PMCID: PMC5686282 DOI: 10.1007/s12553-016-0167-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 12/07/2016] [Indexed: 11/11/2022]
Abstract
The experiment presented in this paper investigated the effects of different kinds of reminders on adherence to automated parts of a cognitive behavioural therapy for insomnia (CBT-I) delivered via a mobile device. Previous studies report that computerized health interventions can be effective. However, treatment adherence is still an issue. Reminders are a simple technique that could improve adherence. A minimal intervention prototype in the realm of sleep treatment was developed to test the effects of reminders on adherence. Two prominent ways to determine the reminder-time are: a) ask users when they want to be reminded, and b) let an algorithm decide when to remind users. The prototype consisted of a sleep diary, a relaxation exercise and reminders. A within subject design was used in which the effect of reminders and two underlying principles were tested by 45 participants that all received the following three different conditions (in random order): a) event-based reminders b) time-based reminders c) no reminders. Both types of reminders improved adherence compared to no reminders. No differences were found between the two types of reminders. Opportunity and self-empowerment could partly mediate adherence to filling out the sleep diary, but not to the number of relaxation exercises conducted. Although the study focussed on CBT-I, we expect that designers of other computerized health interventions benefit from the tested opportunity and self-empowerment principles for reminders to improve adherence, as well.
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Grindlay K, Grossman D. Prescription Birth Control Access Among U.S. Women at Risk of Unintended Pregnancy. J Womens Health (Larchmt) 2016; 25:249-54. [DOI: 10.1089/jwh.2015.5312] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Daniel Grossman
- Ibis Reproductive Health, Oakland, California
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, San Francisco, California
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MacLaughlin KL, Faubion SS, Long ME, Pruthi S, Casey PM. Should the annual pelvic examination go the way of annual cervical cytology? ACTA ACUST UNITED AC 2015; 10:373-84. [PMID: 25259899 DOI: 10.2217/whe.14.30] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The value of pelvic examination for healthy asymptomatic women has been called into question given the lack of benefit for ovarian and endometrial cancer screening, the ability to screen for sexually transmitted infections without a pelvic examination, and the uncoupling of the procurement of contraception with a pelvic examination. Still, there are indications for performing pelvic examinations in symptomatic women and in some high risk women. How do we as clinicians apply current evidence and expert opinion to our medical practice? Our recommendation to consider a pelvic examination at 3-5-year intervals with cervical cancer screening to elicit gynecologic and sexual health concerns offers a compromise between continuation of unnecessary annual pelvic examinations and complete elimination of these examinations.
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Affiliation(s)
- Kathy L MacLaughlin
- Department of Family Medicine, 200 First Street SW, Mayo Clinic, Rochester, MN 55905, USA
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Mohammad-Alizadeh-Charandabi S, Mirghafourvand M, Froghy L, Javadzadeh Y, Razmaraii N. The effect of multivitamin supplements on continuation rate and side effects of combined oral contraceptives: A randomised controlled trial. EUR J CONTRACEP REPR 2015; 20:361-71. [PMID: 25676163 DOI: 10.3109/13625187.2015.1010115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES This study aimed to assess the effect of multivitamin use during the pill-free interval on the continuation rate and side effects of combined oral contraceptives (COCs) within the first few cycles of use. METHODS In this trial, 332 women presenting to public health centres in an Iranian city each received a COC pack containing 21 pills and were randomised to one of three groups: two of the groups also received 42 multivitamin pills or 42 placebo pills to be taken once a day for 7 days before starting COCs and again during the 7-day pill-free interval for five cycles, while the third group received no multivitamin or placebo pills with their COCs. The groups were compared using Cox regression and χ(2) tests. RESULTS There were no losses to follow-up. Continuation rates at the sixth cycle were 88% for the multivitamin group, 75% for the placebo group and 67% for the no intervention group. Compared with the multivitamin group, the six-cycle discontinuation rate was significantly higher in the placebo group (hazard ratio [HR] 2.26, 95% confidence interval [CI] 1.15-4.45; p = 0.019) and no intervention group (HR 3.15, 95% CI 1.66-5.99; p < 0.001). Nausea, mood changes, weight gain and breast tenderness were significantly less common in the multivitamin group than in the other groups in all cycles, and spotting/irregular bleeding and dizziness were significantly less common in most of the second, third and sixth cycle follow-up. CONCLUSIONS Multivitamin supplements could significantly reduce the side effects of COCs in the initial cycles and improve continuation rates. However, the study limitations do not allow for any definite conclusion for their use in clinical practice, especially in communities rich in nutrients.
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Affiliation(s)
| | - Mojgan Mirghafourvand
- b Department of Midwifery , Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences , Tabriz , Iran
| | - Laya Froghy
- c Students' Research Committee, International Branch of Aras, Tabriz University of Medical Sciences , Tabriz , Iran
| | - Yousef Javadzadeh
- d Pharmaceutics Department, Faculty of Pharmacy, Tabriz University of Medical Sciences , Tabriz , Iran
| | - Nasser Razmaraii
- e Drug Applied Research Centre, Students' Research Committee, Tabriz University of Medical Sciences , Tabriz , Iran
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Grindlay K, Foster DG, Grossman D. Attitudes toward over-the-counter access to oral contraceptives among a sample of abortion clients in the United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2014; 46:83-89. [PMID: 24602230 DOI: 10.1363/46e0714] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
CONTEXT Women having abortions are at high risk for future unintended pregnancy, and removing the prescription requirement for oral contraceptives may increase continuation and adoption of this effective method. METHODS A survey fielded from May to July 2011 collected information from 651 women aged 15-46 seeking abortion services at six urban clinics from across the United States. Descriptive statistics, chi-square tests and logistic regression analyses were conducted to estimate women's interest in over-the-counter access to oral contraceptives. RESULTS Eighty-one percent of respondents supported over-the-counter access to oral contraceptives; while 42% of women planned to use the pill after their abortion, 61% said they would likely use this method if it were available over the counter. Thirty-three percent of women who planned to use no contraceptive following their abortion said they would use an over-the-counter pill, as did 38% who planned to use condoms afterward. In multivariable analysis, several subgroups had increased odds of likely over-the-counter use: women who were older than 19 (odds ratios, 1.8 for those aged 20-29 and 1.6 for those aged 30-46), were uninsured (1.5), had ever used the pill (1.4), had had difficulty obtaining a prescription refill for hormonal contraceptives (2.7) or planned to use the pill postabortion (13.0). By contrast, compared with white respondents, women of other races or ethnicities were less likely to say they would use over-the-counter pills (0.4-0.7). CONCLUSIONS Interest in a hypothetical over-the-counter oral contraceptive was high in this sample, and this delivery model has the potential to reduce unintended pregnancy among abortion patients.
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Merki-Feld GS, Gruber IML. Broad counseling for adolescents about combined hormonal contraceptive methods: the choice study. J Adolesc Health 2014; 54:404-9. [PMID: 23932259 DOI: 10.1016/j.jadohealth.2013.06.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 06/21/2013] [Accepted: 06/22/2013] [Indexed: 12/31/2022]
Abstract
PURPOSE The Contraceptive Health Research of Informed Choice Experience study involved 11 European countries with the goal of evaluating the influence of counseling on the user's choice among three different types of combined hormonal contraceptive (CHC) administration: pill, transdermal patch, and vaginal ring. Here, we report the results of the youngest age group (age 15-20 years) for Switzerland. METHODS A total of 1,032 adolescent women who contemplated a CHC form of contraception were counseled about the three CHCs. Questionnaires were filled out to determine the women's preferred choice before and after counseling, and the reason for their final decision. RESULTS After counseling, more than one third of the women decided to use a different contraceptive method than initially intended. The fraction of vaginal ring users increased from 7.5% to 21.8%, and that of patch users from 3.3% to 5.8%. At pre-counseling, 225 women had no preconceived idea about which method to choose. Only 29 women were still undecided post-counseling. The main reasons adolescent women chose the vaginal ring or the patch were the monthly or weekly use and the ease of use. CONCLUSIONS Adolescent women's decision about which CHC to use is greatly influenced by counseling that provides balanced information on all CHCs.
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Affiliation(s)
| | - Isabel M L Gruber
- Division of Medical Affairs, MSD Merck Sharp and Dohme AG, Luzern, Switzerland.
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Over-the-counter access to oral contraceptives as a reproductive healthcare strategy. Curr Opin Obstet Gynecol 2013; 25:500-5. [DOI: 10.1097/gco.0000000000000019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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McIntosh J, Wahlin B, Grindlay K, Batchelder M, Grossman D. Insurance and access implications of an over-the-counter switch for a progestin-only pill. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2013; 45:164-169. [PMID: 24020778 DOI: 10.1363/4516413] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Jennifer McIntosh
- Jennifer McIntosh is visiting researcher at the Department of Pharmacy, Hospital Clínic, Barcelona, Spain
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Adherence to hormonal contraception among women veterans: differences by race/ethnicity and contraceptive supply. Am J Obstet Gynecol 2013; 209:103.e1-11. [PMID: 23524170 DOI: 10.1016/j.ajog.2013.03.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/28/2013] [Accepted: 03/18/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of the study was to assess the adherence to hormonal contraception (pill, patch, ring, or injectable) among women veterans and examine the relationships between race/ethnicity and the months of contraceptive supply dispensed with contraceptive adherence. STUDY DESIGN We conducted a retrospective analysis of the Department of Veterans Affairs (VA) national databases to examine the adherence to hormonal contraception over 12 months among women aged 18-45 years who had hormonal contraceptive coverage during the first week of fiscal year 2008. We examined several adherence indicators including gaps between refills and months of contraceptive coverage. Descriptive statistics and multivariable models were used to examine the associations between race/ethnicity and contraceptive supply dispensed with adherence. RESULTS Our cohort included 6946 women: 47% were white, 6% were Hispanic, 22% were black, and 25% were other race or had missing race information. Most women (83%) received a 3 month supply of contraception at each fill. More than 64% of women had at least 1 gap in coverage of 7 days or longer. Only 22% of women received a full 12 months of contraception without any gaps (perfect adherence). Compared with whites, Hispanics were significantly more likely to experience gaps (64% vs 70%; P = .02), and Hispanics and blacks received fewer months of contraceptive coverage (9.3 vs 8.9 and 9.0, P < .001). Compared with women receiving 3 month supplies, those receiving 1 month supplies had a higher likelihood of a gap (63% vs 72%, P < .001), fewer months of coverage (9.3 vs 6.9, P < .001), and a lower likelihood of perfect adherence (22% vs 11%, P < .001). CONCLUSION Adherence to hormonal contraception among women veterans is poor. Efforts to improve contraceptive adherence and lower risk of unintended pregnancy are needed; dispensing more months of supply for hormonal contraception may be a promising strategy.
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Castaño PM, White KO. Should we do more to improve oral contraceptive continuation? WOMEN'S HEALTH (LONDON, ENGLAND) 2013; 9:145-156. [PMID: 23477321 DOI: 10.2217/whe.13.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Oral contraceptives are commonly chosen methods whose contraceptive effectiveness is very user-dependent. Approaches to significantly improving oral contraceptive continuation have been largely unsuccessful. Long-acting reversible methods are the most highly effective reversible contraceptives, with the highest continuation rates, and should be the first-line methods offered to reproductive-aged women.
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Affiliation(s)
- Paula M Castaño
- Columbia University Medical Center, New York, NY 10032, USA.
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Grindlay K, Burns B, Grossman D. Prescription requirements and over-the-counter access to oral contraceptives: a global review. Contraception 2012; 88:91-6. [PMID: 23352799 DOI: 10.1016/j.contraception.2012.11.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 11/12/2012] [Accepted: 11/29/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since the prescription requirement for oral contraceptives (OCs) can act as a barrier for some women, over-the-counter (OTC) access may improve uptake and continuation. The goal of this study was to ascertain the prescription requirements and informal OTC availability of OCs worldwide. STUDY DESIGN From April 2011 to September 2012, we researched official documentation and conducted an online survey with government officials and pharmaceutical and reproductive health specialists on OC availability in countries worldwide. Results were compiled in a database and entered into a map for analysis of regional patterns. RESULTS Data were obtained for 147 countries. OCs were informally available without prescription in 38% of countries, legally available without prescription (no screening by a health professional required) in 24% of countries, legally available without prescription (screening required) in 8% of countries and available only by prescription in 31% of countries. Notable regional patterns in OC prescription requirements emerged. CONCLUSIONS OCs are available without prescription in the majority of countries. Country experiences with OTC provision may provide evidence about the safety and effectiveness of OTC provision as a strategy to improve access to effective family planning.
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Holzgreve W, Pietrzik K, Koletzko B, Eckmann-Scholz C. Adding folate to the contraceptive pill: a new concept for the prevention of neural tube defects. J Matern Fetal Neonatal Med 2012; 25:1529-36. [PMID: 22272814 DOI: 10.3109/14767058.2011.648672] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although it is proven for a long time that folic acid supplementation in the periconceptional period can prevent neural tube defects (NTDs) effectively, all measures taken so far including food fortification and awareness campaigns so far had only limited success. Since more than 50% of the pregnant women in Europe get pregnant after they have used oral contraceptives (OCs) before, OCs are an ideal vehicle to increase not only the awareness for periconceptional folate application, but they can also help to bridge the gap between the recognition of a pregnancy and closure of the neural tube which is before day 26. In order to reach a truly protective folate level at the critical time period during pregnancy, now OCs are available which contain metafolin. The availability of this innovative type of OC will significantly reduce the number of NTDs.
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Abstract
INTRODUCTION Theory-based research is needed to understand poor contraceptive behavior and related reproductive health sequelae. The purpose of this review was to examine the Health Belief Model (HBM) as a comprehensive, well-tested social-cognitive framework suitable for explaining and predicting contraceptive behavior. METHODS Existing literature, including editorials and research reports, describing HBM-guided contraceptive research between January 1966 and February 2011 was retrieved from established electronic databases. After consideration of inclusion/exclusion criteria, 10 articles were included in the review. RESULTS Issues in original family planning applications of HBM included inconsistent conceptualizations of contraceptive behavior and limited use of all HBM constructs in research surveys, interventions, and analyses. Knowledge of contraceptive behavior has evolved, warranting more comprehensive use of the HBM for pertinent reproductive health contexts, behaviors, and methods. DISCUSSION With more rigorous applications, the HBM can help us understand modern contraceptive behavior determinants and facilitate strategies to prevent unintended pregnancy and promote positive family planning outcomes.
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Affiliation(s)
- Kelli Stidham Hall
- Office of Population Research, Center for Health and Wellbeing, Princeton University, Princeton, NJ 08544, USA.
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Merki-Feld GS, Gruber IML. Intention to use a combined contraceptive method and decision after counselling in Switzerland – Swiss data from the European CHOICE study. EUR J CONTRACEP REPR 2011; 17:119-27. [DOI: 10.3109/13625187.2011.630114] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Foster DG, Higgins JA, Karasek D, Ma S, Grossman D. Attitudes toward unprotected intercourse and risk of pregnancy among women seeking abortion. Womens Health Issues 2011; 22:e149-55. [PMID: 22000817 DOI: 10.1016/j.whi.2011.08.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 07/01/2011] [Accepted: 08/09/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the high prevalence of unintended pregnancies caused by lack of contraceptive use, little is known about women's reasons for or attitudes toward unprotected intercourse (UI). METHODS We included 562 women seeking pregnancy termination at six U.S. abortion clinics who completed surveys on their experiences and attitudes about UI, knowledge of the risk of conception, and willingness to engage in UI in the future. RESULTS Respondents reported an average of 18 acts of UI leading up to conception. The most commonly reported reasons for UI were thinking one could not get pregnant (42%), difficulties procuring a contraceptive method (40%), and not planning to have sex (38%). When asked about attitudes toward UI, 48% reported that UI feels better or more natural, 36% said it is okay to have UI once in a while or at certain times of the month, and 28% cited partner or relationship benefits as a reason to engage in UI. In addition, 23% said they were somewhat or extremely likely to engage in UI in the next 3 months. Younger women (<20 years), women who named partner or relationship benefits to UI, and women who underestimated the risk of conception were significantly more willing to engage in UI in the next 3 months. CONCLUSIONS Given the prevalence of risk taking and the perceived benefits of UI, contraceptives, particularly long-acting methods, need to be made easy to procure and use. The success of coital specific methods may be limited by women underestimating the risk of conception.
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Affiliation(s)
- Diana Greene Foster
- Bixby Center for Global Reproductive Health, University of California-San Francisco, Oakland, CA, USA.
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Foster DG, Higgins JA, Biggs MA, McCain C, Holtby S, Brindis CD. Willingness to have unprotected sex. JOURNAL OF SEX RESEARCH 2011; 49:61-68. [PMID: 21516592 DOI: 10.1080/00224499.2011.572307] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Little is known about people's willingness to engage in sex without protection from unwanted pregnancy. This study surveyed 1,497 women and men at 75 clinics and physician offices across California after their reproductive health care visits in late 2007 and early 2008. When asked if they would have sex without contraception, 30% said definitively that yes, they would have unprotected sex, and 20% indicated they would "sometimes" or "maybe" engage in unprotected sex. In multivariate models, compared to non-Latino White respondents, Latinos who responded to the survey in English were 52% more likely and African Americans were 75% more likely to report willingness to have unprotected intercourse. Wanting a child within the next three years was associated with increased willingness to have unprotected sex. Age, gender, parity, and relationship status were not significant in multivariate models. A considerable proportion of women and men may be willing to have unprotected sex, even with access to subsidized contraceptive services and even when recently counseled about birth control. The dominant behavioral models of contraceptive use need to acknowledge the widespread likelihood of occasional unprotected sex, even among people motivated to usually use contraceptives. Findings underscore the need to make contraceptive methods accessible, easy to use, and even pleasurable.
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Affiliation(s)
- Diana Greene Foster
- Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, CA 94612, USA.
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Rubin SE, Fletcher J, Stein T, Segall-Gutierrez P, Gold M. Determinants of intrauterine contraception provision among US family physicians: a national survey of knowledge, attitudes and practice. Contraception 2010; 83:472-8. [PMID: 21477692 DOI: 10.1016/j.contraception.2010.10.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 10/12/2010] [Accepted: 10/13/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Poor contraception adherence contributes to unintended pregnancy. Intrauterine contraception (IUC) is user-independent thus adherence is not an issue, yet few US women use IUC. We compared family physicians (FPs) who do and do not insert IUC in order to ascertain determinants of inserting IUC. STUDY DESIGN We surveyed 3500 US FPs. The primary outcome variable was whether a physician inserts IUC in their current clinical practice. We also sought to describe their clinical practice with IUC insertions. RESULTS FPs who insert IUC had better knowledge about IUC (adjusted OR 1.85, 95% CI 1.32-2.60), more comfort discussing IUC (adjusted OR 2.35, 95% CI 1.30-4.27), and were more likely to believe their patients are receptive to discussing IUC (adjusted OR 2.96, 95% CI 2.03-4.32). The more IUC inserted during residency, the more likely to insert currently (adjusted OR 1.44, 95% CI 1.12-1.84). Only 24% of respondents inserted IUC in the prior 12 months. CONCLUSIONS US FPs have training and knowledge gaps, as well as attitudes, that result in missed opportunities to discuss and provide IUC for all eligible patients.
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Affiliation(s)
- Susan E Rubin
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
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Hall KS, White KO, Reame N, Westhoff C. Studying the use of oral contraception: a review of measurement approaches. J Womens Health (Larchmt) 2010; 19:2203-10. [PMID: 21034277 PMCID: PMC2990281 DOI: 10.1089/jwh.2010.1963] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although oral contraception (OC) misuse is presumed to play an important role in unwanted pregnancy, research findings have often been equivocal, perhaps reflecting unaddressed inconsistencies in methodological approaches. METHODS Using established databases, we performed a systematic review of measurement methods for OC use using primary research reports published from January 1965 to December 2009. RESULTS Terminology used to describe OC use, which included "continuation," "compliance," and "adherence," differed across studies and was rarely defined. The majority of studies (n = 27 of 38, 71%) relied solely on self-report measures of OC use. Only two reports described survey or interview questions, and reliability and validity data were seldom described. More rigorous measurement methods, such as pill counts (electronic or manual), serum and urinary biomarkers, and pharmacy records, were infrequently employed. Nineteen studies simultaneously used more than one method, but only three studies compared direct and indirect methods. CONCLUSIONS The lack of a consistent, well-defined measurement of OC use limits our understanding of contraceptive misuse and related negative outcomes. Future research should clarify terminology, develop standardized measures, incorporate multimethod approaches with innovative methods, and publish details of measurement methods.
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Hughey AB, Neustadt AB, Mistretta SQ, Tilmon SJ, Gilliam ML. Daily context matters: predictors of missed oral contraceptive pills among college and graduate students. Am J Obstet Gynecol 2010; 203:323.e1-7. [PMID: 20643390 DOI: 10.1016/j.ajog.2010.05.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 04/16/2010] [Accepted: 05/27/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this study was to understand the relationship between daily contextual factors and oral contraceptive (OC) adherence among students who attend college or graduate school. STUDY DESIGN Data on OC adherence, demographics, contextual factors, and side-effects were collected as part of the acceptability of the NuvaRing (Merck & Co, Whitehouse Station, NJ) vs OC study, in which students were assigned randomly to the contraceptive vaginal ring or to a low-dose OC. We performed bivariate and multivariable analyses to create an explanatory model for nonperfect OC adherence (missed at least 1 pill during 3 months of use). RESULTS In a multivariable predictive model, missing a pill was associated positively with high perceived stress (odds ratio [OR], 3.16; P = .007), having ≥10 hours per week of paid employment (OR, 2.13; P = .075), and living with a partner (OR, 9.92; P = .040). CONCLUSION Stressful and hectic lives contribute to poor OC adherence. When counseling women about contraception, clinicians should consider the influence of daily life on contraceptive adherence.
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Bertin-Steunou V, Bouquet E, Cailliez E, Tanguy M, Fanello S. [General practitioners' (GPs) practice regarding the line to take in case of missed pill]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2010; 39:208-17. [PMID: 20334984 DOI: 10.1016/j.jgyn.2010.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 02/12/2010] [Accepted: 02/16/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To explore general practitioners' (GPs) practice face of missed pill and prevention of such missings. MATERIAL AND METHOD Twenty-five GPs from Sarthe Department (Western France) took part in semistructured interview during which they expressed themselves on the prevention of missed pill and its consequences. RESULTS Twelve out of 20 physicians stated positively that their female patients often forget their pill. However, they noted that missed pill was seldom a reason for phone call or consultation. During the initial pill prescription, GPs insisted on how to take the pill (14/25) as well as advice in case of a missed pill (22/25), their availability (12/25) and the instruction leaflet (16/25). But only five quoted the importance of involving women in the choice of contraception. On prescription renewal, only nine out of 25 ask their patients about observance defect and eight out of 25 repeated the information. If patients asked for further explanation, only two doctors out of 25 had practices in line with the French National Authority for Health's (HAS) recommandation guidelines. CONCLUSION GPs' attitudes are partly due to a lack of practice's knowledge in primary and emergency contraception methods. It seems essential to promote GPs' training and to take into account their expectations and needs. Furthermore, female patient must be actor of the choice of her contraceptive method in order to improve compliance and, therefore, effectiveness.
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Affiliation(s)
- V Bertin-Steunou
- UFR médecine, département de médecine générale, 49045 Angers cedex, France
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Why do women experience untimed pregnancies? A review of contraceptive failure rates. Best Pract Res Clin Obstet Gynaecol 2010; 24:443-55. [PMID: 20335073 DOI: 10.1016/j.bpobgyn.2010.02.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 02/04/2010] [Indexed: 12/11/2022]
Abstract
Contraceptive failure contributes to a substantial proportion of unintended pregnancy, particularly in the developed world. A number of socio-demographic factors seem to impact on the risk of a woman experiencing contraceptive failure. Many of the issues exist across cultural boundaries and are complex to address. In discussing the failure rates for individual contraceptive methods, this article will highlight the advantage of improving uptake of long-acting reversible methods of contraception which have a high efficacy and are less user-dependent than many of the other available methods.
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Chin-Quee D, Otterness C, Wedderburn M, McDonald O, Janowitz B. One versus multiple packs for women starting oral contraceptive pills: a comparison of two distribution regimens. Contraception 2009; 79:369-74. [DOI: 10.1016/j.contraception.2008.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Revised: 11/20/2008] [Accepted: 11/20/2008] [Indexed: 10/21/2022]
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Matter S, Meier B. Prospective memory affects satisfaction with the contraceptive pill. Contraception 2008; 78:120-4. [DOI: 10.1016/j.contraception.2008.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Revised: 04/03/2008] [Accepted: 04/24/2008] [Indexed: 11/28/2022]
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Friedman DS, Hahn SR, Gelb L, Tan J, Shah SN, Kim EE, Zimmerman TJ, Quigley HA. Doctor–Patient Communication, Health-Related Beliefs, and Adherence in Glaucoma. Ophthalmology 2008; 115:1320-7, 1327.e1-3. [DOI: 10.1016/j.ophtha.2007.11.023] [Citation(s) in RCA: 177] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Revised: 11/01/2007] [Accepted: 11/15/2007] [Indexed: 10/22/2022] Open
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Suppression of ovarian activity with a drospirenone-containing oral contraceptive in a 24/4 regimen. Contraception 2008; 78:16-25. [PMID: 18555813 DOI: 10.1016/j.contraception.2008.02.019] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Revised: 02/21/2008] [Accepted: 02/22/2008] [Indexed: 11/22/2022]
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Graziottin A. Safety, efficacy and patient acceptability of the combined estrogen and progestin transdermal contraceptive patch: a review. Patient Prefer Adherence 2008; 2:357-67. [PMID: 19920983 PMCID: PMC2770395 DOI: 10.2147/ppa.s3233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The worldwide introduction of the first, unique patch for hormonal contraception (ethinyl estradiol/norelgestromin, EE/NGMN patch) was widely recognized as a significant event in the development of drug delivery systems. This innovation offers a number of advantages over the oral route, and extensive clinical trials have proved its safety, efficacy, effectiveness, and tolerability. The weekly administration and ease of use/simplicity of the EE/NGMN patch contribute to its acceptability, and help to resolve the two main problems of non-adherence, namely early discontinuation and inconsistent use. The patch offers additional benefits to adolescents (improvement of dysmenorrhea and acne), adults (improvement in emotional and physical well-being, premenstrual syndrome, and menstrual irregularities), and perimenopausal women (correction of hormonal imbalance, modulation of premenopausal symptoms), thus providing high satisfaction rates (in nearly 90% of users). Since its introduction, the transdermal contraceptive patch has proved to be a useful choice for women who seek a convenient formulation which is easy to use, with additional, non-contraceptive tailored benefits for all the ages.
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Affiliation(s)
- Alessandra Graziottin
- Correspondence: Alessandra Graziottin, Via E. Panzacchi 6, 20123 Milano, Italy, Tel +39 02 72002177, Fax +39 02 876758, Email
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, Web www.alessandragraziottin.it
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Gilliam M, Holmquist S, Berlin A. Factors associated with willingness to use the contraceptive vaginal ring. Contraception 2007; 76:30-4. [PMID: 17586133 DOI: 10.1016/j.contraception.2007.03.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Revised: 03/18/2007] [Accepted: 03/21/2007] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The objective of this study was to examine factors associated with willingness to use the contraceptive vaginal ring among college students. MATERIAL AND METHODS We electronically surveyed a random sample of female undergraduates. Factors associated with willingness to use the contraceptive vaginal ring were evaluated using a logistic regression model. RESULTS Six hundred ninety-one women answered the survey. Willingness to use the contraceptive vaginal ring was positively associated with willingness to use the contraceptive patch, being employed at least 20 h/week, acceptability of a monthly contraceptive, acceptability of self-insertion, acceptability of feeling ring during intercourse and concern over potential hormonal side effects. Willingness to use the contraceptive vaginal ring was negatively associated with current use of oral contraceptives. DISCUSSION Busy lifestyle and acceptance of its characteristics were associated with willingness to use the contraceptive vaginal ring. Counseling should focus on addressing women's concerns about vaginal administration and side effects.
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Affiliation(s)
- Melissa Gilliam
- Department of Obstetrics and Gynecology, Section of Family Planning, The University of Chicago, Chicago, IL 60637, USA.
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Foster DG, Parvataneni R, de Bocanegra HT, Lewis C, Bradsberry M, Darney P. Number of oral contraceptive pill packages dispensed, method continuation, and costs. Obstet Gynecol 2006; 108:1107-14. [PMID: 17077231 DOI: 10.1097/01.aog.0000239122.98508.39] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the effect of the number of cycles of oral contraceptive pills (OCPs) dispensed per visit on method continuation, pill wastage, use of services, and health care costs. METHODS We used paid claims data for 82,319 women dispensed OCPs through the California Family PACT (Planning, Access, Care, and Treatment) Program in January 2003 to examine contraceptive continuation and service use. RESULTS Women who received 13 cycles at their first visit in January 2003 received 14.5 cycles over the course of 2003 compared with 9.0 cycles among women receiving three cycles at first visit. When client characteristics are controlled, women who received 13 cycles were 28% more likely to have OCPs on hand and twice as likely to have sufficient OCP cycles for 15 months of continuous use compared with women who received three cycles. Oral contraceptive pill wastage was higher among women initially dispensed 13 cycles (6.5% of the cycles dispensed) than among women who received three cycles (2% of cycles). Despite having one fewer clinician visit, women dispensed 13 cycles were more likely to receive Pap and Chlamydia tests and less likely to have a pregnancy test than women initially dispensed fewer cycles. Over the course of the year, Family PACT paid 99 US dollars more for women who received three cycles and 44 US dollars more for women who received only one cycle than it did for women who received 13 cycles at their first visits of 2003. CONCLUSION Dispensing a year's supply of OCP cycles to women is associated with higher method continuation and lower costs than dispensing fewer cycles per visit. LEVEL OF EVIDENCE II-2.
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Affiliation(s)
- Diana Greene Foster
- Bixby Center for Reproductive Health Research and Policy, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco General Hospital, University of California, San Francisco, CA, USA.
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