Improvement in contraception provision within a hospital Genitourinary Medicine clinic.
ESC Congress Library. Mullin N. 05/28/14; 50520; A-105
Dr. Nicola Mullin
Dr. Nicola Mullin
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Abstract
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Background



In the UK progress has been made locally and nationally with the integration of Contraception and Genitourinary Medicine (GUM) services. A previous audit of our hospital GUM clinic demonstrated inadequate documentation and provision of contraceptive needs. This was, in particular, believed to be inefficient in meeting the needs of younger clients. Subsequently, the staff received additional training in contraception and a new clinical template with an integrated contraception history was created which enabled clinicians to better document contraceptive methods used and a pregnancy risk assessment. A re-audit was undertaken to assess the improvement in our services.

Methods


A retrospective case note analysis of 100 randomly selected female patients who attended from October to December 2012.

Results


The age range was 16-50 years (median age 24 years). Contraception history was documented in 99% (99/100) patients compared to 92% in the previous audit. Pregnancy risk assessment was evident in 97% compared to 29% previously. We identified 32 patients who were taking the combined pill,12 using Depo Provera, 8 taking progestogen-only pills, 5 had a contraceptive implant and 3 women were each using IUD and IUS. There were 20 patients using only condoms, and 8 not using any method.




In 72% (20/28) patients who were using condoms or no method, there was documentation of information given about methods of contraception along with leaflets, in the previous audit this was documented only in 27% of eligible patients. A discussion of long acting reversible (LARC) contraception was documented in 13/28 (46%) patients. Referral to a contraceptive clinic was arranged for 2 women while 3 declined referral; 6/20 (30%) women using condoms were started on a new method of contraception.


Emergency contraception (EC) was given to 2/3 eligible patients along with ‘quick start' regular hormonal contraception, 1 each were given Levonelle 1500 and ellaOne. An emergency IUD was discussed as the best method of EC in these patients. An offer of EC was missed in only 1 eligible patient in our study group.




Conclusion


Results showed an improvement in documentation of contraception history, pregnancy risk assessment and a discussion of available contraceptive methods in relevant patients. This re-audit demonstrates that contraceptive care improved after staff training and the introduction of the new clinical template. We are now better placed to address the contraceptive needs of young people, in particular, attending the hospital GUM clinic. The awareness of LARC methods still needs to  improve in our patients.


Background



In the UK progress has been made locally and nationally with the integration of Contraception and Genitourinary Medicine (GUM) services. A previous audit of our hospital GUM clinic demonstrated inadequate documentation and provision of contraceptive needs. This was, in particular, believed to be inefficient in meeting the needs of younger clients. Subsequently, the staff received additional training in contraception and a new clinical template with an integrated contraception history was created which enabled clinicians to better document contraceptive methods used and a pregnancy risk assessment. A re-audit was undertaken to assess the improvement in our services.

Methods


A retrospective case note analysis of 100 randomly selected female patients who attended from October to December 2012.

Results


The age range was 16-50 years (median age 24 years). Contraception history was documented in 99% (99/100) patients compared to 92% in the previous audit. Pregnancy risk assessment was evident in 97% compared to 29% previously. We identified 32 patients who were taking the combined pill,12 using Depo Provera, 8 taking progestogen-only pills, 5 had a contraceptive implant and 3 women were each using IUD and IUS. There were 20 patients using only condoms, and 8 not using any method.




In 72% (20/28) patients who were using condoms or no method, there was documentation of information given about methods of contraception along with leaflets, in the previous audit this was documented only in 27% of eligible patients. A discussion of long acting reversible (LARC) contraception was documented in 13/28 (46%) patients. Referral to a contraceptive clinic was arranged for 2 women while 3 declined referral; 6/20 (30%) women using condoms were started on a new method of contraception.


Emergency contraception (EC) was given to 2/3 eligible patients along with ‘quick start' regular hormonal contraception, 1 each were given Levonelle 1500 and ellaOne. An emergency IUD was discussed as the best method of EC in these patients. An offer of EC was missed in only 1 eligible patient in our study group.




Conclusion


Results showed an improvement in documentation of contraception history, pregnancy risk assessment and a discussion of available contraceptive methods in relevant patients. This re-audit demonstrates that contraceptive care improved after staff training and the introduction of the new clinical template. We are now better placed to address the contraceptive needs of young people, in particular, attending the hospital GUM clinic. The awareness of LARC methods still needs to  improve in our patients.


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