Variation in prescribing of long-acting reversible contraception in General Practice in UK
ESC Congress Library. Paul O. 05/28/14; 50595; A-180
Dr. O\'Brien Paul
Dr. O\'Brien Paul
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Abstract
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Introduction: In the UK most contraception is provided in General Practice. Long-acting reversible contraceptive (LARC) methods are more effective than the combined pill, and implantable methods are more cost effective than injectable contraception. Increasing the uptake of LARC methods should reduce the numbers of unintended pregnancies.  This study examines the use and variation of LARC methods in general practice.

Methods: We use prescription data for individual general practices in England recently released under the Open Data Platform. From 8.8 million prescriptions for contraceptives in 2012 we extracted 323,000 for implantable methods – intrauterine devices (IUD), intrauterine system (IUS) and implants.

Results: Of over 8,000 practices that provided some form of contraception in 2012, 6049, (66%) prescribed implantable LARCs. Amongst practices that provided IUDs the rates were mostly lower than 10/1,000 women aged 15-44. Practices in more deprived areas had lower rates of IUS insertions but similar rates for IUD and implant insertions compared to less deprived areas. When practices are aggregated into Primary Care Trusts the rates of insertions likewise correlate to deprivation. Prescription rates declined with increase deprivation for each of the three methods, more so for IUS. The relationship was statistically significant for each method. For IUS prescriptions, the association is partly explained by higher rates in rural areas.

Conclusions: One in 12 practices provided no implantable LARC methods in 2012. Practices in high areas of deprivation have lower rates of IUS provision. At PCT level, rates of provision of implantable contraceptive declined with increasing deprivation, partly a reflection of increased deprivation in urban areas. With the recent disruption in contraception provision following the reorganisation of sexual health services, regular monitoring of LARC prescribing is required to detect any fall off in provision.

Introduction: In the UK most contraception is provided in General Practice. Long-acting reversible contraceptive (LARC) methods are more effective than the combined pill, and implantable methods are more cost effective than injectable contraception. Increasing the uptake of LARC methods should reduce the numbers of unintended pregnancies.  This study examines the use and variation of LARC methods in general practice.

Methods: We use prescription data for individual general practices in England recently released under the Open Data Platform. From 8.8 million prescriptions for contraceptives in 2012 we extracted 323,000 for implantable methods – intrauterine devices (IUD), intrauterine system (IUS) and implants.

Results: Of over 8,000 practices that provided some form of contraception in 2012, 6049, (66%) prescribed implantable LARCs. Amongst practices that provided IUDs the rates were mostly lower than 10/1,000 women aged 15-44. Practices in more deprived areas had lower rates of IUS insertions but similar rates for IUD and implant insertions compared to less deprived areas. When practices are aggregated into Primary Care Trusts the rates of insertions likewise correlate to deprivation. Prescription rates declined with increase deprivation for each of the three methods, more so for IUS. The relationship was statistically significant for each method. For IUS prescriptions, the association is partly explained by higher rates in rural areas.

Conclusions: One in 12 practices provided no implantable LARC methods in 2012. Practices in high areas of deprivation have lower rates of IUS provision. At PCT level, rates of provision of implantable contraceptive declined with increasing deprivation, partly a reflection of increased deprivation in urban areas. With the recent disruption in contraception provision following the reorganisation of sexual health services, regular monitoring of LARC prescribing is required to detect any fall off in provision.

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