Increasing the Proportion of Women using Long Acting Reversible Contraception (LARC) within a Geographical Area in Scotland Dr Audrey Brown Dr Alison Bigrigg
Greater Glasgow and Clyde
Long-acting reversible contraception National Institute for Clinical Health and Excellence (NICE) 2005 Women should be offered a choice of all methods including LARC. All LARC methods are more cost effective than the combined oral contraceptive pill even at 1 year of use. IUDs, IUS and implants are more cost effective than the injectable contraceptives. Increasing the use of LARC will reduce unwanted pregnancies
Scotland 2004/5 Uptake intra-uterine device, intra-uterine system, contraceptive implant per 1000 women aged 15-44 Rate per 1000 women within Scotland Rate per 1000 women within GGC 23 17 Target set to increase from 17/1000 to 85/1000 in 5 years
National Drivers Key Clinical Indicator (KCI) on LARC Information and Statistics Division annual reporting of uptake by board area Quality Improvement Scotland (QIS) standard on intrauterine and implantable methods of contraception National LARC awareness campaign
Essential Criteria QIS LARC standard Women requiring contraception are given information about, and offered a choice of, all methods of contraception including intra-uterine and implantable contraceptives 60 or more females per 1000 of reproductive age per year are prescribed intrauterine and implantable contraceptives Contraceptive providers who do not provide intrauterine and implantable contraceptives have an agreed mechanism in place for referring women A consultation appointment with a service providing intrauterine and implantable contraceptives is available within 5 working days Desirable criterion 100 or more females per 1000 of reproductive age per year are prescribed intrauterine and implantable contraceptives by the end of 2011
Media launch Retail outlets Cinemas Gym changing rooms Bar toilets
Local action: Raise awareness through distribution of LARC resource pack Contraceptive prescribing guidance for primary care Improve access to free training, especially for nursing staff Reimburse primary care practitioners for provision of LARC in general practice Locality mapping to drive local planning
CONTRACEPTIVE PRESCRIBING IN PRIMARY CARE Patient requests contraception Take full medical and sexual history Check BP and smear status Offer STI screening Discuss contraceptive choices taking into account the above and patient preference Consider long-acting reversible contraception (LARC) as first line option as this is the most effective way to avoid pregnancy Consider appropriateness of COC or POP taking into account patients age, medical history, risk factors and patient preferences LONG-ACTING REVERSIBLE CONTRACEPTION (LARC) See Nice CG30 (Long-acting Reversible Contraception Oct 2005) Progesterone-only implant (Implanon ) - Lasts 3 years Copper IUD (TT380 Slimline ) - Lasts 10 years Progestogen-only IUS (Mirena ) - Lasts 5 years Useful if menorrhagia present Progestogen-only depot (Depo-Provera ) Given every 12 weeks NB: The effectiveness of LARC preparations containing hormones, such as Implanon may be affected by interacting medicines. Refer to individual SPC or BNF for guidance POP appropriate COC appropriate Micronor or Femulen Should be considered 1 st line POPs Cerazette should only be considered in women who cannot tolerate or have contraindications to oestrogen containing contraceptives Cerazette may also have advantages in women with a history of poor compliance 1 st line choice should be a standard strength 2 nd generation such as Microgynon 30 or Loestrin 30 If patient suffers from acne, consider Marvelon Adverse effects, poor cycle control or poor compliance may dictate further options
Local Enhanced Service Contraceptive Implant In 2009-10 each practice contracted to provide the contraceptive implant service will receive a 25.81 insertion fee and 51.61 removal fee per patient IUD/IUS In 2009-10 each practice contracted to provide the IUD/IUS service will receive a 79.92 insertion fee per patient.
5 years on.. Rate per 1000 women Rate per 1000 women within Scotland within GGC 2004/5 23 17 2005/6 30 31 2006/7 34 37 2007/8 41 46 2008/9 50 63 2009/10 (estimated) - 72
NHS Board NHS Greater Glasgow & Clyde NHS Dumfries & Galloway NHS Orkney NHS Highland NHS Ayrshire & Arran Scotland NHS Tayside NHS Borders NHS Lanarkshire NHS Grampian NHS Western Isles NHS Shetland NHS Lothian NHS Forth Valley NHS Fife 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 Rate per 1000
Summary Uptake of LARC in GGC has increased from 17/1000 women to 63/1000 women over 5 years Increase in uptake in GGC has outperformed that in Scotland as a whole A combination of national and local drivers are likely to have contributed We did not meet our own target of a 5 fold increase in uptake in 5 years But we did meet the essential QIS target of 60 per 1000 women being prescribed LARC