Quick starting contraception after emergency contraception: have clinical guidelines made a difference?
OBJECTIVE
When initiating contraception after emergency contraception (EC), conventional practice had been to wait until the next menses. Since 2010, UK guidelines have endorsed quick starting (QS) contraception, namely offering immediate start when requested. We conducted an audit to assess clinical practice before and after QS guidance publication.


METHODS
A full cycle audit was performed on the clinical notes of women requesting EC during two 2-month periods in 2010 and 2011 in an Integrated Sexual Health Service. All case notes were identified using the National Sexual Health database of sexual health records (Scotland). Information was collated and interpreted using Microsoft Excel and SPSS V.17.


RESULTS
During January and February 2010 and 2011, 190 and 180 women, respectively, attended for EC, of whom 96 and 97 were identified as potential quick starters. Between 2010 and 2011, a statistically significant increase in QS practice was noted from 20.8% (n=20) to 37.1% (n=36) (p=0.011), with a corresponding decrease in the percentage of women traditionally started on hormonal contraception (HC): 24% (n=23) and 14.6% (n=14), respectively. There was also a decrease in those advised to return for commencement of HC [55.2% (n=53) vs 49% (n=47)]. Of those advised to return, 26.4% (n=14) and 31.9% (n=15) had no further contact with the service within at least 6 months.


CONCLUSIONS
QS practice increased after the introduction of clinical guidelines. However, overall provision of HC remained low, with only around half of women prescribed a hormonal method.
ST1, Community Sexual and Reproductive Health, NHS Greater Glasgow and Clyde, Sandyford Sexual Health Service, Glasgow, UK.
Janine
J
Simpson
Researcher, Faculty of Sexual & Reproductive Health Clinical Effectiveness Unit, Glasgow, UK.
Julie
J
Craik
Consultant, Community Sexual and Reproductive Health, NHS Greater Glasgow and Clyde, Sandyford Sexual Health Service, Glasgow, UK, and Clinical Director, Faculty of Sexual & Reproductive Health Clinical Effectiveness Unit, Glasgow, UK.
Louise
L
Melvin
D000293:Adolescent; D000328:Adult; D044363:Contraception, Postcoital / Q000379:methods; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage*; D003281:Contraceptives, Postcoital / Q000008:administration & dosage*; D004363:Drug Utilization; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016912:Levonorgestrel / Q000008:administration & dosage*; D008485:Medical Audit; D057240:Patient Preference; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D018873:Pregnancy Rate; D019233:Retreatment; D012189:Retrospective Studies; D018570:Risk Assessment; D012606:Scotland; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D003278:Contraceptives, Oral, Hormonal; D003281:Contraceptives, Postcoital; D016912:Levonorgestrel
emergency contraception; hormonal contraception; long-acting reversible contraception; oral contraceptives