Use of a national guidance document to audit quality of care in the first prescription of combined oral contraception

Use of a national guidance document to audit quality of care in the first

prescription of combined oral contraception

M.F. Clark, A. Glasier

Lothian Primary Care NHS Trust, Family Planning and Well Woman Services,

Edinburgh, Scotland, UK

Introduction: In 2003 the Faculty of Family Planning and Reproductive

Health Care (FFPRHC) published evidence-based guidance for the first

prescription of the combined oral contraceptive pill (COC). The guidance

provides information to clinicians on steps to be taken before providing a woman

with her first prescription of COC. It has 38 evidence based recommendations

with a further 14 good practice points. Ten of these determine whether a patient

is medically eligible to use the COC (eligibility recommendations) and 22 cover

topics to be discussed with the patient (information and appropriate use

recommendations). We undertook a study to investigate how the guidance could be

used to test the quality of care relating to first pill prescribing and to what

extent the recommendations are being met in a large family planning clinic in


Methods: To investigate whether the recommendations relating to

medical eligibility were being met 109 sets of case notes of new patients

presenting to the clinic and prescribed the COC were scrutinised using a

standard audit record sheet. To investigate whether the information

recommendations had been met a questionnaire was designed to test a patients

knowledge of the COC including risks, benefits and appropriate use. A doctor

interviewed 50 women attending for repeat prescription of the COC.

Results: From the case note review 68% of patients were prescribed the

type of pill recommended by the FFPRHC guidance for their initial COC. When

patients were first prescribed the COC their blood pressure (BP) was recorded in

the notes in 90% and the BMI in 59.6% of cases. From interview 72% of patients

had been given supplementary written information; 92% knew that the COC

increased their risk of venous thromboembolism (VTE); 24% knew it increased

their risk of breast cancer. Knowledge of the health benefits of the pill was

quite good.

Discussion: The tools we developed to test implementation of the

guidance were not difficult or time consuming to use but are not perfect. Some

of the FFPRHC recommendations are easier to audit than others. Despite the

shortcomings of the tools, the clinic performance could improve.

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