Combined oral contraceptive pill: Safety and satisfaction at Bassett Road Surgery

THE PROBLEM:

During a placement at Bassett Road Surgery in Leighton Buzzard, inconsistencies in the timeliness and content of combined pill follow-up were detected. This audit was carried out to investigate the safety of current combined pill prescribing and to explore whether patients are being prescribed the optimal method of contraception for them.

YOUR APPROACH:

A SystmOne search identified women aged 16-50 at the surgery that were due follow-up between January 2019 and March 2020 (n = 102). The occurrence and timeliness of follow-up were assessed, along with the following Faculty of Sexual and Reproductive Healthcare criteria: blood pressure (BP) check, body mass index (BMI) check, discussion about patient satisfaction and discussion about alternative methods of contraception. 

THE LEARNING:

82% of patients were followed up within 15 months of their previous pill review (n = 102). The percentage of follow-ups that included the criteria were as follows (n = 87): BP check (76%), BMI check (38%), patient satisfaction (63%) and alternative methods (54%). It is important to note that there is no system to alert clinicians that a review is due and that follow-up takes on multiple forms: patient questionnaire with manual BP check, pill check template, within a general medication review and within a routine doctor’s appointment. The latter two forms showed considerable variation with regard to the components assessed.

WHY IT MATTERS:

Bassett Road lacks a robust system to ensure that follow-up occurs annually and in full for every patient, and it is likely that other practices also fall short on providing follow-up for this reason. It would be beneficial for all primary care centres to standardise pill follow-up through the use of a patient questionnaire that covers all the criteria and manual BP check. Yearly prescriptions would also eliminate the uncertainty as to when follow-up is needed.