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
Edinburgh.
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.
