No missed opportunity: expanding sexual healthcare provision beyond current service delivery models
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Date
30/06/2018Author
Heller, Rebecca Lily
Metadata
Abstract
BACKGROUND:
Despite a wide range of contraceptive options available in the United
Kingdom, the unplanned pregnancy rate remains high. Contraceptive services are
currently delivered by general practitioners, sexual health clinics and pharmacies, but
there may be scope to expand the places that these are offered, and increase the
options available within each service. Doing so could increase the uptake of
contraceptive methods, particularly the most effective methods, and therefore reduce
the unplanned pregnancy rate.
AIM AND OBJECTIVES:
Research in this thesis aimed to investigate novel delivery
models of contraception. The research had two main areas of focus. Firstly the
capacity of the pharmacy to deliver regular contraception was examined, in the
context of existing literature, and then through a pilot study. After that the expansion
of contraception care to maternity services was investigated, first in the literature and
then using an observational study.
METHODS: In undertaking this thesis I used a variety of methods. Two patient surveys
were employed to investigate patients’ perspectives on proposed novel methods of
contraceptive delivery. A pilot study investigated the feasibility and acceptability of
delivery of the contraceptive injection at the pharmacy. Quantitative results about the
numbers of injections given were collected, as were patient questionnaires.
Qualitative one-to-one interviews were conducted with participating pharmacists,
these were recorded, transcribed and analysed.
An observational study was also undertaken to assess routine delivery of insertion of
intra-uterine contraception at the time of caesarean section. Patients were seen at six
weeks following insertion, and contacted by telephone at three, six and 12 months
about satisfaction and continuation of the method.
RESULTS: 220 women completed a questionnaire about attending the community
pharmacy to receive a contraception injection. 33% of current non-users indicated
that they would consider using this method if it was available at the pharmacy.
50 established users of the contraceptive injection participated in a pilot project
receiving up to three injections from the community pharmacy. Only 48 injections of
a possible 150 were delivered at the community pharmacy. Only 7 participants
received all three injections at the pharmacy, and participants reported mixed
experiences accessing the pharmacy. The practical obstacles around pharmacy
engagement and the challenges of retaining participants were significant, and more
research is necessary before proceeding with a randomised controlled trial.
250 women on a postnatal ward completed questionnaires about their pregnancy
intentions. 96.7% were not planning a baby in the next year, but only 23.6% were
planning on using the most effective methods of contraception. One in three
respondents described themselves as likely to use either an implant or intra-uterine
contraception if it could be inserted before they left the hospital.
In an observational study, 120/877 women opted to have intra-uterine contraception
inserted at the time of caesarean section. Continuation rates at 12 months were 84.8%
of those contacted, and 92.6% were either ‘very’ or ‘fairly’ happy with their
contraception.
CONCLUSION: Although patients are receptive to contraception being delivered using
novel service models, alternatives to current practice need careful investigation.
Contraceptive injections at the community pharmacy are not necessarily more
convenient for patients, and therefore may not increase uptake of this method.
However, offering intrauterine contraception to patients at the time of caesarean
section is highly acceptable to patients, and results in a substantial majority
continuing this highly effective method.
Robust and careful research using a range of methods can help to identify which
innovative approaches to contraceptive delivery offer the most promise.