Counseling for combined hormonal contraception

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A new analysis shows that provider counseling about combined hormonal contraception (CHC) often does not include information about all available options.

The report in the journal Contraception also found that comprehensive information about side effects, benefits or logistics of use is often missing.

The investigators, mostly from the University of California, San Francisco, used data collected by the Patient-Provider Communication about Contraception study. That study recruited reproductive-age women and their providers from six San Francisco Bay Area clinics between 2009 and 2012. 

The women completed pre- and post-visit surveys, plus had their visits audio recorded and transcribed.

Of the 342 women included for analysis, 44% (n=152) had a preference for a specific CHC, whereas 37% (n=127) favored a non-CHC method and 18% (n=63) had no existing method preference.

A full 72% of women who reported preferring a CHC in their pre-visit survey chose that method. An additional 7% selected a different CHC method.

But women were inconsistently counseled about the range of CHC options.

For instance, women who favored CHC or the ring were significantly more likely to leave the office visit with their preferred method than those who designated the patch because providers indicated discomfort with prescribing the patch due to safety concerns.

In addition, side effects, benefits of methods, and strategies to increase the likelihood of successfully using the chosen method were inconsistently discussed.

“In only 73% of visits in which a woman chose a CHC did the provider assess the patient’s ability to use the chosen method correctly, and in 66% of all visits in which women chose a CHC method, providers discussed what to do if she was dissatisfied with the method,” the authors wrote.

A total of 38 providers, with an average age of 50 years (ranging from 35 to 74), took part in the study. Nearly all providers were women (98%), with the majority being nurse practitioners (61%), followed by ob/gyns (17%), family medicine physicians (13%), physician assistants (5%) and certified nurse midwives (5%).

Because counseling can influence patient satisfaction and continuation of the chosen method of contraception, the authors advocate designing interventions to improve a provider’s ability to meet the needs of a patient.

“Comprehensive counseling about all methods and their individual features can improve contraceptive selection and use,” the authors wrote.

More thorough counseling often disclosed that the patient was unaware of other options apart from her original preferred method.

Failure to provide information about correct contraception use and a plan for refills may adversely affect both adherence and continuation of the chosen method. 

A potential limitation of the analysis is that the data were collected up to 10 years ago, thus not accounting for a possible ensuing change in counseling content. However, the authors do not consider this likely because no new CHC methods have been introduced since the original study was conducted.

Likewise, all study clinics were located geographically where all contraceptive methods were available. Providers may also have had greater access to reproductive health training and education due to generous funding for family planning programs in California. These two factors likely resulted in more comprehensive counseling than would be expected for many other populations.