Time trends in contraceptive prescribing in UK primary care 2000–2018: a repeated cross-sectional study

Abstract

BackgroundOver the last 20 years, new contraceptive methods became available and incentives to increase contraceptive uptake were introduced. We aimed to describe temporal trends in non-barrier contraceptive prescribing in UK primary care for the period 2000–2018.MethodsA repeated cross-sectional study using patient data from the IQVIA Medical Research Data (IMRD) database. The proportion (95% CI) of women prescribed non-barrier contraception per year was captured.ResultsA total of 2 705 638 women aged 15–49 years were included. Between 2000 and 2018, the proportion of women prescribed combined hormonal contraception (CHC) fell from 26.2% (26.0%–26.3%) to 14.3% (14.2%–14.3%). Prescriptions for progestogen-only pills (POPs) and long-acting reversible contraception (LARC) rose from 4.3% (4.3%–4.4%) to 10.8% (10.7%–10.9%) and 4.2% (4.1%–4.2%) to 6.5% (6.5%–6.6%), respectively. Comparing 2018 data for most deprived versus least deprived areas, women from the most deprived areas were more likely to be prescribed LARC (7.7% (7.5%–7.9%) vs 5.6% (5.4%–5.8%)) while women from the least deprived areas were more likely to be prescribed contraceptive pills (20.8% (21.1%–21.5%) vs 26.2% (26.5%–26.9%)). In 2009, LARC prescriptions increased irrespective of age and social deprivation in line with a pay-for-performance incentive. However, following the incentive's withdrawal in 2014, LARC prescriptions for adolescents aged 15–19 years fell from 6.8% (6.6%–7.0%) in 2013 to 5.6% (5.4%–5.8%) in 2018.ConclusionsCHC prescribing fell by 46% while POP prescribing more than doubled. The type of contraception prescribed was influenced by social deprivation. Withdrawal of a pay-for-performance incentive may have adversely affected adolescent LARC uptake, highlighting the need for further intervention to target this at-risk group.

Exploring the interface between adolescent dysmenorrhoea and endometriosis: a protocol for a cohort and nested case–control study within the QResearch Database

“…Patterns of contraception use may also change over time, as demonstrated by the ‘pill scare’ of 1995 which caused a reduction in contraceptive pill use. 37 Menstruation and endometriosis do not link with any Quality and Outcomes Framework codes, although long-acting contraception has done, 38 which may act as a driver towards contraception being coded rather than pain or symptoms. Adolescence to adulthood can be a time of mobility, for example, if adolescents leave home to travel elsewhere for work or study, which might limit the duration of follow-up if people de-register from their GP when they move.…”

La contraception à travers le monde

“…L'éducation ciblant les adolescentes est aussi une importante piste à considérer. Une étude, réalisée au Royaume-Uni, incluant 2 705 638 femmes âgées de 15 à 49 ans, a évalué les prescriptions de contraception par les médecins généralistes, entre 2000 et 2018 [21]. Elle a montré que les prescriptions de LARC avaient diminué pour les adolescentes, passant de 6,8 % (6,6 %-7 %) utilisatrices en 2013, à 5,6 % (5,4 %-5,8 %) en 2018, en particulier dans les zones défavorisées, probablement en lien avec une diminution de la prise en charge financière de ces méthodes.…”

“…Malgré le succès de cette mesure, le gouvernement a décidé de l'arrêter en 2014, et la somme globale allouée à la contraception à partir de cette date a nettement chuté. Cette baisse pourrait être à l'origine d'une diminution de l'utilisation des LARC chez les adolescentes [21]. Afin de remédier à cette diminution d'utilisation, les pharmaciens pourraient être impliqués et éduqués.…”

Progestogen only pills commentary

“…The updated Faculty of Sexual and Reproductive Healthcare (FSRH) progestogen only pills (POP) guideline has recently been published1 giving the perfect opportunity to establish what’s new and what has not changed. Although long-acting reversible contraception use is rising, oral contraceptives remain popular, accounting for 38% of contraception in 2019/20202 and POP use more than doubling (4.3%–10.8% of contraceptive use) since 2000 3…”