A growing population

The investigation focused on adherence to different types of hormonal contraception among 6946 female veterans over a 1-year period. Improving adherence to treatment is important in all areas of medicine, but contraceptive adherence is particularly important, since a lapse can lead to an unintended pregnancy, the consequences of which are quite charged in our society.

To study adherence, the investigators used databases belonging to the Veterans Affairs (VA) Health Care System; specifically, the pharmacy benefits management database, which provides prescription records, and the Medical SAS Datasets, which contain inpatient and outpatient clinical information. The latter includes demographic details, International Classification of Diseases , 9th edition codes, information on utilization of VA services, and documentation of contraceptive procedures.

Journal Club members agreed that the VA system was a very interesting choice for this research question, as reproductive-age women are a growing population among veterans. Additionally, as the authors point out, the VA Health Care System has policies designed to enhance adherence including mail-order prescriptions; online, phone, and mail-in methods for reordering prescriptions, provision of a 90-day supply to extend durations between refills, and low fixed copays for all medications. That contrasts with what happens for most women who are prescribed birth control pills; they usually get a 1-month supply and pay higher copays.