In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed:
Borrero S, Zhao X, Mor MK, et al. Adherence to hormonal contraception among women veterans: differences by race/ethnicity and contraceptive supply. Am J Obstet Gynecol 2013;209:103.e1-11.
See related article, page 103
For a summary and analysis of this discussion, see page 153
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How was the study designed?
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How were the data analyzed?
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What were the study results?
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What is the significance of this study?
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What limitations did this study have?
Introduction
In recent practice recommendations for contraceptive use, the Centers for Disease Control and Prevention (CDC) notes that about half of all pregnancies in the United States are unintended. Unplanned pregnancies carry an increased risk for poor outcomes and consume billions of dollars in medical costs. To reduce the rate, health care providers are encouraged to help patients use contraceptives correctly and consistently. For example, the CDC advises that women using oral contraceptives be assured up to a 13-month supply. “The more pill packs given up to 13 cycles, the higher the continuation rates,” the agency says. This month, Journal Club members discussed a new study that supports this rationale.
Thank you for joining this discussion of an article on adherence to different methods of hormonal contraception by women in the Veterans Affairs (VA) Health Care System. This is a very interesting and important question; first and foremost, because rates of unintended pregnancy in the United States are high. Clearly, one way to prevent unintended pregnancies is to make sure women have constant access to birth control during their reproductive years.
The group of study participants, women in the VA Health Care System, is noteworthy since women veterans represent a growing population. 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. The authors were particularly interested in the impact of ethnicity on adherence to birth control pills, and that was the main aim of this study.
George A. Macones, MD, MSCE, Associate Editor
Introduction
In recent practice recommendations for contraceptive use, the Centers for Disease Control and Prevention (CDC) notes that about half of all pregnancies in the United States are unintended. Unplanned pregnancies carry an increased risk for poor outcomes and consume billions of dollars in medical costs. To reduce the rate, health care providers are encouraged to help patients use contraceptives correctly and consistently. For example, the CDC advises that women using oral contraceptives be assured up to a 13-month supply. “The more pill packs given up to 13 cycles, the higher the continuation rates,” the agency says. This month, Journal Club members discussed a new study that supports this rationale.
Thank you for joining this discussion of an article on adherence to different methods of hormonal contraception by women in the Veterans Affairs (VA) Health Care System. This is a very interesting and important question; first and foremost, because rates of unintended pregnancy in the United States are high. Clearly, one way to prevent unintended pregnancies is to make sure women have constant access to birth control during their reproductive years.
The group of study participants, women in the VA Health Care System, is noteworthy since women veterans represent a growing population. 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. The authors were particularly interested in the impact of ethnicity on adherence to birth control pills, and that was the main aim of this study.
George A. Macones, MD, MSCE, Associate Editor
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