Interventions such as educating medical staff, creating patient awareness campaigns, and evaluating contraceptive methods can reduce rates of combined hormonal contraceptive (CHC) use among smoking women, according to a recent study published in Cureus.
Takeaways
- Interventions such as education for medical staff, patient awareness campaigns, and evaluating contraceptive methods can reduce the use of combined hormonal contraceptives (CHCs) among smoking women, addressing significant health risks.
- Family planning includes counseling with a family doctor, emphasizing the importance of understanding contraceptive risks and benefits to make informed decisions.
- CHCs, when combined with smoking, increase the risk of myocardial infarction (MI) and venous thromboembolism, leading to recommendations that female smokers aged 35 and older should avoid CHC use.
- A study in a Portuguese Family Health Unit successfully reduced CHC usage in female smokers aged 35 and older through a series of interventions over a 9-month period, highlighting the positive impact on medical practice and patient outcomes.
- The study showed a 7.9% reduction in CHC prevalence and an increase in progestogen-only contraception usage rates, indicating a significant decrease in cardiovascular risk factors among the target population.
Family planning includes counseling with a family doctor’s clinical practice. This allows patients to understand the risks and benefits of each contraceptive method, making an informed and individualized decision. To facilitate this practice, clinicians should have up-to-date knowledge on the eligibility criteria and contraindications for any potential contraceptive method.
Women of reproductive age often use CHCs, which are available orally, as a vaginal ring, or as a transdermal patch. However, CHCs are associated with increased risks of venous thromboembolism and myocardial infarction (MI).
CHCs alongside smoking lead to significant increases in MI risk, yet in 2019, daily tobacco use was reported in 14.8% of European Union women. Risks associated with combined smoking and CHC use have led to recommendations that female smokers aged 35 years and older avoid CHC use.
Investigators conducted a study to improve the quality of hormonal contraceptive prescriptions in female smokers aged 35 to 54 years in primary care. The study occurred in a Portuguese Family Health Unit between October 2021 and August 2022. All eligible female smokers aged 25 to 54 years were included in the analysis.
Women with tobacco abuse were determined by the P17 code in the International Classification of Primary Care-2. Clinical records of patients were evaluated for data on age, contraceptive method use, and smoking habits. Exclusion criteria included having undergone hysterectomy, being pregnant, and being an ex-smoker or non-user.
Data collection was completed at the baseline evaluation, an intermediate evaluation, and a post-intervention evaluation. These interventions occurred in October 2021, February 2022, and August 2022, respectively.
The first intervention, a clinical session focusing on physicians and nurses, took place in November 2021. Results related to CHC prescriptions status within the study population were discussed, and CHC usage eligibility criteria reviewed. This intervention aimed to raise awareness among health care professionals and improve hormonal contraceptive prescription.
Physicians and nurses were also presented results of the intermediate evaluation in February 2022. These results indicated the need for a second intervention, leading teams to identify female smoker patients aged 35 to 54 years and alter contraceptive method use in these patients if necessary.
There were 152 women aged a mean 44 years with tobacco abuse included in the final analysis. CHC use was reported in 16.4% of this population, with 12.5% using combined oral contraceptives, 3.3% using a vaginal ring, and 0.7% using a transdermal patch.
Progestogen-only contraception was the most common contraceptive method, reported by 25.7% of patients. Smoking under 15 cigarettes a day was reported by 69.1% of the evaluated sample.
In the intermediate evaluation, CHC use was reported in 14.1% of the evaluated sample, indicating a 2.3% reduction in CHC usage following the first intervention. In the final post-intervention evaluation in August 2022, the evaluated sample had a CHC prevalence of 8.5%.
In the 9-month period between the first evaluation and the final post-intervention evaluation, a 7.9% reduction in CHC prevalence was observed. Additionally, progestogen-only contraception usage rates increased, seen in 34% of users.
These results indicated decreased rates of CHC usage in female smokers aged 35 years and older following interventions, mitigating significant cardiovascular risk factors. Investigators concluded these results highlight the positive impact on medical practice and patient outcomes.
Reference
Novais C, Santos J, Alves C, et al. Optimizing contraceptive prescription in smoking women: A quality improvement study. Cureus. 2023;15(9):e45701. doi:10.7759/cureus.45701
