Biomedical
Time trends in contraceptive prescribing in UK primary care 2000– 2018: a repeated cross-sectional study
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Thomas Joshua Pasvol,
Thomas Joshua Pasvol
The Research Department of Primary Care and Population Health, University College London,
E Anne Macgregor,
E Anne Macgregor
Centre for Reproductive Medicine, Barts and the London School of Medicine and Dentistry Centre for Neuroscience and Trauma,
Greta Rait,
Greta Rait
The Research Department of Primary Care and Population Health, University College London,
Laura Horsfall
Laura Horsfall
The Research Department of Primary Care and Population Health, University College London,
Abstract
Background Over 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. Methods A 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. Results A 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. Conclusions CHC 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.
Key Questions
What was the main objective of the study on contraceptive prescribing trends?
The study aimed to analyze time trends in contraceptive prescribing in UK primary care between 2000 and 2018 to identify changes in the types and frequency of contraceptive methods prescribed.
What key trends were observed in contraceptive prescribing between 2000 and 2018?
The study found significant changes, including a decline in the prescribing of combined oral contraceptives and a rise in long-acting reversible contraceptives (LARCs), such as the intrauterine device (IUD) and implant.
Why is it important to track time trends in contraceptive prescribing?
Tracking these trends is crucial for understanding patterns in contraceptive choices, the impact of healthcare policies, and the evolving preferences of women regarding contraception, which can inform healthcare strategies and improve service provision.
What factors may have contributed to the observed shift towards long-acting reversible contraceptives (LARCs)?
Factors contributing to the shift include increased awareness of the benefits of LARCs, such as their high efficacy and convenience, as well as changes in public health campaigns and healthcare provider recommendations.
How does the study contribute to our understanding of contraceptive prescribing in primary care?
The study provides valuable insights into the evolving trends in contraceptive prescribing over nearly two decades, highlighting shifts in preferences and the growing adoption of LARCs, helping to guide future primary care practices and policy decisions.
What role did demographic factors play in the trends observed in contraceptive prescribing?
The study found that demographic factors, such as age and socioeconomic status, influenced contraceptive prescribing patterns, with younger women more likely to receive LARCs and older women tending to use combined oral contraceptives.
Were there any significant regional differences in contraceptive prescribing trends across the UK?
Yes, regional differences were noted, with certain areas exhibiting higher uptake of LARCs compared to others, reflecting disparities in access to services, healthcare policies, and local demographic characteristics.
How can healthcare providers use the findings from this study to improve contraceptive care?
Healthcare providers can use the findings to ensure they are offering a range of contraceptive options, emphasizing the benefits of LARCs, and addressing any barriers to access or awareness, particularly in underserved or disadvantaged populations.
What are the implications of this study for future contraceptive research and policy?
The study highlights the need for ongoing research into the factors influencing contraceptive choices, as well as the importance of policies that support equitable access to a variety of contraceptive methods, especially long-acting options like IUDs and implants.
What was the methodology used in this study to analyze contraceptive prescribing trends?
The study used a repeated cross-sectional design, analyzing data from UK primary care electronic health records over a 19-year period. It examined trends in the prescribing of different contraceptive methods, including oral contraceptives, LARCs, and others.
