Priority 19 from the Contraception PSP

UNCERTAINTY: Do models of care (video information, telephone assessments, single appointments) increase access to intrauterine contraceptives and implants?  (JLA PSP Priority 19)
Overall ranking 19
JLA question ID 0049/19
Explanatory note Since 2013 the responsibility for commissioning contraceptive services moved to local councils. A report  from the Advisory Group on Contraception (AGC), which FSRH is a member of, details that half the councils had cut their budgets  and - 1 in 3 councils has closed services since 2015. The majority of individual who use community sexual health clinics are women (9 out of 10), the majority of visits are about contraception (3 out of 4).Visits to community clinics are reducing  (about 2% per year). To ensure effective use of resources access to intrauterine contraception is often triaged though an initial appointment, to ensure the woman has adequate information and this was a suitable method and fitting. However requiring two appointments is often sited as a barrier to accessing LARC.  Alternate ways methods of delivering this information have been evaluated but further research is needed.
Evidence

Interactive computer-based interventions for sexual health promotion .Julia V Bailey , Elizabeth Murray , Greta Rait , Catherine H Mercer , Richard W Morris , Richard Peacock , Jackie Cassell and Irwin Nazareth, Online Publication Date: September 2010. DOI: 10.1002/14651858.CD006483.pub2

Brief educational strategies for improving contraception use in young people.  Laureen M Lopez, Thomas W Grey, Elizabeth E. Tolley, Mario Chen. March 2016 

Giving information about the contraceptive implant using a DVD: is it acceptable and informative? A pilot randomised study. Lucy Michie, Sharon T Cameron, Anna Glasier, Anne Johnstone. Journal of Family Planning and Reproductive Health Care Jul 2016, 42 (3) 194-200; DOI: 10.1136/jfprhc-2015-101186 

Interventions to promote informed consent for patients undergoing surgical and other invasive healthcare procedures. Paul Kinnersley , Katie Phillips , Katherine Savage , Mark J Kelly , Elinor Farrell , Ben Morgan , Robert Whistance , Vicky Lewis , Mala K Mann , Bethan L Stephens , Jane Blazeby , Glyn Elwyn and Adrian GK Edwards Date: July 2013
Health Research Classification System category Reproductive Health and Childbirth
Extra information provided by this PSP
Original uncertainty examples

“Women tell me they often struggle to get a doctor's appointment for a coil fitting at the appropriate time and fpcs often have limited opening times.  How can more 'user-friendly' access be offered for contraception services?” (HCP)  ~  “If I decide to get a LARC, where can I get this? Do I drop in or make an appointment? I also need to know about the side affects after it so I can decide whether to go to work after it's fit.” (Patient)  ~  Why do I need to have an appointment to discuss getting an IUD before getting one (note that I'm not saying that people shouldn't be able to have a pre-appointment if they want)?  Surely the pre-screening can be done online, and I'm quite capable of reading the NHS guidance myself (especially as I've had two already), and it seems like an unnecessary use of both patient and NHS time. (Patient)
Submitted by Healthcare Professionals x 2~Patients x 8~Both x 4
PSP information
PSP unique ID 0049
PSP name Contraception
Total number of uncertainties identified by this PSP. 57  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 21 April 2017