Op-214 Practices Of Prescribing Combined Hormonal Contraception: A Survey Among Primary Care Physicians In Finland

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Author(s): 
Sannisto T. (Tampere), Kosunen E. (Tampere)
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Purpose of the study: Public primary health care services in Finland include contraceptive counselling free of charge. The purpose of this study was to investigate professional practices and medical eligibility criteria applied when prescribing combined hormonal contraception (CHC, including combined oral contraceptives [COCs], vaginal ring and contraceptive patch) among primary care physicians.
Design and Methods: An online questionnaire survey was conducted in Pirkanmaa Hospital District in Western Finland among 122 health centre physicians involved in family planning in their community health centres (N = 63). Clinical practices when initiating CHC were assessed against Finnish and WHO guidelines.
Results: Eighty-three (68%) physicians responded. Of them, 41 (49%) initiated COCs weekly and 38 (46%) every month. Prescribing rings or patches was less common (42% and 19%monthly). Most physicians routinely took a number of tests and examinations when initiating CHC, including pelvic examination, blood pressure measurement and cervical cytology. Some gaps were identified in physicians’ knowledge about the medical eligibility criteria for CHC. Most strikingly, 34 (41%) respondents did not recognize migraine with aura as a contraindication. Twenty-five (30%) physicians applied a minimum age for use of CHC (13–16 years). Nine (11%) respondents reported no age limits for smoking women, and of those who did, 13 prescribed CHC even for smokers over 35. Fifty-six respondents (67%) applied a maximum blood pressure limit, but that limit varied widely. Only 16 (19%) respondents reported the recommended limits (140/90 mm Hg). Prescribing CHC in extended cycles was rather uncommon.
Conclusions: Overall, prescribing practices of CHC among Finnish primary care physicians were satisfactory. However, the primary health care system has been quite slow to adopt the latest recommendations for medical eligibility criteria and new prescription practices.
Literature: 
OP-214
Practices of prescribing combined hormonal contraception: A survey among primary care physicians in Finland