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APHA Scientific Session and Event Listing

Diana Greene Foster, PhD¹, Ram Parvataneni, MD, MPH², Heike Thiel de Bocanegra, PhD, MPH³, Michael Policar, MD, MPH³, Mary Bradsberry³, Carrie Lewis, MPH³, Phillip Darney, MD, MPH², and Claire Brindis, DrPH⁴. (1) University of California, San Francisco, Bixby Center for Reproductive Health Research & Policy, 655 13th Street, Suite 201, Oakland, CA 94602, (510) 836-2128, greened@obgyn.ucsf.edu, (2) Center for Reproductive Health Research and Policy, University of California, San Francisco, 1001 Portero Ave, Ward 6D, San Francisco, CA 94110, (3) Bixby Center for Reproductive Health Research & Policy, University of California, San Francisco, CDHS Office of Family Planning, P.O. Box 997413, MS 8400, Sacramento, CA 95899-7413, (4) Bixby Center for Reproductive Health Research and Policy, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94118

Introduction Imperfect use of oral contraceptives (OCs) is a leading cause of unintended pregnancy. One out of seven women seeking abortion in the United States reported using pills in the month they conceived. Nearly half (47%) of pill users miss 1 or more pills per cycle. The third most common reason for missing a pill is “no new pill pack.” Nationally, 73% of women get 1 cycle of pills per visit. Yet there is no research on the relationship between contraceptive continuation and the number of OC cycles dispensed.

Methods We use Family PACT (California's family planning waiver program) claims data for the 82,322 women who received OCs in January 2003 to examine continuation, wastage and service utilization for 15 months.

Results In 2003, women getting 13 cycles had 1 fewer clinician visit, 2.7 fewer pharmacy visits, 0.75 fewer pregnancy tests and cost the program $99 less than women who got 3 cycles. Women who got 13 cycles at their January 2003 visit were more likely to be still using OCs 15 months later than women who received 1 or 3 cycles (70%, 60%, 64%, respectively). OC wastage was somewhat higher among 13 cyclers compared to 3 cyclers (6.5% vs. 2% of cycles) but averages fewer than 1 cycle out of 13.

Discussion Dispensing a year's supply of oral contraceptives at one visit may be a cost effective way to encourage OC continuation and reduce extraneous office and pharmacy visits that may act as a barrier to effective method use.

Learning Objectives:

• 1.Understand the importance of consistent and correct pill use and the factors which impede it.
• 2.Describe who gets 1, 3, and 13 cycles of pills at an encounter.
• 3.Identify service utilization and pill wastage patterns among women by initial dispensing quantity.
• 4.Discuss the reasons for higher method continuation and more efficient service utilization patterns among women who get 13 cycles.

Keywords: Contraception, Quality Improvement

Presenting author's disclosure statement:

Not Answered