Long-acting reversible contraception

1
Long-acting reversible contraception

• Clinical Guideline 30
• Published October 2005

2
NICE clinical guidelines

• Recommendations for good practice based on best
  available evidence.
• DH document Standards for better health
  includes expectation that organisations work
  towards implementing clinical guidelines.
• Healthcare Commission will monitor compliance
  with NICE guidance.

2
3
Why you should implement the LARC guideline

• Improve services by giving women more choice.
• Help reduce numbers of unintended pregnancies.
• More cost-effective use of NHS resources.

3
4
Teenage pregnancy target

• Reduce the under 18 conception rate by 50 by
  2010
• Teenage Pregnancy Strategy 1999
• National Standards, Local Action planning
  framework 2005-08.

4
5
What this guideline covers

• Best-practice advice for all women who may wish
  to use long-acting reversible contraception
  (LARC) methods.
• Specific issues for use during the menarche and
  before the menopause.
• Use by particular groups of women those who have
  HIV, those who have learning or physical
  disabilities, and under 16s.

5
6
Definition of LARC

• Methods that are administered less than once per
  cycle or month.
• Three progestogen-only methods
• intrauterine system
• injectables
• implants.
• The copper intrauterine device (non-hormonal).
  

6
7
Barriers to uptake of LARC

• Commissioners purchasing behaviour
• High initial costs of LARC may restrict
  availability.
• Womens reasons for not using LARC
• Lack of knowledge of methods.
• Concern about potential side effects.
• Satisfaction with current method.

7
8
Key priorities for implementation

• Contraceptive provision.
• Provision of information to women.
• Training of health professionals.

8
9
Contraceptive provision

• Women should be offered a choice of all methods
  including LARC.
• All LARC methods are more cost effective than the
  combined oral contraceptive pill even at 1 year
  of use.
• IUDs, IUS and implants are more cost effective
  than the injectable contraceptives.

9
10
Information to give to women

• Efficacy of method.
• Duration of use.
• Risk and possible side effects.
• Non-contraceptive benefits.
• The procedures for initiation and
  discontinuation.
• When to seek help.

10
11
Information - special considerations

• Support with decision making
• an interpreter for women who do not speak English
• an advocate for women with sensory impairment or
  learning disabilities.
• Legal implications for people
• younger than 16 years
• with learning disabilities.

11
12
Training of health professionals

• Practitioners should be
• informed about all methods and their risks and
  benefits
• competent to provide LARC or have an agreed
  referral mechanism
• able to manage common side effects and problems.

12
13
Implementation issues for managers

• Identify one or more clinical leads.
• Carry out a baseline assessment.
• Consider workforce planning and training issues.
• Assess cost.
• Develop, disseminate and implement an action
  plan.
• Monitor, audit and review progress.

13
14
Questions to ask about your service

• What LARC services do you provide?
• How do you raise awareness of LARC methods with
  women locally?
• Are there clear referral mechanisms to providers
  who are trained to administer LARC?

14
15
Cost of implementation

• It is estimated that implementing the guidance in
  England will deliver an annual saving of 102.3
  million.
• There will be an initial non-recurrent cost of
  900K to train additional staff to fit
  intra-uterine devices and implants.

15
16
Improving practice

• Identify what needs to change.
• Monitor the impact on
• uptake of LARC
• funding, availability, and accessibility of LARC
• training and competency of staff
• effects on teenage pregnancy rates.

16
17
Tools to support this guideline

• Costing tools
• a local costing template
• a national costing report.
• Audit criteria.
• This slide set.
• Available on NICE website www.nice.org.uk/imple
  mentation

17
18
Versions of the guideline

• Quick reference guide
• Summary of the recommendations for health
  professionals
  www.nice.org.uk/CG030quickrefguide
• NICE guideline
• All the recommendations
  www.nice.org.uk/CG030NICEguideline
• Full guideline
• All the evidence and rationale behind the
  recommendations
  www.nice.org.uk/CG030fullguideline
• Information for the public
• Plain English version for patients, carers and
  the public
  www.nice.org.uk/CG030publicinfo

18
19
www.nice.org.uk
19