Hormonal Contraception – Less Pulmonary Embolisms and Thromboses?
Ein Ansatz zur Verbesserung der VersorgungPDF german translation / full article
An Approach to Improve Care
Background: In Germany, third and fourth generation combined oral contraceptives (COC) are prescribed to two thirds of women using oral anticontraceptives up to the age of 20. Their risk of developing a thrombus is about twice as high as for those taking first and second generation COC. First and second generation COC carry a risk of thrombosis twice that of non-use. Given that half of Germany’s family doctors prescribe COC, professional guidelines and accessible patient information were developed.
Methods: We carried out a selective literature search using PubMed and Cochrane Library; an evaluation of the prescription data of oral contraceptives by family practitioners, provided by the AOK Baden-Württemberg and preprocessed by the aQua institute; an evaluation of nationwide data from the Techniker Krankenkasse. Published risk disclosures were translated into equivalent numbers. Based on this evidence, we estimated the likely effect on incidence of thrombosis following a proposed change in prescription practice in Germany. A patient information brochure was developed and evaluated in an application trial using a modified DISCERN-questionnaire.
Results: Extrapolating from previous data, we estimated that approximately 1.280–1.730 thrombi and 700–900 hospitalizations due to pulmonary emboli in women 15 to 49 years of age could be avoided each year in Germany if third and fourth generation COC were not used anymore. We developed a user-friendly algorithm enabling healthcare workers who prescribe COC to identify oral anticontraceptives that are currently not recommended. A patient information brochure concerning the risk of thrombosis and pulmonary embolism was also developed. This brochure was for the most part evaluated as very good or good.
Conclusions: The developed algorithm and patient information brochure could significantly reduce the use of third and fourth generation COC. Current evidence strongly suggests that unnecessarily high risk COC should be removed from health insurance based funding.