Computer-assisted provision of hormonal contraception in acute care settings

Abstract

Background: We evaluated whether computerized counseling about contraceptive options and screening for contraindications increased women's subsequent knowledge and use of hormonal contraception.

Methods: For the study 814 women aged 18-45 years were recruited from the waiting rooms of three emergency departments and an urgent care clinic staffed by non-gynecologists and asked to use a randomly selected computer module before seeing a clinician.

Results: Women in the intervention group were more likely to report receiving a contraceptive prescription when seeking acute care than women in the control group (16% vs. 1%, p=.001). Women who requested contraceptive refills were not less likely than women requesting new prescriptions to have potential contraindications to estrogen (75% of refills vs. 52% new, p=.23). Three months after visiting the clinic, women in the intervention group tended to be more likely to have used contraception at last intercourse (71% vs. 65%, p=.91) and to correctly answer questions about contraceptive effectiveness, but these differences were not statistically significant.

Conclusion: Patient-facing computers appear to increase access to prescription contraception for women seeking acute care.

Figure 1. Flow of participants through trial

Figure 2. Sample Screenshots from Intervention

Two examples of what the intervention module looks like – choice of method to learn about next, and the first page of information about the contraceptive ring.

Figure 3. Requests for contraceptive prescriptions

Flowchart of prescriptions requested, contraindicated, and received. Arrows indicate participants being removed from consideration for a prescription, due to choice or contraindication (as stated). POP=progestin-only pill COC=combined oral contraceptive Rx=prescription Contra=contraindication