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Better way of working
Telephone counselling for subdermal implants and intrauterine contraceptives
  1. Caitlin D Gorman1,
  2. Joanne Dennis2,
  3. Jennifer A Heathcote2
  1. 1 Medicine and Health, School of Medicine, The University of Manchester Medical School, Manchester, UK
  2. 2 East Cheshire Community Sexual Health Clinic, East Cheshire NHS Trust, Macclesfield, UK
  1. Correspondence to Miss Caitlin D Gorman, The University of Manchester Medical School, Manchester M13 9PL, UK; caitlindrewgorman{at}hotmail.com

https://doi.org/10.1136/bmjsrh-2017-101883

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    What initiated the change?

    The rate of unintended pregnancies remains high in the UK, at an estimated 16%.1 Long-acting reversible contraceptives (LARC) provide a highly effective alternative to the widely used contraceptive pills and condoms, which depend heavily on user reliability.2 3 There is a clear need to increase the uptake of LARC by reducing barriers to access and removing obstacles in the process.

    The requirement of a separate counselling appointment prior to insertion is a key factor in deterring women from LARC use.4 5 Additionally, clinicians at East Cheshire Centre for Sexual Health have noted that women often comment that they do not require a counselling appointment as they feel they have already been given the information elsewhere. However, if a counselling appointment is not arranged, at insertion women are often found to be unsuitable for a variety of reasons, including the possibility of pregnancy, sexually transmitted infection (STI) risk or the need for further investigation.

    What changes were put in place?

    In an attempt to tackle this, in January 2017 we implemented a telephone counselling service for women requesting an intrauterine contraceptive (IUC) or subdermal implant. This aimed to increase the likelihood of procedures going ahead and minimise the need for patients to attend multiple appointments. Currently, there is one telephone clinic per week with six 20-min appointments, conducted by the clinical lead who pioneered this service.

    If a patient opts for telephone counselling, their contact  number is checked with electronic records and an appointment is issued. The patient is informed that they will receive their call within a 1-hour window, for example, ‘between 2 and 3pm’. At the appointment, the clinician calls their number. The standard LARC counselling template is followed, as in a face-to-face consultation. If STI screening is required, the patient is sent a postal kit, or advised to access their local clinic or general practitioner for …

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    Footnotes

    • Contributors All authors contributed to the manuscript as follows:JD: implementation of telephone service; CG and JD: production of questionnaires; CG: study design and analysis and interpretation of data; CG: drafting the article; JD and JH: revising it critically for important intellectual content; CG, JD and JH : final approval of the version to be published. All authors read and approved the final manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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      British Medical Journal Publishing Group
      BMJ Sexual & Reproductive Health 2018; 44 75-76 Published Online First: 12 Apr 2018. doi: 10.1136/bmjsrh-2018-200108