Hot topic: Medicine that is evidence-based

This year will see development of new evidence-based documents for the family planning resource library: the U.S. Selected Practice Recommendations for Contraceptive Use from the Centers for Disease Control & Prevention (CDC) and the newly-updated Title X Program Guidelines, issued by the Office of Family Planning within the Department of Health & Human Services' Office of Population Affairs.

The U.S. Selected Practice Recommendations for Contraceptive Use (SPR) will provide evidence-based guidance for how to use contraceptive methods safely and effectively once they are deemed to be medically appropriate or safe, based on recommendations in the U.S. Medical Eligibility Criteria for Contraceptive Use (US MEC), says Emily Godfrey, MD, MPH, guest researcher at the CDC. The US MEC was released in June 2010, with an update issued in July 2011.1,2

The SPR addresses important controversies or inconsistencies regarding how to maximize the effectiveness of contraceptive methods and how to manage their side effects or other problems during use, notes Godfrey, who presented information at the recent Contraceptive Technology Quest for Excellence conference in Atlanta.3

The U.S. SPR is an adaptation of the World Health Organization's Selected Practice Recommendations for Contraceptive Use4, which is one of four documents that make up the agency's evidence-based family planning guidance, known as the "Four Cornerstones," explains Godfrey. The intent of these documents is to help improve access to and quality of family planning services.

The SPR is planned to be released in early 2013, says Godfrey. The document will be published by the CDC in the Morbidity and Mortality Weekly Report. (Register at the CDC MEC web site, http://www.cdc.gov/reproductivehealth/unintendedpregnancy/USMEC.htm, to receive notices on the US MEC, which allow will facilitate notices on the SPR).

In addition, the CDC will be working with partner agencies and medical news organizations to alert health care providers about the new evidence-based guidance, says Godfrey. (Stay tuned to CTU for news concerning the publication.)

New guidance for Title X

The new Title X guidance is the first new guidance issued in the last decade. The guidelines originally were established in 1970; the last revision was made in 2001. Those involved in the current revision process have focused their efforts in key areas, says Michael Policar, MD, MPH, clinical professor of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco School of Medicine. They include:

  • utilizing best evidence to design preventive services;
  • prioritizing provision of core family planning services;
  • allowing flexibility for recommended services;
  • avoiding services where harms exceed benefits;
  • supporting client decisions regarding which services she receives or declines;
  • removing barriers to care for the client and provider;
  • improving clinic efficiency;
  • anticipating changes in source of primary care arising from the Affordable Care Act.5

Those involved in the revision process also are developing a mechanism to keep the guidelines current, says Policar, who has participated in the guidelines review. The review of evidence, as well as the gaps identified, also will help to inform the federal agency's future research efforts.

The agency is projecting the draft guidance will be available for comment in March 2012; the draft will be available at the agency's web site, http://www.hhs.gov/opag. The final document is projected for release in the fall of 2012.

Why is it important?

For clinicians, evidence-based medicine provides an opportunity to impact quality, says Policar. It provides patients with services that work, and it avoids the provision of services that don't work.

By receiving care that is evidence-driven, patients receive services that are the most likely to prevent pregnancy and protect reproductive health, Policar notes. Barriers are removed to desired services, and patients avoid time lost for visits and services of limited/no benefit, he adds.

Another benefit of evidence-based medicine is that it minimizes the hazards of false positive test results, says Policar. This minimizing reduces anxiety for the patients, prevents unnecessary invasive work-ups, and avoids the consequences of overtreatment, he says.

References

  1. Centers for Disease Control and Prevention. US medical eligibility criteria for contraceptive use, 2010. MMWR Early Release 2010;59:1-86.
  2. Tepper NK, Curtis KM, Jamieson DJ, et al. Update to CDC's U.S. Medical Eligibility Criteria for Contraceptive Use, 2010: Revised recommendations for the use of contraceptive methods during the postpartum period. MMWR 2011; 60:878-883.
  3. Godfrey EM. Contraception updates from the CDC. Presented at the Contraceptive Technology Quest for Excellence conference. Atlanta; November 2011.
  4. World Health Organization. Medical Eligibility Criteria for Contraceptive Use. Fourth ed. Geneva: WHO; 2009.
  5. Policar M. Preventive health screening in family planning: separating the "musts" from the "shoulds." Presented at the Contraceptive Technology Quest for Excellence conference. Atlanta; November 2011.