The New Year will bring new recommendations

Get ready to add new information to your contraceptive clinical dataset. The Centers for Disease Control & Prevention (CDC) is working with national family planning experts in preparing the U.S. version of the World Health Organization’s Selected Practice Recommendations (SPR) for release in spring 2013 to provide clinicians with practical applications for contraceptive management.

The recommendations are one of the four cornerstones of family planning guidance as developed by the World Health Organization, says Tara Cleary, MD, MPH, research assistant professor at the University of North Carolina — Chapel Hill and CDC guest researcher. U.S. clinicians already are familiar with the Medical Eligibility Criteria for Contraceptive Use1, which was adapted for U.S. use in 2010. The recommendations act as a companion piece to the criteria, notes Cleary, who spoke at the recent Contraceptive Technology: Quest for Excellence conference in Atlanta.2 The international organization also has developed a decision-making tool for family planning clients and providers, as well as a global family planning guidebook for providers. (Information on all four publications is available at http://bit.ly/SFxVbA.)

According to Andrew Kaunitz, MD, professor and associate chair in the Obstetrics and Gynecology Department at the University of Florida College of Medicine — Jacksonville, the US Selected Practice Recommendations for Contraceptive Use has been developed to help clinicians address such contraceptive management issues as:

  • when to initiate methods;
  • what assessments are appropriate before method initiation;
  • what follow-up is appropriate after method initiation and during method use;
  • • how to manage common issues during contraceptive use;
  • when to stop contraception in older reproductive age women.

“The SPR will provide a treasure trove of evidence-based management guidance for clinicians who provide contraceptive services,” says Kaunitz, who served as one of many advisers in development of the recommendations.

Check possible topics

An initial meeting was held in October 2010 to determine if the recommendations should be considered for U.S. adaptation, says Cleary. The experts present at that meeting recommended that most of the existing material be reviewed for adaptation. Removed from review were any recommendations dealing with contraceptive methods not available in the United States.

New topics for consideration included such issues as:

  • female sterilization;
  • when to stop contracepting;
  • what can be done if a woman has menstrual abnormalities while using continuous combined hormonal contraception;
  • expansion of recommendations to include the contraceptive patch and vaginal ring;
  • addition of ulipristal acetate to emergency contraception pill recommendations;
  • how to start regular contraception after use of emergency contraceptive pills.

A systematic review of evidence was conducted from 2010-2011, with a meeting of experts held October 2011 to discuss and draft recommendations. Those recommendations have been developed into the final version, which will be printed in the CDC’s Morbidity and Mortality Weekly Report in early 2013, says Cleary.

The recommendations are not a comprehensive textbook, nor are they a substitute for the Medical Eligibility Criteria, says Cleary. Clinicians should not look at them for rigid guidelines, and they do not speak to well-woman care, she notes.

The U.S. guidance will highlight the essential points for each question, with algorithms and charts added to make it user-friendly, says Cleary. Each topic has recommendations, comments, evidence summary, and provider tools, as well as a listing of gaps in evidence research, she notes.

Get out the word

When the guidance is released, the CDC plans to work closely with its partners in reproductive health and primary care to disseminate and implement this guidance, says Kathryn Curtis, PhD, a health scientist in the CDC’s Women’s Health and Fertility Branch in the Division of Reproductive Health.

The CDC will work through professional and service organizations to disseminate the guidance to healthcare providers, states Curtis. It also is working on several implementation activities, including development of clinical algorithms and other provider tools, electronic access to the guidance and tools, development of training materials for residency programs, and continuing education activities, explains Curtis. Also in preparation are hands-on case studies and examples of how to use the guidance in practice to facilitate its use, says Curtis.

The CDC will completely review the US SPR every three to four years, with updates published at http://1.usa.gov/chY2AV. The agency also will be conducting a survey of family planning providers before and after release of the recommendations to assess attitudes and practices related to contraceptive use. Results from this survey will assist the CDC in evaluating the impact of the guidance on contraceptive provision in the United States.3

References

  1. World Health Organization. Medical Eligibility Criteria for Contraceptive Use. Fourth edition. Geneva; 2009.
  2. Cleary TP. The new U.S. Selected Practice Recommendations: practical applications for contraceptive management. Presented at the Contraceptive Technology: Quest for Excellence conference. Atlanta; November 2012.
  3. Curtis KM, Tepper NK, Jamieson DJ, et al. Adaptation of the World Health Organization’s Selected Practice Recommendations for Contraceptive Use for the United States. Contraception 2012. Doi:10.1016/j.contraception.2012.08.024.