Computer assisted provision of hormonal contraception
Awarded 2008
Large Research Grants
Eleanor Bimla Schwarz, MD, MS
University of Pittsburgh

Objectives: To evaluate the feasibility of using a patient-operated computer program to assist with provision of hormonal contraception in urgent care settings. Methods: Between January and July 2011, while seeking non-contraceptive urgent or emergent care, women aged 18 – 45 were invited to use an interactive computer program to learn about their contraceptive options and request prescriptions. The computer screened for contraindications to estrogen and printed prescriptions which were signed by a clinician after checking blood pressures recorded in the patient’s medical record. As a control, half of the women who consented to use the program were randomized by the computer (after eligibility screening) to educational information about Chlamydia testing and received no information about birth control. Three months after the date they used the program, we called and emailed all eligible women who had used one of these computer programs asking them to complete a follow-up questionnaire assessing their knowledge and use of contraception. Results: Over 7 months, 811 women recruited from 4 clinical sites consented to use the computer; 397 were randomized to the module about Chlamydia and 414 were randomized to the Family Planning module. Once randomized to the Family Planning module, 125 were determined ineligible because they had no need for use of hormonal contraception (due to pregnancy, sterilization, or same sex partners); 74 exited before completing screening. Of the remaining 215 women, 27.4% (59/215) requested hormonal contraception, 13.6% (8/59) of whom requested progestin-only pills. More than half (53%) of women requesting a contraceptive prescription reported having had unprotected sex one or more times since their last period. Of women who requested estrogen-containing contraception, 45.0% (23/51) were notified of a potential contraindication to the use of estrogen (most commonly for a history of migraines). Of these women, 26.1% (6/23) requested the mini-pill after being told of the potential contraindication to estrogen. Clinicians spent less than 2 minutes verifying blood pressure and signing each requested prescription. Almost all women (96%) who requested a prescription reported the computer was easy to use; 77% would recommend it to friend; and 77% trusted the recommendations made by the computer. About half (57%) would prefer to discuss birth control with a clinician. Of the 161 women who exited the program without requesting a prescription, 72.0% (116/161) reported they already had birth control. In preliminary analyses (as follow up data collection remains ongoing), 3 months after visiting the study clinic, women who used the Family Planning module were significantly more likely than women who used the Chlamydia control module to report having received a prescription for contraception the day they visited the urgent care clinic (12% vs. 2%, p=0.03). In addition, women who used the family planning module had more accurate knowledge of the typical use failure rates of condoms (27% vs. 14%, p=0.002). However, 3 months after visiting the study clinic, women who had used the Family Planning module were as likely to report recent use of contraception than women in the control group (91% vs. 95%, p=0.4). This was accomplished with minimal effect on clinic wait times, minimal clinician time to sign the desired prescriptions and no additional clinic staff (although the research assistant did encourage women to use the computer programs). Conclusions: Computer technology appears to be a feasible, acceptable and efficient way to increase access to hormonal contraception information and prescriptions outside traditional family planning clinics. However, women who have most need for contraception may be least likely to complete follow up surveys; thus our preliminary findings regarding the effect of this technology on women’s contraceptive use at 3 months likely underestimates the true impact such technology could have. Further work is needed to improve access to contraception for women with limited access to routine health care.