Put US SPR guidance into your practice

Put US SPR guidance into your practice

Have you put the U.S. Selected Practice Recommendations for Contraceptive Use, 2013 (US SPR) into practice?¹ A new American College of Obstetricians and Gynecologists (ACOG) committee opinion has endorsed use of the guidance in counseling patients about how to most effectively use current birth control methods.² (Read the US SPR online at http://1.usa.gov/1crWrWH, and the ACOG opinion at http://bit.ly/1agyF1P.)

The Centers for Disease Control and Prevention (CDC) released the US SPR as a companion document to its previously published U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 (US MEC).³ While the US MEC provides guidance for which contraceptive methods are safe for women with selected characteristics and medical conditions, the US SPR offers guidance on how to use these methods most effectively. Both publications have been adapted from global guidance published by the Geneva, Switzerland-based World Health Organization; a panel of U.S. family planning experts aided the CDC in adapting material for U.S. use.

The US SPR decreases medical barriers to contraception, says Tara Cleary, MD, MPH, research assistant professor at the University of North Carolina — Chapel Hill, and guest researcher at the CDC. Cleary presented an update on the US SPR at the recent Contraceptive Technology Quest for Excellence conference.⁴

It is important that clinicians understand that the US SPR guidance is not comprehensive, nor is it the US MEC, says Cleary. Its purpose is to assist healthcare providers when they counsel patients about contraceptive use, she states. The medical eligibility criteria tell clinicians who can use various methods, says Cleary. The selected practice recommendations tell clinicians and counselors how to use various contraceptives, she notes.

The US SPR provides clear, evidence-based recommendations in three general categories: initiation of contraceptive methods, follow-up conditions to routinely check, and management of problems during method use, states a recent editorial by Herbert Peterson, MD, Kenan Distinguished Professor and chair of the Department of Maternal and Child Health in the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill and Ward Cates, MD, MPH, president emeritus and distinguished scientist at FHI 360 in Durham, NC.⁵

"Managing modern contraceptive choices has become a clinical subspecialty of its own, and more than ever, providers need synthetic access to the evidence base upon which their practice depends," the editorial states. "The US SPR answers this need."

When to start a method?

One of the many important points contained in the US SPR is that any contraceptive method can be started at any time during the menstrual cycle, as long as there is reasonable certainty that a woman is not pregnant. This point means that the Quick Start method of initiating contraception doesn’t apply just to combined hormonal contraceptives, such as the Pill, says Cleary.

For clinicians who follow patients who use combined hormonal pills, missed pills represent a major reason for oral contraceptive failure leading to unintended pregnancies. The U.S. SPR provides algorithms for what to do if women miss pills, as well as offers recommendations for provision of a one-year supply of pills.

The guidance also offers information on the management of bleeding abnormalities with intrauterine contraceptives, progestin-only pills, and extended use of combined hormonal contraceptives. It covers initiation of contraception following emergency contraception and information for when a woman can stop use of birth control. Guidance also is provided on when women and men can rely on female and male sterilization after such procedures are performed.

What tests are needed?

Most women can start most contraceptive methods at any time, and few examinations or tests, if any, are needed before starting a contraceptive method, says Cleary. The US SPR provides a chart for necessary exams and tests prior to method initiation. For example, the only essential, mandatory procedure prior to IUD use include bimanual examination and cervical inspection; for combined hormonal methods, a blood pressure measurement must be obtained.¹

The US SPR provides evidence-based guidance to help clinicians provide quality family planning care, says Cleary.

"It can help individuals use methods correctly and consistently," she notes. "It also decrease medical barriers to contraceptive use."

REFERENCES

1. Committee opinion no. 577: understanding and using the U.S. Selected Practice Recommendations for Contraceptive Use, 2013. Obstet Gynecol 2013; 122(5):1,132-1,133.
2. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. U.S. Selected Practice Recommendations for Contraceptive Use, 2013: adapted from the World Health Organization Selected Practice Recommendations for Contraceptive Use, second edition. MMWR Recomm Rep 2013; 62(RR-05):1-60.
3. Centers for Disease Control and Prevention. U.S. Medical Eligibility Criteria for Contraceptive Use. MMWR 2010; 59(RR04):1-6.
4. Cleary TP. Update on the new U.S. Selected Practice Recommendations for Contraceptive Use. Presented at the 2013 Contraceptive Technology Quest for Excellence conference. Atlanta; November 2013.
5. Peterson HB, Cates W. Evidence-based medicine in action: the United States Selected Practice Recommendations for Contraceptive Use. Contraception 2013; 87(5):509-510. n