Do Norwegian health personnel comply with guidelines when prescribing COCs to starters?

Abstract

Introduction: Combined oral contraceptives (COCs) containing levonorgestrel are associated with the lowest risk of venous thromboembolism (VTE). The Norwegian Medicines Agency (NOMA) updated the guidelines in 2011 and recommends the low risk products to starters.

Aim: The purpose of this study is to assess changes in prescription pattern of COCs to starters between 2008 and 2016 by provider in line with changes in national recommendations for use.

Material and methods: In a case series design, we have analyzed types of COCs prescribed to starters between 2008 and 2016 in the Norwegian Prescription Database (NorPD). All analyses were done in SPSS version 22.0 with Chi-square test for categorical variables.

Results: The total prescription rate of COCs with levonorgestrel to starters increased from 41% in 2008 to 80% in 2016, with the greatest increase from 2011 to 2012. The rate has increased among starters in all age groups, but it decreased by increasing age of starters. Public health nurses and midwifes, who had highest compliance to guidelines, prescribed COCs with levonorgestrel to 96% of the starters < 20 years in 2016, compared with 75% and 86% among the other main prescribers general practitioners and doctors with no specialty. All professions prescribed recommended COCs in a smaller proportion to older starters.

Conclusion: All professions have increased their prescription rate of COCs with levonorgestrel to starters, public health nurses and midwifes to the greatest extent. General practitioners, who are one of the main prescribers, may prescribe a larger proportion of the recommended COCs to starters to further increase the population of users with the lowest risk of VTE.