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ABSTRACT
Objectives To encourage healthcare professionals to counsel women seeking combined hormonal contraceptives (CHCs) about alternative CHCs and to study the influence of counselling on women's selection of CHCs.
Methods Women (15–40 years old) in 11 countries who consulted HCPs about CHCs were counselled about the pill, transdermal patch, and vaginal ring. Both the HCPs and the women completed questionnaires.
Results Of women who were counselled (n = 18,787), 47% selected another CHC method than originally planned. One in four who intended to use the pill chose another method (16% chose the patch; 65% chose the ring). In total, patch use increased from 5% –8% (difference = 3.7% [97.5% CI: 3.3–4.2]; p < 0.0001). Ring use nearly quadrupled from 8% –30% (difference = 21.7% [97.5% CI: 21.0–22.5]; p < 0.0001). Nearly all women who were undecided prior to counselling selected a method after counselling. Selection of the pill increased most in Russia (+ 11%) and Sweden (+ 5%); patch selection was greatest in Russia (+ 7%) and Israel (+ 6%); ring use increased most in Ukraine and in the Czech Republic and Slovakia (+ 36%).
Conclusions Counselling increases use of alternative CHCs, such as the patch and the ring. Considerable differences between countries were noted.
ACKNOWLEDGEMENTS
The International Steering Committee of CHOICE included: Dr Christian Egarter (Austria), Dr Steven Weyers (Belgium), Dr Tomáš Fait (Czech Republic), Dr Arie Yeshaya (Israel), Dr Frans Roumen (the Netherlands), Prof. Leszek Pawelczyk (Poland), Dr Marina Anatolyevna Tarasova, Prof. Vera Prilepskaya (Russia), Dr Vladimir Cupanik (Slovakia), Prof. Kristina Gemzell-Danielsson (Sweden), Prof. Johannes Bitzer, Dr Brigitte Frey Tirri (Switzerland), and Dr Vyacheslav Kaminskiy (Ukraine).
The authors would like to thank all contraceptive counsellors who participated in this study. A. Peter Morello III, PhD, of Evidence Scientific Solutions, Philadelphia, PA, provided editorial and medical writing assistance but did not meet all ICMJE criteria for authorship.
Declaration of interest: Merck, Sharp & Dohme, Corp. (MSD), a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ, USA, initiated the study and provided financial support to the conduct of this study. The study was overseen by an International Steering Committee. JB, KGD and FR were involved in the design and execution of the study, the development of the counselling materials, and the analysis and interpretation of the data. The authors received no compensation or honoraria in association with this manuscript and exercised sole and complete editorial responsibility for this paper.
Dr Bitzer is president and Dr Gemzell-Danielsson is a board member of the ESC. Drs Bitzer, Gemzell-Danielsson and Roumen have served on medical advisory boards of MSD and occasionally serve as ad hoc lecturers for MSD. Drs Bitzer, Gemzell-Danielsson and Roumen also serve on the medical advisory boards of other pharmaceutical companies. Dr Oddens and Mrs Marintcheva-Petrova are employees of MSD and may potentially own stock and/or hold stock options in the Company. Mr van Bakel is a consultant of OCS Consulting, ‘s-Hertogenbosch, the Netherlands.