Objective. Recently, there has been substantial media coverage against third-generation birth control pills. It recalled the augmentation of vascular risks due to their consumption. It led to the cutting back on their reimbursement by the government. Following this, numerous recommendations concerning birth control were updated and sent back to professionals of the health sector. The first aim of this work was to present the professional practices, regarding consultations for the prescription of first-line oral contraception. The second aim was to assess whether the professional's strategies for the prescription choices were consistent with the recommendations. Methods. This descriptive study was conducted from November 2013 to January 2014 using a questionnaire distributed to health professionals able to prescribe first-line oral contraception, ie general practitioner, obstetricians and midwives. It targeted professionals working in private, hospital, PMI, family planning and orthogenic center. The questionnaire consisted of three parts and the questions were based on the recommendations of the HAS 2013. The first part analyzed the profile of the participants, the second one studied the course of a consultation for first-line oral contraception, and the third part presented five clinical cases to analyze the contraceptive choice of professionals. Results and conclusion. The majority of the consultations were conducted in accordance with the recommendations of contraception. 94% prescribed first-line 2nd generation pill for a patient without any medical history and with a normal result at the clinical examination. Prescriptions are relatively homogeneous amongst all professionals, except with patient suffering from acne. In this case 24% of all professionals prescribe a 3rd generation pill. In this situation, the midwife would prescribe significantly (p = 0.00377) more 2nd generation pills than obstetricians. It appears that in case of a disease, 37% of the midwives don't prescribe any pill. This heterogeneity in the prescriptions is linked to the different places of practice between liberal midwives and employed midwives.
Authors
- Bibliographic Reference
- Kathleen Fourche. Contraception et risque vasculaire : évaluation des pratiques professionnelles concernant la prescription de la contraception orale en première intention. Gynécologie et obstétrique. 2014. ⟨dumas-01002682⟩
- HAL Collection
- ['Versailles Saint-Quentin-en-Yvelines', 'Université de Versailles Saint-Quentin-en-Yvelines', 'DUMAS', 'LA SANTÉ DANS DUMAS']
- HAL Identifier
- 1002682
- Institution
- Université de Versailles Saint-Quentin-en-Yvelines
- Published in
- France
Table of Contents
- KATHLEEN FOURCHE 2
- CONTRACEPTION ET RISQUE VASCULAIRE 2
- EVALUATION DES PRATIQUES PROFESSIONNELLES 2
- CONCERNANT LA PRESCRIPTION DE LA 2
- CONTRACEPTION ORALE EN 1 INTENTION 2
- Avertissement 3
- Remerciements 4
- Table des matières 5
- Liste des tableaux 7
- Liste des figures 8
- Liste des annexes 9
- Contraception et risque vasculaire évaluation 10
- Contraception and vascularrisk assessing 12
- Professional praticesregarding the prescription 12
- 1 Première partie Introduction 14
- 1.1 La contraception orale 14
- 1.1.1 Contraception orale combinée ou œstroprogestative 14
- 1.1.2 Contraception progestative 17
- 1.2 Maladie thromboembolique et contraception orale 19
- 1.2.1 Les complications thromboemboliques sous contraception 19
- 1.2.2 Incidence des accidents thromboemboliques 20
- 1.2.3 Modification de lhémostase sous contraception 21
- 1.3 Nouvelles recommandations en contraception 22
- 1.3.1 Le rapport bénéficerisque 22
- 1.3.2 Contre-indication aux COC 37 23
- 1.3.3 Les règles de prescription 24
- 2 Seconde partie Etude 27
- 2.1 Matériel et Méthode 27
- 2.1.1 Objectifs 27
- 2.1.2 Type détude 27
- 2.1.3 Population étudiée 27
- 2.1.4 Recueil de données 28
- 2.1.5 Analyse statistique 28
- 2.2 Résultats 29
- 2.2.1 Profil des participants 29
- Date de la dernière formation continue en matière de contraception 33
- Fréquence prescription contraception orale de 1ère intention 34
- 2.2.2 Déroulement dune consultation type concernant la 36
- Durée moyenne dune consultation pour une première prescription de contraception 36
- 2.2.3 Analyse des pratiques par rapport à la première prescription 39
- Femme nayant aucun antécédent particulier et avec un examen clinique normal 39
- Femme sans antécédent ou pathologie particulière mais se plaignant dacné 39
- Jeune femme sans antécédent ou pathologie particulère mais fumant 41
- Femme ayant dans ses ATCD familiaux un accident thromboembolique au 1er degré 44
- Femme étant hypertendue 45
- 3 Troisième partie Discussion 46
- 3.1 Les limites 46
- 3.2 Analyse des résultats 47
- 3.2.1 Profil des participants 47
- 3.2.2 Déroulement dune consultation-type concernant la 52
- 3.2.3 Analyse des pratiques par rapport à la première prescription 55
- Conclusion 64
- Bibliographie 66
- Annexes 72
- Annexe I Questionnaire 73
- 1 PARTIE 73
- Généralités 73
- 2 PARTIE 77
- Profil de différents 77
- Annexe II Liste des contraceptifs oraux commercialisés 79
