Audit of Continuation Rates of Implanon Contraceptive Implant

1.    Reason for the audit:

The nearest family planning clinic to the practice is 15 miles away with very limited public transport. As it became apparent that the contraceptive implant was gaining popularity particularly amongst teenagers, it was felt that the practice should be able to provide this service. I undertook appropriate training and having obtained Letter of Competence in Subdermal Contraceptive Implant Techniques from the Faculty of Family Planning and Reproductive Health Care in July 2005, began providing this service.
Implanon is a very reliable method of contraception and is cost effective provided there are reasonable continuation rates. Having provided this service in the practice for more than 3 years I wished to audit the continuation rates.

2.    Criteria Measured:
Continuation rates for six months, 1 year, 2 years and 3 years were recorded.

       3.    Standard Set:
      Continuation rates published in Contraception 2006 by Lakha F and Glasier A
      These figures were obtained for 324 women choosing Implanon in a family
       planning clinic in  Scotland. 

4.    Preparation and Planning:
Analysis of the log maintained of Implanon insertions between July 2005 and July 2008 and removals between July 2005 and July 2009 of patients who had been registered with the practice throughout this period. People were excluded if they had left the practice after insertion and prior to removal or had joined the practice with Implanon already inserted. This allowed for analysis of at least 1 year follow up for all insertions.

 

5.    Results and Interpretation of data collection:

 

Insertions	Continuation at
		6 mths	1 year	2 year	3yyear
2005/6	18	17	12	9	7
2006/7	19	16	13	13	na
2007/8	22	20	18	na	na
Continuation rate %		90	73	59	39
Published rate %		89	75	59	47

 

Reason for removal	Less than 6 months	6 - 12 months	1-2 years
Bleeding	5/6	8/10	2/4
Weight Gain	1/6	0	1/4
Planning pregnancy	0	2/10	1/4

 

6     Proposals for Change
Although the continuation rates compare favourably with published data, the numbers in the practice are very small in comparison.

 Analysis of the reasons for removal, highlights the frequency of unacceptable bleeding patterns particularly in the first few months of use. This is widely recognised and it is suggested that women be offered up to 3 months of the combined oral contraceptive pill to see if this will allow time for the bleeding pattern to regulate. This is an off label use of the combined oral contraceptive pill, but is recommended by the Clinical Effectiveness Unit of FFPRHC. Initially this was offered in the practice when women returned complaining of unacceptable bleeding but many had already decided they wanted removal of the implant and did not take up this option.

Discussion took place between the 2 GP's providers in the practice and it was agreed that we would inform women of this use of the combined oral contraceptive pill when counselling before insertion. Women are now informed that they would be offered up to 3 months of the combined oral contraceptive pill if bleeding was unacceptable - provided there were no contraindications.