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According to an article by Mosher and Jones published in the August 2010 issue of Vital and Health Statistics, 82% of women of reproductive age in the United States have used oral contraceptive pills (OCPs). However, one of the primary reasons that women discontinue OCPs is running out of pills, in addition to difficulty in accessing pills, as reported by Smith and Oakley in the September-October 2005 issue of the Journal of Midwifery & Women's Health and by Kerns and colleagues in the November-December 2003 issue of Perspectives on Sexual and Reproductive Health. In the June 2007 issue of Obstetrics & Gynecology, Westhoff and colleagues noted that OCPs are often provided as a 3-month supply by packs in hand or by prescription. In the March 2011 issue of Obstetrics & Gynecology, Foster and colleagues found that women who received a greater supply of OCPs were more likely to continue OCP use.
This randomized study by O'Connell White and Westhoff assesses whether providing a 3- or 7-cycle supply of OCPs affects the continuation of OCP use at 6 months, with subgroup analysis by age and pill supply as packs or prescription.
Providing a greater supply of OCP packs when they are initiated may improve continuation rates, according to the results of a randomized, controlled trial reported in the September issue of Obstetrics & Gynecology.
"The often small number of [OCP] cycles provided may contribute to high rates of discontinuation," write Katharine O'Connell White, MD, MPH, and Carolyn Westhoff, MD, MSc. "We examined the effect of an increased OCP supply on 6-month continuation rates."
At an urban family-planning clinic, 700 women starting OCP use were randomly assigned to receive either 3 or 7 cycles of OCPs. Participants younger than 18 years and those who were uninsured received their entire OCP supply as packs, whereas those older than 18 years and who had insurance were further assigned to receive either OCP packs or a prescription for refills. At 6 months after enrollment, participants were telephoned to determine rates of OCP continuation and adverse events.
More than three quarters (76%) of participants had available follow-up data (260/342 participants in the 3-pack group; 244/319 participants in the 7-pack group). Rates of continuation at 6 months were higher in the 7-pack group than in the 3-pack group (51% vs 35%; P < .001). Among women younger than 18 years, the treatment effect was more pronounced (49% vs 12%; P < .001) than among women aged 18 years and older (52% vs 40%; P =.018).
Compared with women who received packs, those who received a prescription had lower OCP continuation rates (42% vs 21%; P = .027). Adverse events were infrequent and were not associated with receiving more OCP packs.
"A greater OCP supply at the time of initiation can improve continuation rates, especially among women younger than 18 years of age," the study authors write.
Limitations of this study include a smaller than anticipated insured subgroup, and a largely Hispanic, urban, and poor study population with low generalizability to all groups of women.
"Many medications need to be taken regularly to prevent disease progression and disability," the study authors conclude. "Drug-dispensing limits — 30-day supplies when filled at community pharmacies — are used to control prescription drug costs but may result in overall higher costs as a result of worsening disease. Medication continuation could be greatly enhanced by simply allowing patients to have a greater supply of pills on hand."
A grant from the Office of Population Affairs, Department of Health and Human Services, supported this study. Some of the study authors report various financial relationships with the Department of Health and Human Services, Duramed/Teva, Merck, Bayer, and/or Pfizer.
Obstet Gynecol. 2011;118:615-622. Abstract