Patterns of contraception in UK women with Type 1 diabetes mellitus: A GP database study

Aim: To establish the patterns of contraceptive prescribing for women aged 15–49 with Type 1 diabetes mellitus (DM) and compare them with the patterns in women without diabetes.Methods: This was a cross-sectional study using a UK primary care database.Results: Nine hundred and thirty-eight women with a diagnosis of Type 1 DM were identified. A comparison group of women aged 15–49 without diabetes (n = 10 000) were randomly selected from the database. Twenty-five per cent of the women with diabetes and 32% without diabetes were prescribed a hormonal contraceptive in 1994. Women with Type 1 DM were more likely to be prescribed a combined oral contraceptive than a progestogen only pill (POP) but were 2.12 (95% CI 1.65–2.72) times more likely to be prescribed a POP than women without diabetes and were less likely to be prescribed a combined pill – odds ratio 0.53 (95% CI 0.44–0.64). The pregnancy rate in women with Type 1 DM over the age of 25 years was lower than for women without diabetes. Women under 25 years with Type 1 DM seemed more likely to record a pregnancy.Conclusions: Differences between women with Type 1 DM and those without diabetes highlight the variation in the way that GPs and patients evaluate the risks and benefits when deciding on contraception.<br/

Venous thromboembolic disease and combined oral contraceptives: A re-analysis of the Mediplus database

In October 1995 the Committee on Safety of Medicines advised UK doctors and pharmacists that oral contraceptives containing desogestrel and gestodene were associated with double the risk of venous thromboembolic events (VTE) compared to pills containing other progestogens. In 1997 data was analysed from the MediPlus database of UK general practitioner records, which reported odds ratios for desogestrel and gestodene lower than that for levonorgestrel. Here the results of a more stringent nested case control analysis on the MediPlus database are reported. The study was larger and cases were verified. A crude incidence of idiopathic VTE was found amongst users of combined oral contraceptives of 4.6 per 10 000 exposed women years. Using levonorgestrel 150 ?g + ethinyloestradiol 30 ?g as reference, non-significant odds ratios of 1.1 (0.5–2.6) for desogestrel 150 ?g + ethinyloestradiol 30 ?g and 1.1 (0.5–2.4) for gestodene 75 ?g + ethinyloestradiol 30 ?g were found. The results of this study show no significant difference in risk between different formulations of combined oral contraceptive. <br/

Primary care units in A&amp;E departments in North Thames in the 1990s: initial experience and future implications

Background. In 1992, the Tomlinson Report recommended a shift from secondary to primary care, including specific primary care provision in accident and emergency (A&amp;E) departments. Availability of short-term so-called Tomlinson moneys allowed a number of experimental services. A study of the experience of A&amp;E-based staff is reported to assist general practitioners (GPs) and purchasers and identify areas for further research.Aims. To find the number and scope of primary care facilities in A&amp;E services in North Thames; to find factors encouraging or inhibiting the setting-up of a successful service; to examine the views of a range of A&amp;E staff including GPs, consultants, and nurses; and to suggest directions for more specific research.Method. A postal questionnaire was sent to all North Thames A&amp;E departments, and an interview study of staff in one unit was arranged, leading to a questionnaire study of all GPs employed in North Thames primary care services in A&amp;E. This was followed by interviews of staff members in five contrasting primary care units in A&amp;E.Results. By mid-1995, at least 16 of the 33 North Thames A&amp;E departments ran a primary care service. Seven mainly employed GPs, the others employed nurse practitioners (NPs). Problems for GPs included unclear role definition and their non-availability at times of highest patient demand. GPs' reasons for working in A&amp;E sometimes differed from the aims of primary care in an A&amp;E service. Staff interviews revealed differing views about their role and about use of triage protocols. Ethnicity data were being collected, but not yet being used, to improve service to patients.Conclusions. A number of benefits follow the introduction of primary care practitioners into A&amp;E. Different models have evolved, with a variety of GP and NP staffing arrangements according to local ideas and priorities. There is some confusion over whether these services aim to improve A&amp;E-based care or to divert it to general practice. Cost information is inadequate so far, though the use of GPs has shown the possibility of economy. Appropriate location of services requires clearer identification of costs. This may be possible for the proposed primary care groups. <br/

A comparison of the risks of venous thromboembolic disease in association with different combined oral contraceptives

AimsIn October 1995 in response to the results of three studies, the Committee on the Safety of Medicines advised doctors and pharmacists that oral contraceptives containing desogestrel (DSG) and gestodene (GST) were associated with around a two-fold increase in the risk of thromboembolism compared with those containing other progestogens. The objective of this study was to estimate the risk of idiopathic venous thromboembolic disease (VTE) in users of combined oral contraceptives (COCs), to compare the risk between formulations and to examine the effect of using age banding as opposed to matching by exact year of birth.MethodsA nested case control study was conducted using the General Practice Research Database. Women with a VTE event recorded between 1992 and 1997, who were treated with an anticoagulant, from consideration of their prescription records were likely to have been using a COC prescription on the day of the event and also had no exclusion factors, were deemed cases. For comparison with the previous studies, two nested case control studies were undertaken. Study 1 used controls matched by practice and year of birth. Study 2 used controls matched by practice and within 5 years age bands.ResultsWe found an incidence of idiopathic VTE amongst users of combined oral contraceptives of 3.8 per 10 000 exposed women years. Incidence rates increased markedly after 35 years of age. The nested case-control study using controls matched by year of birth showed no significant difference in risk between the major COC formulations. With levonorgestrel (LNG) 150 µg and ethinyloestradiol (EE) 30 µg as the reference, the adjusted ORs for GST 75 µg and EE 30 µg was 1.3 (95% CI 0.8, 2.1), for DSG 150 µg and EE 30 µg it was 1.0 (95% CI 0.7, 1.7) and for DSG 150 µg and EE 20 µg it was 0.8 (95% CI 0.4, 1.6). Using less rigorous matching criteria, matching controls to cases within 5 years age bands, the ORs increased. When a mixed group of COCs, characterized by having LNG as the progestogen component was used as the reference category, there was an elevation in the ORs for the newer products. We found a significant association between idiopathic VTE and current smoking (OR 2.0 (1.4, 2.7)), BMI over 35 (OR 3.8 (1.8, 8.0)) and asthma (OR 1.9 (1.3, 2.9)). The OR for women who had proxy evidence of general ill health (indicated by the number of prescriptions issued) was 2.2 (1.7, 3.7).ConclusionsThe results of this study indicate that a number of the characteristics of the women taking COCs affect the risk of VTE. There is no evidence to support the hypothesis that there is any difference in risk between COC formulations containing under 50 µg ethinyloestradiol