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Nuvaring availability a ‘postcode lottery’

Posted by hannahflynn on February 12, 2010

Where you live can affect your access to a form of contraception, results from my survey of Primary Care Trusts (PCT) in England has shown.

The NuvaRing, which was approved by the National Institute for Health and Clinical Excellence (NICE) for use in January 2009, could be unavailable in nearly one third of PCTs in England.

These results were obtained by a survey of PCTs in England using Freedom of Information requests. The results shown in the Google map below are preliminary, as more responses are needed for a comprehensive overview of the situation.

The NuvaRing is a form of combined hormonal contraception which comes in the form of a vaginal ring. This is left in for three weeks, and then removed for a week to allow a withdrawal bleed (similar to the pill) before another ring is inserted.

It has become clear during this investigation that the NuvaRing is still being considered for inclusion on formularies in many areas. Some PCTs can give no time frame for when a decision will be made and many do not expect a decision to be made for many months.

The reasons given for this are varied. They include a lack of information regarding where funding will come from and very frequently, a lack of demand for the product. In the case of Trafford PCT, the drug has been clinically approved but ‘financial concerns have not been resolved’.

Cost concerns arise again, even where the NuvaRing is available. Nearby Manchester’s PCT warned, ‘We advocate principles of cost effectiveness and where applicable this may mean using the drug of the lowest acquisition cost.’

The NuvaRing costs, on average, £9 a month. This figure is ‘comparatively expensive’  compared to combined contraceptive pills, which vary in cost but average a couple of pounds a month. However, it is by no means the most expensive form of contraception a couple can opt for. The new ‘morning after pill’ or ‘Plan B’, Ellaone which was launched in the UK in October 2009 costs £16.95 per dose and costs three times as much as Levonorgestrel . Implanon, one of the LARCs being recommended costs the NHS £79.46 (correct April 2009) , which is cost effective if used for 3 years, but if removed sooner than a year can prove far less cost effective than the contraceptive pill. Though of course, these figures do not take into account the cost of a pregnancy, unintended or otherwise.

All contraception is available free of charge to patients in the UK on the NHS.

Since 2005 NICE has recommended that all women requiring contraception should be offered a choice of all methods of contraception by their GP, including long-acting reversible forms of contraception (LARCs). Last year in 2009, the NHS introduced three new sexual health indicators into their Quality and Outcome Framework (QOF), which is a voluntary annual reward and incentive programme for all GP surgeries in England. These included:

  • The percentage of women prescribed an oral or patch contraceptive method in the last year who have received information from the practice LARCs in the previous fifteen months and,
  • The percentage of women prescribed emergency hormonal contraception at least once in the year by the practice who have received information from the practice LARCs at the time of, or within one month of, the prescription.

Currently, the NuvaRing does not count as a LARC under NHS guidelines, but one of the benefits of use is that user error is lower; you only have to remember to change it once a month rather than take a pill every day.

In order to fulfill the NICE guidelines laid out in 2005, the NHS launched the ‘Contraception – Worth talking about’ campaign in November 2009. It was revealed in written answers to questions submitted to the Health Secretary Gillian Merron in January 2010  that estimated advertising expenditure ‘to date’ was £1,218,000 and estimated advertising costs for further activity planned for February 2010 is approximately £1,513,000. Budgets for 2010-11 and 2011-12 are currently under review.

Although some PCTs cite a lack of demand for the NuvaRing (for example in Redbridge and South Staffordshire PCTs no application had been made for the NuvaRing), South and Eastern Kent PCT reports 60 being prescribed in the last financial year.

One further problem associated with the NuvaRing is that it requires storage in a fridge. Some PCTs claim they do not have storage available for the product.

While some PCTs have banned the prescription of the NuvaRing by coding it RED or RED RED on their formularies, other PCTs have made it available to women who are unsuitable candidates for other available forms of contraception. Surrey PCT resported, in response to the FOI request submitted that, ‘The Medicine Management sub–committee (May 2009) agreed that Nuvaring® may be of benefit in a small number of patients and therefore should be available to patients in family planning clinics where other treatments are not suitable.’

I await further information to add to this investigation.

* You can become part of this investigation here.

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NuvaRing investigation: Google map

Posted by hannahflynn on February 11, 2010

Above is a map showing the results, so far, of my investigation into the availability of the NuvaRing in England, by Primary Care Trust (PCT).

  • Red signifies a PCT where the NuvaRing is not available.
  • Yellow signifies a PCT where the NuvaRing is available with restrictions.
  • Green signifies a PCT where the NuvaRing is available.

The responses are available where appropriate for you to peruse.

It has become clear during this investigation so far,  the NuvaRing is still being considered for inclusion in many areas. Some can give no time frame for when a decision will be made and many do not expect a decision to be made for many months.

The reasons given for this are varied. They include a lack of information regarding where funding will come from and very frequently, a lack of demand for the product. In the case of Trafford PCT, the drug has been clinically approved but ‘financial concerns have not been resolved’.

Cost concerns arise again, even where the NuvaRing is available. Nearby Manchester PCT warned, ‘ We advocate principles of cost effectiveness and where applicable this may mean using the drug of the lowest acquisition cost.’

Although some PCTs cite a lack of demand for the NuvaRing (for example in Redbridge and South Staffordshire PCTs no application had been made for the NuvaRing), South and Eastern Kent PCT reports 60 being prescribed in the last financial year (the NuvaRing became available in January 2009).

I await further information to add to this investigation.

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NuvaRing investigation: Background information

Posted by hannahflynn on January 27, 2010

An article from Pulse from October 2008 caught my attention today. The article, (here), outlined how plans were made as far back as 2008 to aline LARC availability with NICE guidlines.

They also suggest offering 3 QOF points to surgery’s offering all available contraception to women, including LARCS, amoung other measures.

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Investigation: Help needed

Posted by hannahflynn on January 23, 2010

The NuvaRing, a new form of contraception, was launched in the UK in January 2009 after it was approved by NICE. However, it has become apparent that nearly one year after it was launched many PCTs in the country have listed this form of contraception as RED RED, RED orAMBER on their formularies (a list of which drugs are available to patients) meaning it is unavailable unless a doctor requests it specifically for a patient from the PCT. This is normally only done when there are health risks associated with the patient not receiving a drug.

In the past 18 months there has been increasing pressure to increase the availability of different forms of contraception on the NHS, specifically LARCs (long acting reversible contraception). The NuvaRing is unique in that it lasts a month, and is completely reversible. I has been launched in the US and has become increasingly popular.

I have started an investigation to find out how many PCTs in England and Wales have not made the NuvaRing available to patients. I want to find out which ones have branded it Amber, Red or Red Red and why.

I have left Scotland out of this investigation as the rules concerning formularies are different and it was launched there at a different time.

Here’s how you can help:

Call up your local PCT and ask them how the NuvaRing is branded in your area. Information can be found here.

Call up your local family planning clinic and ask if and how you can access it.

If you have had any problems or have not been happy with your access to contraception via the NHS, please leave your comments below.

Please send any information to hannahbflynn@googlemail.com

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10 reasons you should have the HPV vaccine

Posted by hannahflynn on October 1, 2009

Following the tragic death of a fourteen year-old girl just two hours after receiving the HPV vaccine as part of the UK’s policy to vaccinate all girls under 18, the media has been awash with confused stories regarding the safety of the jab.

The first stages of the postmortem showed she had an underlying health problem, most likely a heart defect which would commonly present for the first time at this age, which was the cause of her sudden death.

However, when the story broke, before the first results from the postmortem became available the media insinuated the HPV vaccine may have caused in her death. 

It is important we do not have a vaccination scare on the scale of the MMR, and young girls (and perhaps their families) are comfortable receiving this potentially life saving jab.

Therefore, here are ten reasons you should have the HPV vaccine:

1. It protects against the two types of HPV which cause 70% of cervical cancers.

2. Women have, on average, a 1.6% chance of developing cervical cancer in their life time; there is less than a 1 in a million chance of severe anaphylaxis due to this vaccine (3).

3. Cervical cancer kills 1,000 women every year in the UK. It is thought the vaccination programme could save 400 of them.

4. The risks are low. All vaccines carry risk, but the HPV vaccine has shown few contraindications. The most common side effect is ‘sore arm’.

5. 50% of sexually active women contract HPV by the time they are 30 .

6. Sexually transmitted diseases are on the rise which can increase your susceptibility to HPV and increase your risk of cervical cancer up to six times (1). For example, women who also have genital herpes are more likely to get more invasive forms of cervical cancer (2).

7. Cancer is a killer, but not only that. Treatment for cervical cancer can include surgery and chemotherapy which can leave you infertile, or with difficulty conceiving. This has happened to many women in their twenties.

8. We need as many people as possible to be vaccinated in order to reduce the prevalence of HPV in the population. Normally, vaccination programmes require 80% of the whole population (men included) to be vaccinated in order to eliminate a disease.

9. Promiscuity alone does not cause cervical cancer, as one third of women with only one sexual partner contract HPV within one year. As previously mentioned, 50% of women have been exposed to HPV by the time they are 30.

10. The NHS (and many other health authorities) have emphasised the importance of, and have promised to continue cervical screening. But there is no reason to not use belt and braces girls!

1. P Koskela, T Anttila, T Bjørge, A Brunsvig. (2000). Chlamydia trachomatis infection as a risk factor for invasive cervical cancer.International journal of cancer.
2. 2003. Cervical cancer risk rises if women with HPV also have herpes infection. International Family Planning Perspectives
3.  D. Cooper, (2007). Determinants of sexual activity and its relation to cervical cancer risk among South African Women. BMC Public Health

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World Contraception Day

Posted by hannahflynn on September 23, 2009

Ahead of World Contraception Day this Saturday 26 September, a number of studies have come out to hammer home the safe sex message.

Lloyds Pharmacy’s latest research shows the average British adult has indirectly had sex with 2,881,024 people. This shocking statistic is based on the average British adult having sex with 7.65 people in their life time.

 “When we have sex with someone, we are, in effect, not only sleeping with them, but also their previous partners and so on,” Clare Kerr, head of sexual health for the chemist chain,  as reported in the Metro today.

 You can calculate your own figure using the tool on their website.  This will base your answer on your age, your number of sexual partners and the age that they were.

 In a similar vein, the Australian publication, Pharmacy News reported an alarming number of women are ignorant of the potential threat to their health and the risk of pregnancy which can result from unprotected sex.

 The research was commissioned by Sexual Health and Family Planning Australia (SHFPA) and Bayer Schering and they found two out of three adult women admitted to having unprotected sex.

SHFPA’s Dr Christine Read said, “It’s worrying that young women continue to engage in unprotected sex, but it is equally concerning that many women don’t have basic knowledge of their menstrual cycle. For example, many women don’t realise they can get pregnant even if they have unprotected sex outside the time they’re ovulating.”

Dr Read went on to say that women taking hormonal contraceptive pills should be given more information about how to take them properly.

Today Conceptus, a company engaged in women’s health care recognised World Contraception Day. This year’s motto is “Your life, your voice: Talk Contraception.” One of the main focuses is encouraging more women to consider permanent forms of birth control.

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Stonewall poster campaign highlights lesbian health issues

Posted by hannahflynn on September 16, 2009

Gay rights group Stonewall has launched a new poster campaign with the Department of Health encouraging lesbian and bisexual women to take better care of themselves.

The move follows the results of ‘Prescription for Change’, the first major survey ever conducted into lesbian and bisexual women’s health in Britain, which has revealed half of the UK’s 1.8 million lesbians report a recent negative NHS experience. The Stonewall research used over 6,000 lesbian and bisexual women in the study.

Stonewall has developed the slogan ‘Love your inner lesbian’ which is going to accompany the campaign. The research, released last year, found deeply disturbing levels of self-harm, substance abuse and exclusion from routine testing for cervical cancer.

The survey also found lesbian and bisexual women are reluctant to be honest about their sexual orientation when talking to doctors. The poster campaign which will hit healthcare centres and clinics soon, aims to encourage women to talk frankly to their doctors about their healthcare needs.A series of posters is now been available depicting the slogan, as well as key statistics from the report – including smear testing, lesbian parenting, mental health issues and drink and drug habits.

The lack of attendance to cervical screening by lesbian and bisexual women is worrying considering the increasing trend for sexually transmitted diseases which can lead to the development of abnormalities on the cervix which can lead to cancer. However, 30% of cervical cancers  occur without pre-exposure to HPV; a cancer causing virus, meaning groups which are not in a high risk group for HPV, Chlamydia and gonorrohea i.e lesbian women, are still at risk of developing the disease. The report suggested their is an increased cost in treating lesbian and bisexual women who usually present with a disease later than their heterosexual peers.

One of the recommendations of the report is to make lesbian health issues more visible so women are more comfortable discussing them with a doctor.

Source: Utalkmarketing.com

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Socialised medicine, obesity, the pill and guessing games

Posted by hannahflynn on July 17, 2009

Because it’s Friday, here’s a round up of a week in the blogosphere:

  • The American Medical Association endorsed Obama’s healthcare reform bill, marking the end to nearly a century of opposition to ‘socialised medicine in the United States. The White House Blog has a video of the speech Obama made explaining why reform is needed now.
  • Dr Kathryn Clancy, Assistant Professor of Anthropology at The University of Illinois, gives her opinion on the effects of the pill when considering the population as a whole in her three part series, What does this anthropologist think about hormonal contraception?.
  • Twitter fave, His Boys Can Swim are running a contest to see who can guess the time their baby will be born. ‘Jane’ is currently 39 weeks pregnant and has been providing an account of her pregnancy through Twitter since the beginning.

Send your news and round ups to the comments box.

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5 Reasons Health Forums are a Bad Idea

Posted by hannahflynn on July 15, 2009

1) It’s not medical advice – Obvious, but something which is often forgotten. People responding to your queries or the queries of others are offering an opinion, not medical knowledge. Plus, though some forums such as Yahoo! Answers has a system which allows medical experts to identify themselves, there are few ways of authenticating the claims of respondents.

2) It’s US dominated – Fair enough if you are living in the United States and have very comprehensive medical insurance, but many people don’t fall into this category. Therefore anybody without patient choice, i.e. most European individuals, are unlikely to be able to use a lot of the ‘get  a second opinion’ advice. The same goes for people without medical insurance in the United States.

3) The anecdote rules – Have you heard the one about the 44 year-old woman who had been trying to conceive through IVF for years and then after giving up, conceived healthy twins? Well it was a one-off and it’s probably not going to happen to you. These forums almost never quote statistics but provide you with stories about how one ‘cure’ worked for someone. Its worst on pregnancy forums too. Every single twinge, absence of twinge, weird feeling and bodily function is analysed within an inch of its life by expectant mothers. Useful for support perhaps, but dangerous if used in place of medical advice at such a vulnerable time.

4) The advice is narrow – As few of the respondents are likely to be medical experts the range of potential causes and complications being discussed is exceedingly narrow. Most threads come to the conclusion the subject is either pregnant or has endometriosis. Sometimes polycystic ovaries. And fften advice is given with only minimal background information provided. A doctor, nurse or midwife is indispensable when it comes to taking medical backgrounds and using them appropriately to diagnose rarer or more complicated problems.

5) It will tell you what you want to hear – Type ‘late period’ into Google and the world will tell you that you are undoubtably pregnant. No matter what your background or circumstances, that is what they will say. Why? Because the internet is dominated by pregnancy forums with women desperate to get pregnant. I recently found a forum where a women who had experienced cramps and bleeding (i.e. a period) was told this was a sign of early pregnancy by numerous women who had experienced the same thing when they were trying. This is confusing and simplified at best, and dismissive and dangerous at worst.

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Epidurals prevent bonding according to male midwife

Posted by hannahflynn on July 14, 2009

The Associate Professor in Midwifery at Nottingham University has caused a furore over the last few days by suggesting pain during childbirth is a rite of passage, helps strengthen the bond between mother and child and that women should forgoe epidurals as they increase the risk of intervention.

The Daily Mail quoted him saying, “A large number of women want to avoid pain, but more should be prepared to withstand it. Pain in labour is a purposeful, useful thing which has a number of benefits, such as preparing a mother for the responsibility of nurturing a newborn baby.” He also said, “emerging evidence shows that normal labour and birth prime the bonding areas of the mother’s brain more than Caesarean or pain-free birth.”

Much of the focus has been on the Associate Professor’s sex – Dr Denis Walsh is a midwife and a man – rather than the evidence behind his research. Published in Evidence Based Midwifery Dr Denis Walsh has claimed epidural rates are already too high and are rising.

His terminology has rightly been called into question by Maureen Freeley in Comment is Free in The Guardian. She has asked “Even if this man had a degree in anthropology, I’d want to question his terms. And what the hell does he know about Bonding with Baby?” She goes on to argue this most recent commentary on childbirth is typical, “As is so often the case in discussions about motherhood, it is laden with moral assumptions.”

The Times’ Alpha Mummy blog points out “his attitude that pain prepares women for motherhood sounds a bit old Testament to me.” The Alpha Mummy team go on to argue that yes, childbirth is a natural process, but so is infant mortality. They also make the interesting point the tables appear to have turned on the assumption The Man was trying to push interventionist approaches to childbirth on women, but now things are going in a different direction.

In the good old-fashioned name of balance the papers have been providing other expert opinions on the matter, many of which are surprisingly blunt in suggesting Dr Walsh’s analysis is lacking.”He’s exaggerating the risks of epidurals. They aren’t overused. In the main they’re a good thing and almost always necessary.” says Dr Justin Clark, an ObGyn based at Birmingham Women’s Hospital in The Telegraph.

Our very own Dr Maggie Blott, mother and head of the Royal College of Obstetricians warned the BBC, “Do not under-estimate the pain of having a baby – it is a very, very intense and painful experience. If it is happening hour after hour in a very prolonged labour it is very tiring and wears people down and I think epidurals are very useful in that situation.” She was backed up in her comments by Cathy Warwick, general secretary of the Royal College of Midwives who said, “At the moment it is very easy for most women to ask for an epidural, and if they want one they definitely should get one.”

For a more irreverent look at the realities of obtaining an epidural on the NHS, have a look at Zoe William’s brilliant Anti-Natal column in the Guardian here.

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