Documented short-term continuation rates for combined hormonal contraceptives in an indigent population with ready access to contraceptive supplies.

OBJECTIVE: One problem women have successfully using combined hormonal contraception is the limited supplies they are dispensed. Patients at the Women's Health Care Clinic at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center have virtually no barriers to method switching, so it is possible to estimate the impacts that more generous prescribing policies have on short-term continuation rates. STUDY DESIGN: Anonymous chart review of all women who initiated hormonal contraception between Jan. 1 and June 30, 2005. RESULTS: Only 40.4% of women had documented use for at least 3 months. Women dispensed supplies for 3 or more cycles at the initial visit were more likely to continue use for 3 months (47.8%) than were women dispensed fewer cycles (31.9%) (P < .0001). CONCLUSION: More liberal dispensing policies may increase the wastage of combined hormonal contraceptive product, but they significantly increase at least intermediate term use of those methods.

Ambulatory diagnosis and medical management of ectopic pregnancy in a public teaching hospital serving indigent women.

OBJECTIVE: The study was undertaken to evaluate the outcomes of indigent women with possible ectopic pregnancy who were cared for in a public teaching hospital outpatient clinic by multiple residents. STUDY DESIGN: Retrospective review of patients seen in the Obstetric-Gynecologic Urgent Care Center at Harbor-UCLA Medical Center from September 1, 2000, through August 30, 2001, was performed. RESULTS: Of the 243 women being evaluated for possible ectopic pregnancy, 4 required surgical intervention during their diagnostic workup and 58 were lost to follow-up. Of the 31 women given methotrexate therapy, 25 successfully completed therapy, 2 required surgery, and 4 were lost to follow-up. Substantial investment was needed to contact patients who missed appointments. CONCLUSION: It is feasible to manage women with possible ectopic pregnancies on an ambulatory basis in a public teaching hospital, but close oversight is needed and both staff and patients must commit to significant follow-up. Local protocols can be modified to reduce the numbers of visits required.