An evaluation of remote algorithm-assisted consultations for the safe prescribing of progesterone-only pills in a digital setting
Authors: Bagga S , Perera S , Bagga S K , Seyan K 
Published: November 2022

Abstract

Introduction
This study aimed assessed the prescribing quality of progesterone-only pills (POP) to determine whether online asynchronous algorithmic assisted consultations alone could help women or whether enhanced remote consultations still need to be performed. Our digital service follows Faculty of Sexual and Reproductive Healthcare FSRH clinical guidance, patients who have conditions that fall in category of UKMEC 3 and 4 would be signposted to other methods.1,2 The service works by patients completing an online consultation which is supported by algorithm-assisted consultations. The algorithm is written by doctors and pulls out the relevant information for the clinician to suggest whether it safe to prescribe. Asynchronized consultations using algorithms can identify patients for whom POP is not suitable to prescribe. As this is safe and scalable, it has the potential to improve access to contraception for women. For those women where technology identifies that POP is not suitable, there is still an important place for remote interaction to ensure that women are able to make an informed and safe contraceptive choice.

Aim
To review patients who met a Faculty of Sexual and Reproductive Healthcare (FSRH) exclusion for POP to determine adherence to FSRH clinical guidance on signposting these patients to in-person services where appropriate,1.2 and to review patients’ medical records, who were initially declined POP after completing an online consultation to identify the outcome and potential pathway improvement.

Methods
A retrospective case-note review of 362 patients, who met a FSRH exclusion criteria for POP, using a large digital sexual health service for POP (Cerelle, Cerazette, Norgeston, Noriday) between 1.3.21-25.5.22. Those patients who were not prescribed POP were then identified, to see how they were managed; how many were signposted to the clinic and how many were managed remotely and subsequently prescribed POP. The data underwent descriptive statistical analysis. Ethical approval was not required as this was a service evaluation.

Results
Of the 362 patients who met the FSRH exclusion criteria (100% female, aged 18-51), 288 (80%) patients were declined from POP treatment and signposted to in-persons services, 74 (20%) were prescribed POP after clinician review. Of the 288 who were initially declined POP, 110 (38%) patients sought further advice with a clinician remotely, resulting in 83 being prescribed POP and 27 being declined. Overall clinicians correctly followed guidance for 99% (284/288) of POP consultations who met the FSRH exclusion criteria.2 Of these 4 patients reported potential exclusion criteria for POP and were prescribed. Upon reflection, clinicians felt the potential exclusion criteria could have been explored further before prescribing.

Discussion/Conclusion
Asynchronous consultations bring lots of efficiencies, assists clinicians in triaging and managing the majority of patients. We’ve developed a pathway where patients can undertake a further discussion with a clinician remotely, which resulted in provision of remote contraception. This is convenient for patients and has the potential or may ease pressure off in-person services.

References
1. Faculty of Sexual & Reproductive Healthcare (FSRH). Clinical Effectiveness Unit. FSRH Guidance – Progesterone-only pills. March 2015. Amended April 2019. Royal College of Obstetricians & Gynaecologists Website www.fsrh.org/standards-and-guidance/documents/cec-ceu-guidance-pop-mar-2015 Accessed May 2022
2. Faculty of Sexual & Reproductive Healthcare (FSRH). UK Medical Eligibility Criteria (UKMEC) Summery sheets for contraceptive use. April 2016. Amended September 2019. Website www.fsrh.org/standards-and-guidance/documents/ukmec-2016-summary-sheets Accessed May 2022