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      Contraceptive Adherence Counseling

      Pharmacists play a critical role in patients correct and consistent use of hormonal contraceptive products. Current data indicates approximately half of all unintended pregnancies occur among couples using some form of contraceptive in the month prior to conception, namely due to inconsistent and/or improper use or gaps in protection when switching products. Adherence must be near perfect; even 1-2 missed doses could undermine efficacy for hormonal contraceptive products. 

      Counseling best practices:  

        • Use open-ended questions 
        • Avoid jargon
        • Emphasize the most important points  
        • Use the teach-back method to ensure patient comprehension
        • Follow up with the patient, if appropriate  

        Educate

        1. How to use the product, including correct and consistent use 
        2. What to do if she misses a dose and where she can find information on what to do if a dose is missed  
          1. Discuss emergency contraception, as appropriate 
        3. When and how to use back-up methods (i.e., when first starting methods, when doses of contraception are missed or skipped, when taking drugs that interact with the contraceptive or when switching between products)  
        4. Possible side effects and when to seek medical attention 
          1. Reassure her that many of the minor side effects, such as spotting, may be temporary or may be able to be addressed through a switch in method (with a plan in place)  
          2. Help develop strategies for coping with side effects, rather than just discontinuing the method without an alternative 

        Address Adherence

        1. Identify actual and/or potential barriers to adherence and propose solutions to overcome them  
          1. Use DRAW tool 
        2. Offer reminder aids or cues to use the contraceptive and arrange for refills  

        Plan for the Future

        1. Create a plan should she want to switch her contraception method in future 
          1. Instruct her not to stop the method without first having a plan to avoid a gap in protection  
        2. Dispel myths about side effects from contraceptives, such as long-term impact on fertility  
        3. Put the risk of contraceptives in context  
          1. Risks associated with hormonal contraception are much lower than the risks of pregnancy-related complications, especially among young, healthy, nonsmokers  

         

         

        References: