Background Systemic Lupus Erythematosus (SLE) predominately affects reproductive aged women. Contraceptive counseling is an important quality indicator in SLE patient care. Here we evaluate current practice in the documentation of contraceptive use amongst reproductive aged women with SLE cared for at a large safety net hospital.
Methods Using ICD 10 codes for SLE (M32, M320, M321, M328, M329), we identified reproductive aged (ages 16–50) female SLE patients, who presented to the outpatient rheumatology clinic at Parkland Hospital between 07/01/17 and 10/31/17. We performed a retrospective chart review of the documentation of contraception use. We also assessed medication use including potential teratogenic medications.
Results Among 112 clinic encounters, contraceptive use was documented in 60% of encounters. Amongst those women prescribed a potentially teratogenic medication, documentation of contraception was present in 68% of clinic notes. In our patient population, the most commonly prescribed potentially teratogenic medication was mycophenolate mofetil followed by methotrexate. The average age of women who were on potentially teratogenic medicine and had documented contraception was younger (mean 31, SD 7.2) than those in whom contraception was not documented (mean 38, SD 8.6). Greater than 50% of those patients on potentially teratogenic medicine used less reliable contraceptive methods: abstinence or condoms. Providers rarely documented other information in regard to reproductive health such as pregnancy planning and the desire to have children.
Conclusions Contraceptive use documentation amongst reproductive aged women with SLE in a safety net hospital is often lacking even amongst those on potentially teratogenic medication. Documentation of contraception is more common in younger women. Identifying barriers to contraceptive use documentation and implementing interventions to facilitate documentation is a future goal.
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