Background/Purpose: Women of child bearing age with autoimmune diseases are often prescribed teratogenic medications as Methotrexate, Mycophenolate Mofetil, Leflunomide and Cyclophosphamide. Contraceptive compliance in this group of patients has been shown to be low. Patients are required to use reliable methods of birth control to prevent undesirable consequences. Our goal was to improve documentation of variables which help physicians to assess contraception compliance in this group of patients and minimize the deviation from standard of care.

Methods: This study had two retrospective arms, pre and post-implementation of immunosuppressive section to rheumatology clinic note. Subjects are females (50 cases in each arm) aged 21-50 y/o on immunosuppressive medications who are sextually active. Females with hysterectomy, tubal ligation and prisoners were excluded. Variables subjected to review included plan to conceive, contraception use, contraception method, gynecology referral. We applied Chi-squared test to analyze the data.

Results: Documentation of four variables mentioned above was compared between two 50-patient groups (pre-intervention vs post-intervention). There was statistically significant improvement in documentation of all four variables following the intervention as follows: plan to conceive (84% vs 36%)(p=0.000001), contraception used (90% vs 54%)(p=0.00006), type of contraception (76% vs 50%)(p=0.007), gynecology referral (84% vs 38%)(p=0.000002).

Conclusion: Identification of variables which represent patients’ compliance is essential and should be addressed in each patient visit. In this study we improved documentation of variables which could help clinician in early recognizing patients who do not follow the guidelines for contraception to consider them for close monitoring or switch to non-teratogenic medications. In this study in light of poor documentation in the first arm we were unable to compare contraception compliance of patients pre and post intervention.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/contraception-compliance-in-patients-with-rheumatological-diseases-on-disease-modifying-antirheumatic-and-cytotoxic-drugs/