Background/Purpose:

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 11/30/17. We performed a retrospective chart review for contraceptive use documentation. Medication use including potential teratogenic medications was also assessed.

Results:

Among 131 clinic encounters, contraceptive use was documented in 61% of encounters. Amongst those women prescribed a potentially teratogenic medication, myocophenolate mofetil was the most common followed by methotrexate. Amongst those on teratogenic medication, documentation of contraception was present in 67% of clinic notes. The average age of women who were on potentially teratogenic medicine and had documented contraception was younger (mean 30, SD 7) than those in whom contraception was not documented (mean 37, SD 10). 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.

Fig 1. Contraceptive methods used among SLE patients who are on potentially teratogenic medications.

Conclusion:

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.