Transcript LARC in England and London SHA

LARC for London
Stock-Take - where are we now?
Dr Connie Smith
10th March 2012
Connie Smith March 2012
1
Purpose and method
To find out what the various publically available
datasets can show us about access to LARC
contraception in London
Using limited statistical techniques to
interrogate these datasets and then to display
the results clearly
Connie Smith March 2012
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Comparison of % women 15-44 years England/London
40-44
Age groups of women
35-39
30-34
% All women LONDON
25-29
% All Women ENGLAND
20-24
15-19
0
2
4
6
8
10
% total women in each age group
Connie Smith March 2012
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Abortion rate per 1,000 resident women 15-44 - 2010
London SHA
England
0.0
5.0
10.0
15.0
Connie Smith March 2012
20.0
25.0
30.0
4
Abortion
services
GP
(LES,
NES)
PCT
LARC
Commissioning
SRH
services
(contraception)
STI
services
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Data sources for service provision
PACT data for GP Prescribing (majority of
provision)
KT31 for sexual and reproductive health services
I could not find data for LARC provision by STI or
abortion providers
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Limitations of this data (briefly)
• The data do not relate to individual women
• They give no view of real ‘woman-years’ of
contraception
• Determinants of successful use of methods (e.g.
continuation of use) are not included
• No postcodes to show PCT of residence
(especially important for KT31 figures as clinics
are open-access, or should be.)
• KT31 is a very broken instrument and we can only
use Total Clinic Attendances as a proxy measure
for SRH LARC activity
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GPs - All LARCs rate/1,000 women
60.0
50.0
40.0
England
30.0
London SHA
20.0
10.0
0.0
2007-8
2008-9
2009-10
Connie Smith March 2012
2010-11
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GPs - IUD+IUS rate/1,000 women
18.0
16.0
14.0
12.0
10.0
England
8.0
London SHA
6.0
4.0
2.0
0.0
2007-8
2008-9
2009-10
Connie Smith March 2012
2010-11
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GPs - Implant rate/1,000 women
14.0
12.0
10.0
8.0
England
London SHA
6.0
4.0
2.0
0.0
2007-8
2008-9
2009-10
Connie Smith – London LARCs March 2012
2010-11
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GPs annual DMPA usage rate/1,000 women (W/Y)
25.0
20.0
15.0
England
London SHA
10.0
5.0
0.0
2007-8
2008-9
2009-10
Connie Smith March 2012
2010-11
11
0
Kensington & Chelsea
Westminster
Camden
Hammersmith & Fulham
Tower Hamlets
Ealing
Southwark
Harrow
Haringey Teaching
Barnet
Lewisham
Islington
Brent Teaching
City & Hackney Teaching
Waltham Forest
Wandsworth Teaching
Hillingdon
Hounslow
Redbridge
Sutton & Merton
Enfield
Newham
Lambeth
Bromley
Rich'd & Twick'ham
Greenwich Teaching
Kingston
Barking & Dagenham
Havering
Croydon
Bexley Care Trust
GP by PCTs - All LARCs rate/1,000 women
200
180
160
140
120
100
80
2010-11
60
2009-10
40
2008-9
20
2007-8
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Kensington & Chelsea
Westminster
Southwark
Camden
Tower Hamlets
Lewisham
Hammersmith & Fulham
Waltham Forest
Islington
Hillingdon
Haringey Teaching
Ealing
Barnet
Barking & Dagenham
Lambeth
Havering
Harrow
Redbridge
City & Hackney Teaching
Brent Teaching
Sutton & Merton
Enfield
Bromley
Wandsworth Teaching
Hounslow
Greenwich Teaching
Newham
Kingston
Croydon
Richmond & Twickenham
Bexley Care Trust
GP by PCTs - IU insertion rate/1,000 women
80
70
60
50
40
30
20
2010-11
10
2009-10
0
2008-9
Connie Smith March 2012
2007-8
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Westminster
Kensington & Chelsea
Camden
Brent Teaching
Ealing
Harrow
Tower Hamlets
Redbridge
Haringey Teaching
Hammersmith & Fulham
City & Hackney Teaching
Waltham Forest
Hounslow
Hillingdon
Barnet
Wandsworth Teaching
Havering
Sutton & Merton
Islington
Enfield
Southwark
Richmond & Twickenham
Lewisham
Newham
Barking & Dagenham
Bromley
Lambeth
Greenwich Teaching
Croydon
Kingston
Bexley Care Trust
GP by PCTs - Implant insertion rate/1,000 women
50
45
40
35
30
25
20
2010-11
15
2009-10
10
2008-9
5
2007-8
0
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Kensington & Chelsea
Westminster
Camden
Hammersmith & Fulham
Barnet
Harrow
Ealing
Wandsworth Teaching
Southwark
Tower Hamlets
Lewisham
Haringey Teaching
Hounslow
Brent Teaching
City & Hackney Teaching
Islington
Richmond & Twickenham
Newham
Lambeth
Kingston
Redbridge
Hillingdon
Bromley
Enfield
Sutton & Merton
Waltham Forest
Greenwich Teaching
Croydon
Bexley Care Trust
Barking & Dagenham
Havering
GP by PCTs - DMPA annual usage rate/1,000 women
100
90
80
70
60
50
40
2010-11
30
2009-10
20
2008-9
10
2007-8
0
Connie Smith March 2012
15
Lewisham
Camden + Islington
Tower Hamlets
Lambeth
Enfield
Ealing
Wandsworth Teaching
Barking Havering Redbridge
Kensington & Chelsea
Waltham Forest
Hounslow
Greenwich Teaching
Hillingdon
Harrow
Sutton & Merton
City & Hackney Teaching
Southwark
Barnet
Newham
Croydon
Hammersmith & Fulham
Haringey Teaching
Brent Teaching
Bromley
Westminster
Richmond & Twickenham
Bexley Care Trust
Kingston
Rate GP LARCs
70.0
70,000
60.0
60,000
50.0
50,000
40.0
40,000
30.0
30,000
20.0
20,000
10.0
10,000
0.0
Rate GP LARC Rx
Connie Smith March 2012
Clinic attendances
Rates GP LARCs and SRH clinic attendances 2010-11
0
Clinic attendances
16
70,000
Clinic attendances
60,000
50,000
Correlation
Co-efficient
- 0.31
40,000
30,000
20,000
10,000
0
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
Rate GP Rx LARCs
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Newham
City & Hackney Teaching
Tower Hamlets
Haringey Teaching
Islington
Waltham Forest
Barking & Dagenham
Greenwich Teaching
Lambeth
Lewisham
Brent Teaching
Southwark
Hammersmith & Fulham
Enfield
Camden
Ealing
Westminster
Kensington & Chelsea
Croydon
Hounslow
Wandsworth Teaching
Redbridge
Hillingdon
Bexley Care Trust
Barnet
Havering
Harrow
Sutton & Merton
Bromley
Kingston
Richmond & Twickenham
Rate GP Rx LARC
70.0
60.0
40.00
35.00
50.0
30.00
40.0
25.00
30.0
20.00
20.0
15.00
10.00
10.0
5.00
0.0
Rate GP LARC Rx
Connie Smith March 2012
Average PCT Deprivation score
PCT Deprivation score and Rate GP Rx LARC 2010-11
45.00
0.00
Average PCT deprivation score
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Average PCT Deprivation score
50.00
Correlation
- 0.26
40.00
30.00
20.00
10.00
0.00
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
Rate GP Rx LARC
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Newham
Brent Teaching
Waltham Forest
Barking & Dagenham
Haringey Teaching
Greenwich Teaching
Southwark
Lambeth
Redbridge
Lewisham
Hounslow
Enfield
Croydon
City & Hackney Teaching
Ealing
Hammersmith & Fulham
Hillingdon
Harrow
Havering
Barnet
Islington
Tower Hamlets
Bexley Care Trust
Bromley
Sutton & Merton
Kensington & Chelsea
Wandsworth Teaching
Kingston
Westminster
Camden
Richmond & Twickenham
Total GP Rx LARCs
70.0
60.0
50.0
30.0
40.0
25.0
30.0
20.0
20.0
15.0
10.0
0.0
Connie Smith March 2012
Abortion rate
Rate GP Rx LARC and Abortion rate 2010-11
45.0
40.0
35.0
10.0
5.0
0.0
20
45.0
40.0
35.0
Abortion rate
30.0
25.0
20.0
Correlation
Co-efficient
0.12
15.0
10.0
5.0
0.0
0
10
20
30
40
50
60
70
Rate GP Rx LARCS
Connie Smith March 2012
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45
40
35
Correlation
Co-efficient
0.61
Abortion rate
30
25
20
15
10
5
0
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
Average PCT deprivation score
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We need to fix……
• Commissioning and organisation of clinical
services
• Health care professional training for
contraception and LARCs
• Re-imbursement
• Data collection
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We need to talk about……..
• Health and Social Care Bill changes
• Sexual Health Tariff
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References
Balanced Sexual Health Scorecard
http://www.apho.org.uk/default.aspx?QN=SBS_
PAGE02
KT31
http://www.ic.nhs.uk/pubs/nhscontra1011
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References
Indices of Deprivation
http://www.communities.gov.uk/publications/cor
porate/statistics/indices2010
Abortion
http://www.dh.gov.uk/en/Publicationsandstatistic
s/Publications/PublicationsStatistics/DH_126769
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Dawn not dusk...
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