Accuracy of self-screening tools for contraindicated use of oral contraceptives: A systematic review
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Abstract
Introduction: Progesterone-only pills have been approved for over-the-counter sale in the United States. The American College of Obstetrics and Gynecology has long supported access to and advises the use of a self-screening tool to identify contraindications if combined oral contraceptives are to be sold without prescription.
Objective: To evaluate whether self-screening tools used by women seeking oral contraceptives are sufficiently accurate to replace in-person screening performed by healthcare professionals to detect relevant contraindications.
Methods: A systematic literature search was conducted using PubMed, Embase, Web of Science, and Scopus on April 16, 2024. Eligible studies were original studies that compared a self-screening tool with in-person screening performed by a healthcare professional. The target condition was defined as the presence of one or more category 3 or 4 contraindications to combined oral contraceptive use according to the World Health Organization's Medical Eligibility Criteria for contraceptive use. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale adapted for cross-sectional studies. Due to the heterogeneity in the study populations and tool format, a narrative synthesis was conducted.
Results: Of the 1353 unique records screened, five cross-sectional studies were included, comprising a total of 4,043 participants. The highest sensitivity of a self-screening tool was 83.2% (95% CI, 79.5-85.3) and lowest was 58.8% (95% CI, 51.0-66.3). Two studies presented agreement percentages between self-screening and healthcare professionals for individual contraindications, with all items above 83.6%. A meta-analysis could not be conducted because of the heterogeneity. The overall quality of the included studies was moderate.
Conclusion: Limited but consistent evidence suggests that self-screening tools indicate contraindications to combined oral contraceptive use with moderate to high sensitivity and negative predictive value. These tools may be suitable for triage in situ considering over-the-counter access to combined oral contraceptives, and further validation is warranted.
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