An Accurx questionnaire allows you to send a questionnaire out to patients to gather data. The COCP questionnaire is used to help gather data that would be useful for a repeat prescription request of the combined oral contraceptive pill (COCP). Using the information gathered, clinicians can determine the most helpful subsequent steps in the review e.g. repeat prescription, appointment.
Please note: This questionnaire is only available to users who are in an area that has purchased Accurx Plus.
💬 Enrolment SMS:
Once the patient has accessed the link, they will be prompted to enter their date of birth in order to access the questionnaire 📆
Questions
1. Do you know the name of the contraceptive pill that you want?
Yes
No
No, but I want the same one that I was given last time
2. What is the name of the contraceptive pill you are requesting a repeat prescription for?
Free text input
3. Have you started taking any new regular medications or health supplements (e.g. St John’s Wort) recently?
Yes
No
4. What are the names of the new regular medications or health supplements (e.g. St John’s Wort) that you have started taking since your last prescription?
Free text field
5. Have you been diagnosed with any new health conditions since we last issued you a prescription for the pill? These could be any conditions but in particular: heart disease, stroke, breast cancer, liver disease.
Yes
No
6. What new health conditions have you been diagnosed with since your last prescription?
Free text field
Information screen
To ensure prescribing the pill is safe, please answer the following questions about medical issues that you may have or that run in your family.
7. Are you getting new or worsening headaches?
Yes
No
8. Do you get migraines?
(A migraine is usually a moderate or severe headache felt as a throbbing pain on one side of the head. For more information about migraines, see here)
Yes
No
I don't know
(If I don't know)
9. Please describe your headaches
Free text field
10. Do you have an aura with your migraines?
(An aura is where you have warning signs before your headache begins such as changes to your vision or numbness/pins and needles.)
Yes
No
I don't know
11. Have you ever had a blood clot (also known as DVT/PEs)?
These are clots that cause swollen and painful arms, legs or chest pain. For more information about blood clots, see here.
Yes
No
12. Have any of your immediate family ever had a blood clot (DVT/PE)?
(Your immediate family includes your father, mother, brother and sister)
Yes
No
I don't know
13. Have any of your immediate family or second degree relatives ever had breast cancer?
(Your immediate family include your father, mother, brother or sister. Your second degree relatives include your aunts, uncles, nephews, nieces, grandparents and grandchildren)
Yes
No
I don't know
14. Which relatives had breast cancer? Approximately, what age were they diagnosed with it?
Free text field
15. Do you have any new unexpected bleeding between your periods since your last review?
Yes
No
16. Do you have any new bleeding after sex since your last review?
Yes
No
17. Are you up-to-date with your cervical screening (smear test)?
Yes
No
18. Are you interested in having any sexual health screening?
(This could be important as the oral contraceptive does not protect against sexually transmitted infections)
Yes
No
19. What is your smoking status?
Current smoker
Ex-smoker
Never smoked
20. How much do you smoke?
< 1 cigarette or equivalent per day
1-9 cigarettes or equivalent per day
10-19 cigarettes or equivalent per day
20-39 cigarettes or equivalent per day
40+ cigarettes or equivalent per day
21. Are you able to provide a blood pressure reading?
To safely prescribe the contraceptive pill, it is important that we have an up-to-date blood pressure reading.
Yes
No
Information screen
Before you take your blood pressure reading:
Sit down comfortably for 5 minutes.
Wear loose-fitting clothing.
Make sure your arm is around the same level as your heart.
Make sure your arm is relaxed.
When taking your blood pressure:
Put the cuff on following the instructions which came with your blood pressure monitor.
Keep still and silent.
Other tips:
Take at least three readings, each two minutes apart.
Your first reading may be much higher than the next readings. If this is the case, keep taking readings until they level out and stop falling. Use this as your reading.
Please seek urgent medical attention if you develop any of the following:
Blood pressure is 180/110 or above (despite repeating it at least 2 times)
Chest pain
Changes in vision
Confusion
Severe headache
Here is a video from the British Heart Foundation on how to take your reading.
22. Please enter your systolic (SYS) blood pressure reading. This is the top reading.
(Picture of bp monitor with systolic reading highlighted)
Field for reading entry
23. Please enter your diastolic (DIA) blood pressure reading. This is the lower reading.
Note: This is NOT the pulse.
(Picture of bp monitor with diastolic reading highlighted)
Field for reading entry
24. Do you know your weight?
Yes
No
25. Please enter your weight in kilograms.
If you only know your weight in stone and pounds, please use this converter here.
Field for weight entry
26. Do you know your height?
Yes
No
27. Please enter your height in metres.
If you only know your height in feet and inches, please use this converter here.
Field for weight entry
28. Are you having any side effects or problems from your contraceptive pill that you would like to discuss with your GP/nurse?
Yes
No
29. Is there anything else regarding the contraceptive pill that you would like us to know?
Free text field
When they have submitted their answers they will be thanked for completing the survey and sent a confirmation SMS 👇
Links:
If a smoker this page will also include:
Smoking cessation advice
Smoking leads to health problems such as cancer, heart disease and strokes. The benefits of stopping smoking include: better health, more money and cleaner air for those around you!
Do you want to stop smoking? Here is some advice on ways to quit smoking, local services and general tips: nhs.uk/smokefree
Response in the Accurx Desktop toolbar: COCP Team 👇
Please then select the save to record button if you wish for these results to be saved to the patient's medical record 📚
SNOMED codes saved to record
The codes added are in bold and italics
The following codes are also saved according to the patient's response:
"What is your smoking status?"
"Current smoker" - Current smoker
"Ex-smoker" - Ex-smoker
"Never smoked" - Never smoked
[if chose 'Current Smoker' above] Smoking: "How much do you smoke?"
"Trivial smoker (<1 cigarettes/day or equivalent)" - Trivial smoker (<1 cigarettes/day or equivalent)
"Light smoker (1-9 cigarettes/day or equivalent)" - Light smoker (1-9 cigarettes/day or equivalent)
"Moderate smoker (10-19 cigarettes/day or equivalent)" - Moderate smoker (10-19 cigarettes/day or equivalent)
"Heavy smoker (20-30 cigarettes/day or equivalent)" - Heavy smoker (20-30 cigarettes/day or equivalent)
"Very heavy smoker (40+ cigarettes/day or equivalent)" - Very heavy smoker (40+ cigarettes/day or equivalent)
Smoking cessation advice given - This code is added for anyone who says they are a current smoker. We display a standard short bit of smoking cessation advice with link to nhs.uk/smokefree.
Self reported systolic blood pressure (Concept ID: 1162737008 / CTV3 2469)
Self reported diastolic blood pressure (Concept ID: 1162735000 / CTV3 246A)
Weight - 162763007
Height - 162755006
BMI - 60621009
Advice about long acting reversible contraception - 376561000000100
If you still have any questions or concerns, feel free to chat with us using the green message bubble in the bottom right-hand corner of this page. 👉