A Florey allows you to send a questionnaire out to patients to gather data. The COCP Florey 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 Florey is only available to users who are in an area that has purchased accuRx Plus.


Content

Enrolment SMS

Hi/Dear NAME,
To prescribe the medication that you have requested, I would like you to provide some information about your health. Please use the link below to submit this.
Thanks, SIGN-OFF



Please follow this link (link will autogenerate here).
You need internet on your phone (otherwise you can open the link on a computer or contact reception).
SENDER ID

First page of questionnaire

Hi NAME,


To prescribe the medication that you have requested, your practice needs you to answer some questions about your health. It should take no longer than ten minutes to complete the questionnaire.

Are you happy to proceed?

This survey is operated by accuRx.

Questions

What is your date of birth?
Example 8 12 1988

  • DD MM YYYY

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

Please describe your headaches

  • Free text field

9. 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

10. 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

11. 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


12. 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

13. Which relatives had breast cancer? Approximately, what age were they diagnosed with it?

  • Free text field

14. Do you have any new unexpected bleeding between your periods since your last review?

  • Yes
  • No

15. Do you have any new bleeding after sex since your last review?

  • Yes
  • No

16. Are you up-to-date with your cervical screening (smear test)?

  • Yes
  • No

17. 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

18. What is your smoking status?

  • Current smoker
  • Ex-smoker
  • Never smoked

19. 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

20. 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.

21. 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

22. 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

23. Do you know your weight?

  • Yes
  • No

24. 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

25. Do you know your height?

  • Yes
  • No

26. 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

27. Are you having any side effects or problems from your contraceptive pill that you would like to discuss with your GP/nurse?

  • Yes
  • No

28. Is there anything else regarding the contraceptive pill that you would like us to know?

  • Free text field

After submitting

Thank you for submitting your answers.

What next?
A clinician will review the answers and you will receive a contact in the next 5 working days to let you know the outcome of your prescription request/pill review.

Please make sure you read this information paying particular attention to:

  • Possible disadvantages/side-effects of the pill
  • Risks of the pill and when to seek medical advice
  • What to do if you forget to take a pill
  • What to do if you vomit or have diarrhoea
  • Effects of other medicines on the pill
  • When you might need emergency contraception

Long-acting reversible contraception
If you are interested in switching from a daily pill to a long-acting contraceptive (such as the coil, implants, injections) you can find more information on these here. Contact the practice if you would like to discuss further.

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 accuRx Inbox

Patient NAME has responded:

Questionnaire : COCP Repeat Prescription Questionnaire

Knows the name of pill : Yes

Requested COCP :

New medications/supplements : Yes

Name of new medication/supplement :

New health conditions : Yes

Name of new health condition :

New or worsening headaches : Yes

Migraines : Yes

Migraine with aura : Yes

PMH VTE : Yes

FH VTE : I don't know

FH breast cancer : Yes

Relative with breast cancer :

IMB : Yes

PCB : Yes

Thinks up to date with smear : Yes

Wants to know more information about sexual health screening : Yes

Smoking status : Current smoker

Smoking quantity : 20-39 cigarettes or equivalent per day

Systolic BP (mmHg) : 120

Diastolic BP (mmHg) : 80

Weight (kg) : 90

Height (m) : 2

BMI : 22.5

Side effects : Yes

Anything else :

SNOMED codes saved to record

The codes added are in 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.

  • Systolic arterial pressure - 72313002
  • Diastolic arterial pressure - 1091811000000102
  • Weight - 162763007
  • Height - 162755006
  • BMI - 60621009
  • Advice about long acting reversible contraception - 376561000000100
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