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Hale N, Lee J, de Jong J, Smith MG, Khoury AJ. Contraceptive Method Use Among a Population-Based Cohort During the South Carolina Choose Well Initiative. JAMA Netw Open 2024; 7:e248262. [PMID: 38656576 PMCID: PMC11043899 DOI: 10.1001/jamanetworkopen.2024.8262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/27/2024] [Indexed: 04/26/2024] Open
Abstract
Importance Evaluating the impact of statewide contraceptive access initiatives is necessary for informing health policy and practice. Objective To examine changes in contraceptive method use among a cohort of women of reproductive age in South Carolina during the Choose Well contraceptive access initiative. Design, Setting, and Participants In this cohort study, baseline data from the initial Statewide Survey of Women administered from October 1, 2017, to April 30, 2018, to a probability-based sample of women of reproductive age in South Carolina and a peer state (Alabama) were linked with 3 follow-up surveys given in 2019, 2020, and 2021. Responses about contraception use from the initial survey were compared with responses across follow-up surveys using the regression-based differences-in-differences method. Data analysis was performed from October 2023 to February 2024. Exposure The South Carolina Choose Well contraceptive access initiative seeks to fill contraceptive access gaps and increase provision of a full range of contraceptive methods through engagement with a wide range of health care organizations across the state. Main Outcomes and Measures Changes in contraceptive method use, including long-acting reversible contraception (LARC), intrauterine devices (IUDs), implants, short-acting hormonal injection, and barrier or other methods between the baseline survey (2017-2018) and 3 subsequent surveys (2019-2021). Results A total of 1344 female participants (mean [SD] age, 34 [7] years) completed the first survey (667 in Alabama and 677 in South Carolina). Use of LARC significantly increased in South Carolina (119 [17.6%] to 138 [21.1%]) compared with Alabama (120 [18.0%] to 116 [18.1%]; P = .004). Use of IUDs increased in South Carolina (95 [14.0%] to 114 [17.4%]) compared with Alabama (92 [13.8%] to 102 [15.9%]; P = .003). These associations persisted in the adjusted analysis, with a significant increase in the odds of LARC (adjusted odds ratio, 1.24; 95% CI, 1.06-1.44) and IUD (adjusted odds ratio, 1.19; 95% CI, 1.06-1.32) use at follow-up in South Carolina compared with Alabama. Conclusions and Relevance In this cohort study of 1344 participants, increases in the use of IUDs in South Carolina were noted after the implementation of the South Carolina Choose Well initiative that were not observed in a peer state with no intervention. Our findings may provide support in favor of statewide contraceptive access initiatives and their role in promoting access to reproductive health services.
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Affiliation(s)
- Nathan Hale
- Center for Applied Research and Evaluation in Women’s Health and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City
| | - Jusung Lee
- College for Health, Community and Policy, University of Texas at San Antonio, San Antonio
| | - Jordan de Jong
- Center for Applied Research and Evaluation in Women’s Health and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City
| | - Michael G. Smith
- Center for Applied Research and Evaluation in Women’s Health and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City
| | - Amal J. Khoury
- Center for Applied Research and Evaluation in Women’s Health and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City
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Leon-Larios F, Alonso Llamazares MJ, Mausbach Reisen H, Parra Ribes I, Rey Novoa M, Lahoz-Pascual I. Impact of the hands-on clinical training program for subdermic implant on contraceptive counseling and users' choice in Spain: A 6-month follow-up study. Contraception 2024; 132:110372. [PMID: 38237672 DOI: 10.1016/j.contraception.2024.110372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVES The study aimed to evaluate the impact of a structured subdermic implant training program on healthcare providers and its effect on the integration of this contraceptive method into patient counselling. STUDY DESIGN The study was a longitudinal experiment with an intervention group, assessing changes at three points: before the training, immediately after, and six months later. The training consisted of a four-hour session combining theory and practical application, conducted by experts in contraception. RESULTS Out of the participants, 376 healthcare professionals (a 34.3% response rate) completed the training and subsequent questionnaires. Post-training, there was an increase in the inclusion of the implant in contraceptive advice and a rise in the monthly number of implants. Knowledge about the implant, including insertion, positioning, removal, and replacement, significantly improved after six months (p<0.05), particularly among general practitioners. CONCLUSIONS The training program successfully enhanced knowledge and handling of the contraceptive implant, leading to its increased recommendation by healthcare providers and selection by patients. Theoretical and practical training in contraception should be compulsory for healthcare providers involved in contraceptive counselling. IMPLICATIONS A training program that includes lectures, video material, and hands-on demonstrations is effective for developing skills in administering the subdermic implant and its integration into contraceptive counselling. Such training should be regular and required for all healthcare professionals providing contraceptive advice.
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Affiliation(s)
- Fatima Leon-Larios
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Facultad de Enfermería, Fisioterapia y Podología, Sevilla, España.
| | - Maria Jesus Alonso Llamazares
- Unidad de Salud Sexual y Reproductiva, Distrito Sanitario Málaga-Guadalhorce, Servicio Andaluz de Salud, Málaga, España
| | | | | | - Modesto Rey Novoa
- Departamento de Obstetricia y Ginecología, Complejo Asistencial Universitario de Burgos, Burgos, España
| | - Isabel Lahoz-Pascual
- Departamento de Obstetricia y Ginecología, Hospital Universitario Lozano Blesa, Zaragoza, España
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Zell B, Effland K, Snyder M, Hays K, Gordon W. Prescriptive Authority for Direct Entry Midwives in Washington State: Increasing Client Access to Contraception. J Midwifery Womens Health 2024. [PMID: 38229277 DOI: 10.1111/jmwh.13606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/18/2023] [Indexed: 01/18/2024]
Abstract
Improving health and achieving health equity includes access to sexual and reproductive health care for all populations, especially those most in need. However, access to life-saving and life-affirming contraception with an individual's chosen perinatal provider can be impeded by restrictive regulations that limit scope and practice authority. This is especially true for the majority of community and direct entry midwives in the United States who have historically been unable to legally provide effective contraceptive methods. Recently, licensed midwives in Washington state were the first in the nation to achieve prescriptive authority, enabling their clients to directly obtain contraception and access to medications for common prenatal and postpartum conditions. Sustained advocacy efforts in the state's capitol enabled the Midwives' Association of Washington State to build relationships over time with legislators and government agencies to achieve this long-term goal. We present a successful midwifery-led innovation that achieved scope expansion for licensed midwives whose practice authority was limited by restrictive laws. Lessons learned are described and strategies offered to aid midwives and their advocates in other locales who want to improve health equity and access to contraception. Midwives are well positioned to provide this essential care to individuals living in underserved rural and urban areas and those from historically marginalized communities, but their ability to do so is limited by restrictive legislation.
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Affiliation(s)
| | - Kristin Effland
- Department of Midwifery, Bastyr University, Kenmore, Washington, USA
| | | | - Karen Hays
- Department of Midwifery, Bastyr University, Kenmore, Washington, USA
| | - Wendy Gordon
- Department of Midwifery, Bastyr University, Kenmore, Washington, USA
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Goldin Evans M, Gee RE, Phillippi S, Sothern M, Theall KP, Wightkin J. Multilevel Barriers to Long-Acting Reversible Contraceptive Uptake: A Narrative Review. Health Promot Pract 2023:15248399231211531. [PMID: 37978809 DOI: 10.1177/15248399231211531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Unintended pregnancies, which occur in almost half (45%) of all pregnancies in the United States, are associated with adverse health and social outcomes for the infant and the mother. The risk of unintended pregnancies is significantly reduced when women use long-acting reversible contraceptives (LARCs), namely intrauterine devices and implants. Although LARCs are highly acceptable to women at risk of unintended pregnancies, barriers to accessing LARCs hinder its uptake. These barriers are greater among racial and socioeconomic lines and persist within and across the intrapersonal, interpersonal, institutional, and policy levels. A synthesis of these barriers is unavailable in the current literature but would be beneficial to health care providers of reproductive-aged women, clinical managers, and policymakers seeking to provide equitable reproductive health care services. The aim of this narrative review was to aggregate these complex and overlapping barriers into a concise document that examines: (a) patient, provider, clinic, and policy factors associated with LARC access among populations at risk of unintended pregnancy and (b) the clinical implications of mitigating these barriers to provide equitable reproductive health care services. This review outlines numerous barriers to LARC uptake across multiple levels and demonstrates that LARC uptake is possible when the woman is informed of her contraceptive choices and when financial and clinical barriers are minimized. Equitable reproductive health care services entail unbiased counseling, a full range of contraceptive options, and patient autonomy in contraceptive choice.
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Affiliation(s)
- Melissa Goldin Evans
- Mary Amelia Center for Women's Health Equity Research, Tulane University, New Orleans, LA, USA
| | | | - Stephen Phillippi
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Melinda Sothern
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Katherine P Theall
- Mary Amelia Center for Women's Health Equity Research, Tulane University, New Orleans, LA, USA
| | - Joan Wightkin
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Koester KA, Colasanti JA, McNulty MC, Dance K, Erguera XA, Tsuzuki MD, Johnson MO, Sauceda JA, Montgomery E, Schneider J, Christopoulos KA. Assessing readiness to implement long-acting injectable HIV antiretroviral therapy: provider and staff perspectives. Implement Sci Commun 2023; 4:128. [PMID: 37858272 PMCID: PMC10588099 DOI: 10.1186/s43058-023-00506-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 10/01/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Long-acting injectable antiretroviral therapy (LAI-ART) represents the next innovation in HIV therapy. Pre-implementation research is needed to develop effective strategies to ensure equitable access to LAI-ART to individuals living with HIV. METHODS We conducted focus group discussions (FGDs) with providers and staff affiliated with HIV clinics in San Francisco, Chicago, and Atlanta to understand barriers to and facilitators of LAI-ART implementation. Participants also completed a short survey about implementation intentions. FGDs were held via video conference, recorded, transcribed, and thematically analyzed using domains associated with the Consolidated Framework for Implementation Research (CFIR). RESULTS Between September 2020 and April 2021, we led 10 FDGs with 49 participants, of whom ~60% were prescribing providers. Organizational readiness for implementing change was high, with 85% agreeing to being committed to figuring out how to implement LAI-ART. While responses were influenced by the unique inner and outer resources available in each setting, several common themes, including implementation mechanisms, dominated: (1) optimism and enthusiasm about LAI-ART was contingent on ensuring equitable access to LAI-ART; (2) LAI-ART shifts the primary responsibility of ART adherence from the patient to the clinic; and (3) existing clinic systems require strengthening to meet the needs of patients with adherence challenges. Current systems in all sites could support the use of LAI-ART in a limited number of stable patients. Scale-up and equitable use would be challenging or impossible without additional personnel. Participants outlined programmatic elements necessary to realize equitable access including centralized tracking of patients, capacity for in-depth, hands-on outreach, and mobile delivery of LAI-ART. Sites further specified unknown logistical impacts on implementation related to billing/payer source as well as shipping and drug storage. CONCLUSIONS Among these HIV care sites, clinic readiness to offer LAI-ART to a subset of patients is high. The main challenges to implementation include concerns about unequal access and a recognition that strengthening the clinic system is critical.
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Affiliation(s)
- Kimberly A Koester
- Division of Prevention Science, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94105, USA.
| | - Jonathan A Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Moira C McNulty
- Chicago Center for HIV Elimination, University of Chicago, Chicago, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Kaylin Dance
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Xavier A Erguera
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Manami Diaz Tsuzuki
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Mallory O Johnson
- Division of Prevention Science, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94105, USA
| | - John A Sauceda
- Division of Prevention Science, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94105, USA
| | - Elizabeth Montgomery
- Women's Global Health Imperative, RTI International, Berkeley, CA, USA
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - John Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Katerina A Christopoulos
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Phillips-Bell G, Roque M, Romero L. Mapping Long-acting Reversible Contraceptive Interventions to the Social Ecological Model: A Scoping Review. Womens Health Issues 2023; 33:497-507. [PMID: 37500420 PMCID: PMC10522259 DOI: 10.1016/j.whi.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Long-acting reversible contraception (LARC) is one option for preventing unintended pregnancies and short interpregnancy intervals. Efforts to increase access to contraception may benefit from applying the social ecological model (SEM), a framework that considers individual, interpersonal, organizational, community, and policy influences on behavior. We aimed to summarize findings from interventions on LARC use and map interventions to SEM levels. METHODS We conducted a scoping review of the 2010-2020 literature in PubMed/MEDLINE and Embase databases to summarize interventions that did and did not increase LARC use. Although increasing LARC use is not an appropriate goal from a reproductive autonomy standpoint, it is the stated goal of much of the research conducted to date and typically indicates an improvement in access. We mapped these interventions to SEM levels and categorized their strategies: cost support, patient counseling, administrative support, provider training, and other. RESULTS Of 27 interventions reviewed, 17 (63%) increased LARC use. We observed a greater proportion of interventions that increased LARC uptake among those with strategies implemented at policy (8/10 [80%]) or organizational (14/19 [74%]) SEM levels compared with interventions implemented at other SEM levels. When both individual and organizational SEM-level components were implemented, five of six interventions (83%) increased uptake. All five interventions with both organizational- and policy-level components increased LARC use. Among the 27 interventions, patient counseling (n = 12) and cost support (n = 12) were common strategies. Five of 12 interventions (42%) involving patient counseling and 11 of 12 (92%) involving cost support increased LARC use. CONCLUSIONS Organizational and policy SEM components and cost support strategies were most prevalent in interventions that increased LARC use. Future interventions to improve access to contraception, while respecting patient autonomy, could incorporate more than one SEM level.
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Affiliation(s)
- Ghasi Phillips-Bell
- Centers for Disease Control and Prevention, Chamblee Campus, Atlanta, Georgia.
| | - Maria Roque
- Texas A&M University, School of Public Health, College Station, Texas
| | - Lisa Romero
- Centers for Disease Control and Prevention, Chamblee Campus, Atlanta, Georgia
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Ciccariello C, Prakash-Zawisza VR, Pace LE. Massachusetts' innovative policy approach to expanding contraceptive options in primary care. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad035. [PMID: 38756677 PMCID: PMC10986274 DOI: 10.1093/haschl/qxad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/08/2023] [Accepted: 08/22/2023] [Indexed: 05/18/2024]
Abstract
As health systems pivot toward value-based care and as the reversal of Roe vs Wade has significantly decreased access to abortion care in the United States, contraception is increasingly recognized as a high-value health service. However, the United States has a long and troubling history of using contraceptive policies and practices, including forced sterilization, to limit the reproductive rights of people of color and individuals with disabilities. We hope to highlight an innovative program developed by Massachusetts' Medicaid program, which seeks to expand access to long-acting reversible contraception (LARC) within primary care clinics in a way that promotes both value and reproductive justice. This program provides financial incentives for clinics that serve patients with Medicaid to offer LARC to all patients within the primary care space. Unlike LARC programs that exclusively target patients with Medicaid insurance and provide incentivizes based on number of LARC insertions, this policy has the potential to "lift all boats" and expand access to LARC for all patients regardless of payer. Careful evaluation of this program will be necessary to ensure that the intended outcomes-to increase access to LARC, promote reproductive justice, and deliver value to the health system-are achieved.
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Affiliation(s)
- Chloe Ciccariello
- Boston Medical Center,Section of General Internal Medicine, Boston, MA 02118, United States
- Boston University,Boston, MA 02118, United States
| | - Viveka R Prakash-Zawisza
- Massachusetts Executive Office of Health and Human Services, MassHealth,Boston, MA 02108, United States
- University of Massachusetts Chan Medical School,Department of Obstetrics and Gynecology, Worcester, MA 01605, United States
| | - Lydia E Pace
- Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital,Boston, MA 02115, United States
- Harvard Medical School,Boston, MA 02115, United States
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Abrahams TL, Pather MK, Swartz S. Knowledge, beliefs and practices of nurses with long-acting reversible contraception, Cape Town. Afr J Prim Health Care Fam Med 2023; 15:e1-e8. [PMID: 37265159 DOI: 10.4102/phcfm.v15i1.3571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Implanon and copper intrauterine contraceptive device (IUCD) are long-acting reversible contraceptives (LARC) available in public primary health care (PHC) South Africa. These methods are the most effective forms of contraception. AIM To evaluate the knowledge, beliefs and practices on provision of LARC. SETTING Primary health care facilities within the Khayelitsha Eastern Substructure, Cape Town. METHODS A descriptive survey of all permanent nurses who provided contraception. Data were collected from 72/90 (80% response rate) via a validated questionnaire and evaluated using Statistical Package for Social Sciences (SPSS). RESULTS Knowledge of eligibility for LARC was tested. The mean knowledge scores for Implanon were 8.56/11 (s.d. 1.42) for the trained and 7.16/11 (s.d. 2.83) for the untrained (p = 0.007). The mean knowledge scores for IUCD were 10.42/12 (s.d. 1.80) for the trained and 8.03/12 (s.d. 3.70) for the untrained (p = 0.019). Participants believed that inaccessibility to training courses (29%), no skilled person available (24%) and staff shortages (35%) were barriers. Less than 50% of women were routinely counselled for LARC. Forty-one percent of nurses were trained and performed IUCD insertion, and 64% were trained and performed Implanon insertion, while 61% and 45% required further training. Confidence was low, with 32% trained and confident in IUCD and 56% trained and confident in Implanon insertion. CONCLUSION Lack of training, poor confidence and deficient counselling skills were barriers to effective LARC provision. The identified system-specific barriers must be addressed to improve uptake.Contribution: The first study to evaluate knowledge, beliefs and practices on LARC in providers in the Western Cape.
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Affiliation(s)
- Tracey-Leigh Abrahams
- Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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Bell N, Hopla D, George T, Durham CO, Miller L, Kelley S. Evaluation of a Hands-On Graduate Training Curriculum in Contraception Care. J Nurse Pract 2023. [DOI: 10.1016/j.nurpra.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
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Yamaguti EMM, Sontag Dos Reis ET, Martins WP, Nadai MN, Soares NF, da Silva Costa F, Vieira CS. Ultrasound-guided repositioning technique for partially expelled intrauterine device: descriptive feasibility study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:109-113. [PMID: 35793228 DOI: 10.1002/uog.26023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/07/2022] [Accepted: 06/21/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To describe the feasibility of an ultrasound-guided repositioning technique for partially expelled intrauterine devices (IUDs) without use of sedation. METHODS This was a descriptive feasibility study of patients with a partially expelled IUD managed in our outpatient clinic from January 2016 to February 2020. The partially expelled IUDs (vertical arm extending partially or entirely through the cervical canal) were repositioned at the uterine fundus using Hartmann alligator forceps under ultrasound guidance. Paracervical or intracervical anesthesia and prophylactic antibiotics were not used. Data related to the procedure and 6-month follow-up were extracted from patient medical records. The primary outcome was the success rate of the repositioning procedure, defined as ultrasound confirmation of the entire IUD located above the internal os. Secondary outcomes included the retention and expulsion rates of the repositioned IUD at 6 months after the procedure and description of complications. RESULTS We included data from 55 women with a partially expelled IUD (35 levonorgestrel IUDs and 20 copper IUDs) referred for repositioning. Ultrasound-guided repositioning of the IUD was successful in 51 (92.7%) cases, while the procedure was not completed in four patients due to pain. Of the 55 procedures, 48 (87.3%) were performed by obstetrics and gynecology trainees under the supervision of a senior specialist. Among the 51 successfully repositioned IUDs, nine (17.6%) were expelled within 6 months after the procedure and six patients were lost to follow-up. No uterine perforation or infection-related complications occurred within 6 months of the procedure. CONCLUSION The ultrasound-guided repositioning technique appears to be a safe and feasible approach for partially expelled IUDs. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E M M Yamaguti
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - E T Sontag Dos Reis
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - W P Martins
- SEMEAR Fertilidade, Reproductive Medicine, Ribeirão Preto, Brazil
| | - M N Nadai
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - N F Soares
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - F da Silva Costa
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- Maternal-Fetal Medicine Unit, Gold Coast University Hospital, Southport, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - C S Vieira
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Hands-On Training in a Digital World: A Novel Simulation-Based Virtual Training Program for Placement and Removal of the Subdermal Contraceptive Implant. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:1167-1173. [PMID: 36087921 PMCID: PMC9451933 DOI: 10.1016/j.jogc.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The COVID-19 pandemic necessitated a shift from traditional in-person instruction for learning new technical skills to virtual delivery of medical education training. The objectives of this study were to develop and evaluate a virtual simulation-based training program for Canadian health care professionals (HCPs) on the insertion, localization, and removal of the etonogestrel subdermal contraceptive implant. METHODS A scientific committee of Canadian family planning experts developed a 2-part virtual training program during the COVID-19 pandemic. Core educational content (part 1) was provided in an asynchronous, self-directed, online format. Part 2 consisted of synchronous, simulation-based training using web conferencing. The HCPs were provided with model arms and placebo applicators; the trainers demonstrated implant insertion and removal techniques, and trainees received individual feedback. All trainees were asked to complete an online evaluation upon completion of the program. RESULTS Between September 22, 2020, and December 31, 2021, 83 trainers conducted 565 virtual training sessions. A total of 3162 HCPs completed part 1 of the training program, of whom 2740 had completed part 2 by December 31, 2021. Participants reported high levels of satisfaction with virtual simulation-based training; 96.5% of respondents (1570/1627) agreed that the virtual format was effective. Additional training prior to inserting the implant in clinical practice was requested by 4.5% of respondents (75/1671). CONCLUSION Virtual simulation-based learning provides effective education and technique training for etonogestrel implant insertion and removal. Online training for implant use can be scaled, as needed, to reach professionals in remote or underserved locations. This virtual training approach may be appropriate for other technical or minor surgical procedures.
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Hands-On Experience With Long-Acting Reversible Contraception for Nurse Practitioner Students. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Romer SE, Kennedy KI. The Colorado Initiative to Reduce Unintended Pregnancy: Contraceptive Access and Impact on Reproductive Health. Am J Public Health 2022; 112:S532-S536. [PMID: 35767790 PMCID: PMC10461486 DOI: 10.2105/ajph.2022.306891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/04/2022]
Abstract
The Colorado Initiative to Reduce Unintended Pregnancy, including its largest subproject, the Colorado Family Planning Initiative, had a significant impact on contraceptive access during and after the project period. This coordinated and multilevel initiative improved reproductive health outcomes by driving change in public health systems, advancing statewide policies, building capacity through training and technical assistance, and increasing public awareness and education. Lessons learned from the implementation and outcomes of the Colorado Initiative to Reduce Unintended Pregnancy continue to inform contraceptive access efforts. (Am J Public Health. 2022;112(S5):S532-S536. https://doi.org/10.2105/AJPH.2022.306891).
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Affiliation(s)
- Sarah E Romer
- Sarah E. Romer is with the Department of Pediatrics, Section of Adolescent Medicine, University of Colorado School of Medicine, Aurora. Kathy I. Kennedy is with the Colorado School of Public Health, Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Kathy I Kennedy
- Sarah E. Romer is with the Department of Pediatrics, Section of Adolescent Medicine, University of Colorado School of Medicine, Aurora. Kathy I. Kennedy is with the Colorado School of Public Health, Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora
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George JL, Hussein N, Goba GK, Hussain NA. What Does He Think? Male Knowledge and Attitudes Regarding Long-Acting Reversible Contraception. J Pediatr Adolesc Gynecol 2021; 34:821-824. [PMID: 34333123 DOI: 10.1016/j.jpag.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/03/2021] [Accepted: 07/22/2021] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE Contraceptive counseling, especially regarding long-acting reversible contraception (LARC), has generally been directed at women. However, male partners and peers may influence contraceptive decision making. As there were no published studies examining male perceptions of LARC in the United States, this study investigated male knowledge and attitudes regarding LARC. DESIGN An anonymous electronic cross-sectional survey collecting qualitative and quantitative data was administered from May to September 2018. SETTING Participants were recruited via university e-mail listservs and in-person at a campus student organization fair at the University of Illinois at Chicago in Chicago (UIC), Illinois. PARTICIPANTS University students identifying as male and 18-24 years of age. INTERVENTIONS None. MAIN OUTCOMES MEASURED Knowledge of LARC, perceptions of LARC, interest in learning about LARC. RESULTS Participants (n = 97) were predominantly heterosexual (83.5%) men. Of those who were sexually active (63.9%), 98.4% reported female partners trying to avoid pregnancy. The most commonly used methods of contraception were oral contraceptive pills (48.4%) and/or condoms (80.6%). The majority (76.3%) of participants had not heard of LARC. Absence of prior LARC use by a partner was associated with knowledge deficits about LARC (odds ratio = 0.26, 95% confidence interval = 0.70-1.00); however, this association was not seen with other contraceptive methods. Participants familiar with LARC were generally neutral to very supportive of LARC (87.0%). Additionally, 80.4% of participants were interested in learning more about LARC. CONCLUSION Males 18-24 years of age had limited knowledge of LARC, with an interest in learning more about LARC. This information could shape interventions to bridge knowledge gaps, ultimately helping women to make supported contraceptive choices.
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Affiliation(s)
- Jessica L George
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois.
| | - Nada Hussein
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois
| | - Gelila K Goba
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois
| | - Nuzhath A Hussain
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois
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15
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DeSisto CL, Estrich CG, Kroelinger CD, Pliska E, Akbarali S, Romero L, Cox S, Velonis A. Increasing Access to Contraception in the United States: Assessing Achievement and Sustainability. J Womens Health (Larchmt) 2021; 30:1217-1224. [PMID: 34524017 DOI: 10.1089/jwh.2021.0414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: During October 2016 through May 2018, a learning community was convened to focus on policies and programs to increase access to the full range of contraceptive options for women of reproductive age. The Increasing Access to Contraception (IAC) Learning Community included 27 jurisdictions, with teams from each jurisdiction consisting of state health department leaders, program staff, and provider champions. At the kick-off meeting, teams from each jurisdiction created action plans that outlined their goals. Methods: We contacted jurisdictions during May-June 2019, 1 year after the learning community ended, and invited them to complete a post-assessment of goal achievement and sustainment through semi-structured interviews over the telephone or via email. Results: Follow-up information was collected from 26 jurisdictions (96%) that participated in the learning community. The teams from these jurisdictions had created 79 total goals. At the time of the learning community closing meeting in May 2018, 35 goals (44%) had been achieved. Three jurisdictions achieved all their goals by the close of the learning community. At the time of the post-assessment 1 year later, jurisdictions were sustaining efforts for 69 (87%) of the total goals. In every jurisdiction, work on at least one goal that originated in the learning community was sustained. Conclusions: The jurisdictions that participated in the IAC Learning Community continued the work of their action plan goals 1 year after the formal closure of the learning community, indicating sustainability of the learning community activities, beyond what jurisdictions accomplished during formal participation.
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Affiliation(s)
- Carla L DeSisto
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia, USA
| | - Cameron G Estrich
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Charlan D Kroelinger
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia, USA
| | - Ellen Pliska
- Family and Child Health, Association of State and Territorial Health Officials, Arlington, Virginia, USA
| | - Sanaa Akbarali
- Family and Child Health, Association of State and Territorial Health Officials, Arlington, Virginia, USA
| | - Lisa Romero
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia, USA
| | - Shanna Cox
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia, USA
| | - Alisa Velonis
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
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16
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Skračić I, Lewin AB, Roy KM. Evaluation of the Delaware Contraceptive Access Now (DelCAN) initiative: A qualitative analysis of site leaders' implementation recommendations. Contraception 2021; 104:211-215. [PMID: 33762171 PMCID: PMC8286296 DOI: 10.1016/j.contraception.2021.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 03/08/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES In 2014, Delaware launched a statewide initiative to reduce the rate of unintended pregnancies and increase access to contraception services. Our study objective was to understand the implementation experiences, barriers, and successes across health care practice settings and to provide recommendations for future, similar initiatives. STUDY DESIGN As part of a larger multicomponent process evaluation, we conducted semistructured interviews with 32 leaders from 26 practice settings implementing the initiative across the state. We analyzed the qualitative data through iterative open, axial, and selective coding using grounded theory methods, employing thematic analysis to identify common themes in implementation experiences. RESULTS Most practices perceived that patient demand for methods of long-acting reversible contraception (LARC) increased. Many practices had to adapt the intervention to fit the needs and constraints of their settings and patient populations. Primary care practices, smaller practices, and practices that served large numbers of adolescents experienced more barriers compared to obstetrics and gynecology or women's health practices. For current and future iterations of the initiative, leaders emphasized: (1) the need for greater implementation flexibility, (2) the importance of inclusive communication at multiple levels, and (3) attending to logistical challenges, particularly around billing. CONCLUSION Varied practice settings required significant flexibility and responsiveness to context in order to implement the initiative. Organizations with greater pre-existing capacity were able to offer the full range of contraceptive care, as the initiative intended, in contrast to practices with less pre-existing capacity for providing methods of LARC and other types of contraception. IMPLICATIONS To meet the specific but heterogenous needs of various practices, it is crucial for future contraceptive access initiatives to conduct a comprehensive pre-implementation assessment. Preceding any training, this assessment should gather input from participants across all roles in a medical practice (e.g., providers, medical assistants, office staff, billing department).
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Affiliation(s)
- Izidora Skračić
- University of Maryland - School of Public Health, College Park, MD, USA.
| | - Amy B Lewin
- University of Maryland - School of Public Health, College Park, MD, USA.
| | - Kevin M Roy
- University of Maryland - School of Public Health, College Park, MD, USA.
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Runyan A, Welch RA, Kramer KJ, Cortez S, Roberts LJ, Asamoah C, Ottum S, Sanders J, Shafi A, Recanati MA. Long-Acting Reversible Contraception: Placement, Continuation, and Removal Rates at an Inner-City Academic Medical Center Clinic. J Clin Med 2021; 10:jcm10091918. [PMID: 33925203 PMCID: PMC8125758 DOI: 10.3390/jcm10091918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022] Open
Abstract
Long-Acting Reversible Contraception (LARCs) has the potential to decrease unintended pregnancies but only if women can easily access a requested method. Retrospective electronic chart review identified women desiring LARC placement over a one-year period ending 31 December 2016. Most of the 311 insertions were for family planning, with 220 new insertions and 60 replacements. Delays occurred in 38% (n = 118) of patients, averaged 5 ± 5 weeks, and 47% received interval contraception. Reasons included absence of qualified provider (n = 44, 37%), pending cultures (n = 31, 26%), and Mirena availability. Teenage LARC use favored Nexplanon whereas older women preferred Mirena (p < 0.01). Of the 11% choosing early LARC removal, a significant number were African Americans (p = 0.040) or teenagers (p = 0.048). Retention time varied by device type; most patients switched to other contraceptives. No patients experienced IUD expulsion. Understanding barriers, attempting to remedy them, and addressing the side effects associated with LARC use is of importance in this inner-city patient population in the United States.
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Affiliation(s)
- Aliye Runyan
- Department of Obstetrics and Gynecology, Westchester Medical Center, Valhalla, NY 10595, USA;
| | - Robert A. Welch
- Department of Obstetrics and Gynecology, Hurley Medical Center, Flint, MI 48503, USA;
| | - Katherine J. Kramer
- Department of Obstetrics and Gynecology, St. Vincent’s Catholic Medical Centers, New York, NY 10011, USA;
| | - Sarah Cortez
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48202, USA; (S.C.); (L.J.R.); (C.A.)
| | - LeAnne J. Roberts
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48202, USA; (S.C.); (L.J.R.); (C.A.)
| | - Clementina Asamoah
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48202, USA; (S.C.); (L.J.R.); (C.A.)
| | - Sarah Ottum
- Department of Surgery, Wayne State University, Detroit, MI 48202, USA;
| | - Jessica Sanders
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA;
| | - Adib Shafi
- Department of Computer Science, Wayne State University, Detroit, MI 48202, USA;
| | - Maurice-Andre Recanati
- NIH-Women’s Reproductive Health Research (WRHR) Scholar, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48202, USA
- Correspondence:
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Maples JM, Espey E, Evans ML, Breeze JL, Ogburn T, Zite NB. Obstetrics-gynecology resident long-acting reversible contraception training: the role of resident and program characteristics. Am J Obstet Gynecol 2020; 222:S923.e1-S923.e8. [PMID: 31866517 DOI: 10.1016/j.ajog.2019.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Obstetrics-gynecology residents should graduate with competence in comprehensive contraceptive care, including long-acting reversible contraception. Lack of hands-on training and deficits in provider education are barriers to long-acting reversible contraception access. Identifying the number of long-acting reversible contraception insertions performed by obstetrics-gynecology residents could provide insight into the depth and breadth of long-acting reversible contraception training available to obstetrics-gynecology residents in Accreditation Council for Graduate Medical Education-accredited residency programs. OBJECTIVE Our study investigates long-acting reversible contraception-specific training in obstetrics-gynecology residency programs across the United States, including the self-reported number of long-acting reversible contraception insertions per resident and the impact of resident demographic characteristics and residency program characteristics on training. STUDY DESIGN Obstetrics-gynecology residents completed a voluntary electronic survey during the 2016 Council on Resident Education in Obstetrics and Gynecology examination. The survey included resident demographic characteristics and residency program characteristics as well as resident education and training in long-acting reversible contraception (number of intrauterine devices and implants inserted, training in immediate postpartum intrauterine device placement). A binary "long-acting reversible contraception insertion experience" variable dichotomized respondents as having a low level of long-acting reversible contraception insertions (0 implants and/or 10 or fewer intrauterine devices ) or a high level of long-acting reversible contraception insertions (1 or more implants and/or 11 or more intrauterine devices). χ2 tests were used to compare the presence of long-acting reversible contraception insertion experience by postgraduate year, resident demographic characteristics, and residency program characteristics. Adjusted logistic regression was performed to ascertain the independent effects of gender, race/ethnicity (non-Hispanic white vs other), residency program type (university vs community), and residency program geographic region on the likelihood of "low" overall long-acting reversible contraception insertion experience. RESULTS In total, 5055 obstetrics-gynecology residents completed the survey (85%); analysis included only residents in United States obstetrics-gynecology programs (N=4322). Of the total analytic sample, 1777 (41.2%) had low long-acting reversible contraception insertion experience. As expected, the number of intrauterine device insertions, implant insertions, and overall long-acting reversible contraception experience increased as residents progressed through training. Long-acting reversible contraception insertion experience varied by residency program geographic region: 169 (27.1%) residents in programs in the West had low long-acting reversible contraception insertion experience compared with 498 (39.0%) in the South, 473 (45.3%) in the Midwest, and 615 (46.0%) in the Northeast. Only 152 (14.9%) of all postgraduate year 4 residents had low long-acting reversible contraception insertion experience. Among postgraduate year 4 residents, low long-acting reversible contraception insertion experience was significantly associated racial/ethnic minority status and community-based residency program type (compared with university-based). Postgraduate year 4 residents in programs located in the Northeast and Midwest had 4.25 (95% confidence interval, 2.04-8.85) and 2.75 (95% confidence interval, 1.27-5.97) times the odds of low long-acting reversible contraception experience compared with those in residency programs in the West, even after adjusting for other respondent characteristics and other residency program characteristics. CONCLUSION Obstetrics-gynecology residents experience a range of long-acting reversible contraception training and insertions, which differed according to resident race/ethnicity and residency program characteristics (program type and geographic region). Residency programs with low long-acting reversible contraception training experience should consider opportunities to improve competence in this fundamental obstetrics-gynecology skill.
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Thompson CM, Broecker J, Dade M. How Long-Acting Reversible Contraception Knowledge, Training, and Provider Concerns Predict Referrals and Placement. J Osteopath Med 2019; 119:725-734. [PMID: 31657827 DOI: 10.7556/jaoa.2019.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Context Providing long-acting reversible contraception (LARC; eg, subdermal implants and intrauterine devices [IUDs]) can help mitigate rates of unintended pregnancy because they are the most effective reversible contraceptive methods. However, many varied barriers to LARC placement are reported. Medical education and training can be tailored if there is a better understanding of how barriers predict LARC referral and to predicting LARC placement. Objective To understand how a variety of key barriers to LARC placement are related to one another; to identify which of the barriers, when considered simultaneously, predict LARC referral and LARC placement; and to assess the barriers to LARC placement that persist, even when a major barrier, training, is removed. Methods We recruited providers (obstetricians and gynecologists, family physicians, pediatricians, internal medicine physicians, certified nurse practitioners, and certified nurse midwives) across the state of Ohio. Participants were compensated with a $35 Amazon gift card for completing an online survey comprising 38 Likert-type items, an 11-item knowledge test, LARC placement and referral questions, and demographic questions. We conducted data analyses that included correlations, odds ratios, and independent samples t tests. Results A total of 224 providers participated in the study. Long-acting reversible contraception knowledge, training, and provider concerns were correlated with one another. Training was found to positively predict placement and negatively predict referral when other barriers, such as knowledge and provider concerns, were considered simultaneously. Of providers who were trained to place implants, 18.6% (n=16) said they referred implant placement, and 17.4% (n=15) said they did not place implants. Of providers who were trained to place IUDs, 26.3% (n=26) said they referred IUD placement, and 27.3% (n=27) said they did not place IUDs. Those who referred placement and those who did not place LARCs reported greater barriers (in type and magnitude) to LARC placement than those who did place LARCs. Conclusion(s) Long-acting reversible contraception knowledge, training, and provider concerns about barriers to LARC placement were interdependent. Even when providers were trained to place LARCs, a significant portion referred or did not place them. Efforts to increase LARC placement need to address multifaceted barriers.
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