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Contraceptive knowledge found lacking by many California healthcare providers

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Many women are in the need for a reliable form of long-acting reversible birth control. Unfortunately, a new study by researchers at the University of California, San Francisco found that many healthcare providers lack knowledge about long-acting reversible contraception. They published their findings in the March edition of the journal Obstetrics & Gynecology.

The study authors note that in 2009, long-acting reversible contraception (LARC), such as intrauterine devices (IUDs) and the single-rod implant, was recommended by the American College of Obstetricians and Gynecologists (ACOG) as a first-line contraceptive option. ACOG noted that LARCs were suitable choices for almost all women, with only rare exceptions. Despite this recommendation, the authors note that barriers to LARC provision exist, including: lack of awareness; misconceptions about their safety, side effects, and suitable candidates; lack of trained and experienced healthcare providers; and structural and financial obstacles. California's Family Planning Access Care and Treatment (PACT) program is the largest Medicaid family planning expansion in the nation; it serves more than 1.8 million individuals annually and has eliminated the financial barrier to provision by offering LARC as well as all other contraceptives for free to low-income and uninsured California residents. A 2006 survey found that almost all Family PACT clinicians considered IUDs to be safe; however, they felt they were suitable for a very limited pool of candidates. The study stressed the need for healthcare provider trainings on updated insertion guidelines and method-specific side effects. In view of the foregoing, the investigators conducted a study to evaluate LARC beliefs and practices among senior healthcare providers representing the family planning services delivered in their practices to evaluate the effect of enhanced birth control.

In the fall of 2011, the researchers conducted a survey by mail to medical directors from 1,000 sites listed in the PACT program provider database. The participants responded by mail, online, or telephone. Data regarding family planning clients served and LARC dispensing were acquired from administrative claims data. All analyses were limited to advanced practice healthcare provider. The analyses revealed the respondent and practice characteristics associated with LARC provision.

The investigators found that, after three follow-up mailings and telephone calls, 636/939 (68%) of the eligible sites responded to the survey. Most respondents were physicians (448/587). They were most likely to consider women with a history of pelvic inflammatory disease unsuitable for hormonal (27%; 161 women) and copper (26%; 154 women) intrauterine devices. Smokers were the most likely to be considered unsuitable for the implant (16%; 96 women). Most of the respondents routinely discussed intrauterine devices (413/561; 75%) and 271/558 (50%) discussed implants with their contraceptive patients. Characteristics that predicted that a clinician would prescribe a LARC included LARC training, beliefs, and healthcare provider type.

The authors noted that significant progress has occurred in the expansion of access and understanding about LARC, many healthcare providers from sites offering family planning services held beliefs limiting the provision of intrauterine devices and were unfamiliar with the implant; thus, suggesting the need for targeted trainings focused on informing clinicians of recent developments in LARC recommendations.

Take home message:
No form of birth control is perfect; however, the newer types of intrauterine devices have less side-effects than older ones. They are best suited for a woman in a stable monogamous relationship. Having multiple partners and not using a condom increases the risk of a sexually transmitted disease (STD). A woman with an intrauterine device who is exposed to a STD has an increased risk of a pelvic infection, which can effect health and fertility. Additional information regarding contraception can be found at the ACOG website.