Training contraceptive providers to offer intrauterine devices and implants in contraceptive care: a cluster randomized trial

Thompson, K.; Rocca, Corinne H.; Stern, Lisa; Morfesis, Johanna; Goodman, Suzan; Steinauer, Jody

doi:10.1016/j.ajog.2018.03.016

Cited by 33 publications

(31 citation statements)

References 25 publications

(42 reference statements)

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“…In addition, past increases in both IUD and implant use between 2008 and 2014 were documented across almost all reproductive-age women (7), whereas increases in both of these methods between 2014 and 2016 were concentrated among particular population groups. Use of an IUD increased between these time periods among those who fell into more (27,28), and evidence indicating that adolescents prefer implants over IUDs among LARC choices (29,30), it may be that these latest data represent the first time point at which the impact of these many intersecting factors can be detected at the national level for the youngest age group. Although receiving family planning care at a Title X site, a federally funded family planning program established explicitly to provide funding for contraceptive service delivery to young and low-income people, was not significantly associated with implant use in our analysis, a recent analysis of Family Planning Annual Report Data from the Office of Population Affairs (31) suggests that the Title X program may be playing a role in facilitating access to implant use among Title X patients.…”

Section: Discussionmentioning

confidence: 98%

Use of contraception among reproductive-aged women in the United States, 2014 and 2016

Kavanaugh

Pliskin

2020

F&S Reports

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To examine current levels, correlates of, and changes in contraceptive use among reproductive-age women in the United States between 2014 and 2016. Design: We conducted simple and multivariable logistic regression analyses to identify associations between user characteristics and contraceptive use, with specific attention to methods requiring a visit to a health care provider. Setting: Not applicable. Patient(s): All self-identified female respondents to the surveys. Secondary analysis of two rounds of the National Survey of Family Growth, an in-home, nationally representative survey of people ages 15-44 years (2013-2015) and 15-49 years (2015-2017). Intervention(s): None. Main Outcome Measure(s): Current use of a contraceptive method, including use of individual methods and grouped method use in 2016, and change in use from 2014. Result(s): Contraceptive use remained steady between 2014 and 2016 among sexually active females not seeking pregnancy (88%). Among users, use of long-acting reversible contraceptive (LARC) methods increased from 14% to 18%, as use of short-acting reversible contraceptive (SARC) methods fell from 32% to 28%. Implant use among 15-to 19-year-olds rose from 6% to 16% and represents one of the largest increases observed. Access to sexual and reproductive health care was strongly associated with use of all LARC and SARC methods except for the implant (adjusted odds ratios ranged from 3.21 to 13.53). Conclusion(s): Contraceptive users are shifting primarily among the most and moderately effective method groups, and not from contraceptive nonuse to use. Reductions in access to sexual and reproductive health care could have implications for individuals' ability to use their preferred contraceptive methods. (Fertil Steril Rep Ò 2020;1:83-93. Ó2020 by American Society for Reproductive Medicine.

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Section: Discussionmentioning

confidence: 98%

Use of contraception among reproductive-aged women in the United States, 2014 and 2016

Kavanaugh

Pliskin

2020

F&S Reports

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“…We are also limited by the inability to determine the percentage of Medicaid-insured patients in our study that solely qualified due to pregnancy status. Finally, LARC-method specific analyses are limited given the low numbers of implants requested and received and as 17% of our providers are not certified to place implants [20]. …”

Section: Discussionmentioning

confidence: 99%

Medicaid and receipt of interval postpartum long-acting reversible contraception

et al. 2019

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“…These findings underscore the importance of resident training in contraception, including LARC provision, which is associated with subsequent provision of these services in practice. 17,18 While approximately half of the study participants in this study completed fellowship training in obstetrics or family planning, this additional training is neither necessary to provide contraception nor practical for the vast majority of clinicians. One possible strategy to train PCPs who have already completed residency is the expansion of regional centers that provide high volume procedural training over a short amount of time, and have been associated with significant improvements in physician knowledge and comfort with contraceptive counseling, although less robust results in increasing LARC provision.…”

Section: Discussionmentioning

confidence: 99%

Contraceptive Care for Women With Medical Conditions: A Qualitative Study to Identify Potential Best Practices for Primary Care Physicians

Kang

Guetterman

Prussack

et al. 2019

Fam Med

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Background and Objectives: Women with medical conditions are at higher risk of pregnancy-related morbidity and mortality than women without medical conditions. Thus, women who do not desire pregnancy should be offered contraceptive counseling and methods. The objective of this qualitative study was to identify potential best practices to guide primary care physicians (PCPs) in providing contraception and contraceptive counseling for women with medical conditions. Methods: We conducted semistructured qualitative interviews of 10 PCPs who routinely provide contraception including long-acting reversible contraception (LARC). To inform the data collection and analysis, we adapted constructs from the Theoretical Domains Framework. We coded transcripts and identified themes until saturation of our theoretical constructs was achieved. Results: Physician time constraints, lack of patient knowledge, and competing demands related to medical condition management were identified as barriers to contraceptive care. The study participants reported multiple strategies to mitigate these barriers. They emphasized providing reproductive health education in the context of an individual’s chronic conditions and medications, educating about LARC methods, and using the US Medical Eligibility Criteria (US MEC) as a point-of-care clinical tool to guide contraceptive selection. Conclusions: The study participants (PCPs experienced in contraceptive care), described multifaceted approaches to providing contraception for women with medical conditions, including tailored contraceptive education and use of the US MEC for clinical guidance. Future research is needed to assess if such strategies can improve patient outcomes and be adopted by PCPs who have less experience with contraceptive care.

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Training contraceptive providers to offer intrauterine devices and implants in contraceptive care: a cluster randomized trial

Cited by 33 publications

References 25 publications

Use of contraception among reproductive-aged women in the United States, 2014 and 2016

Use of contraception among reproductive-aged women in the United States, 2014 and 2016

Medicaid and receipt of interval postpartum long-acting reversible contraception

Contraceptive Care for Women With Medical Conditions: A Qualitative Study to Identify Potential Best Practices for Primary Care Physicians

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