Assessment of Clinician Attitudes and Practices in the Use of Long-Acting Reversible Contraceptives [248

Abstract

INTRODUCTION: Approximately half of all unintended pregnancies result from incorrect or inconsistent contraceptive use. Although the American College of Obstetricians and Gynecologists (the College) has urged the use of intrauterine devices (IUDs) and contraceptive implants (long-acting reversible contraception [LARC]) as first-line choices because of their low failure rates convenience and safety they are underutilized. This study evaluated physician and nurse current knowledge and practice patterns with respect to IUDs and implants as part of a national continuing medical education (CME) needs assessment. METHODS: An Internet-based CME certified self-assessment consisting of 21 case-based questions about knowledge skills attitudes barriers and practices relating to LARC methods was administered for free to physicians physician assistants and nurses and advance practice nurses. This analysis focuses on data collected during March 27 2014 and April 8 2014. RESULTS: A total of 300 obstetrician-gynecologists (ob-gyns) 171 primary care physicians and 5127 nurses provided data for this analysis. The first-year typical-use failure rate of combined hormonal contraceptives and injection was underestimated by 28-63% of physicians and 56% of nurses. When measured against current Centers for Disease Control and Prevention (CDC) practice recommendations 46% of ob-gyns 70% of primary care physicians and 41% of nurses of did not correctly identify when (during the menstrual cycle) to place LARCs; 61% 90% and 81% indicated performing unnecessary medical assessments before implant use; 39% 57% and 61% misidentified the mechanisms of action for the levonorgestrel IUD; 68% 78% and 75% did not use recommended IUD placement techniques; and 86% 85% and 88% underestimated IUD placement pain respectively. CONCLUSION: Despite new CDC guidelines and College recommendations the majority of clinicians exhibited significant gaps about LARC use which constitutes an ongoing barrier to LARC utilization.