Clinician Perspectives on the Barriers and Facilitators of Extended Use of the Contraceptive Implant [ID: 1373916

Abstract

INTRODUCTION: The contraceptive implant is approved by the U.S. Food and Drug Administration (FDA) for 3 years. There is evidence that it is effective at preventing pregnancy for 5 years, known as extended use. We explored clinician perspectives and the barriers and facilitators to offering extended use. METHODS: We utilized the Consolidated Framework for Implementation Research (CFIR) to guide 20 IRB-approved, semistructured qualitative interviews among reproductive health clinicians. Participants were recruited from a nationwide cross-sectional survey on use of the contraceptive implant, with sampling to optimize the geographic and clinical diversity of participants. We coded interviews using ATLAS.ti, and then generated themes by CFIR domain and participant type. RESULTS: We interviewed 20 clinicians: 5 (25%) family medicine physicians, 6 (30%) advanced practice clinicians, 3 (15%) complex family planning (CFP) specialists, and 6 (30%) non-CFP obstetrician–gynecologists. Themes regarding barriers and facilitators to extended use emerged across CFIR domains. Within the outer setting, the dominant barrier was the current FDA approval for 3 years, while the strongest facilitator was educational materials for patients and providers. For the inner setting, the main barrier was clinician concern about liability with off-label use of a contraceptive device and the main facilitator was a champion of extended use. The primary barriers within intervention characteristics were patient concerns about changes in bleeding and future insurance coverage for contraception. CONCLUSION: Clinician education about extended use of the contraceptive implant up to 5 years as well as more data on the expected patient bleeding profile may increase offering of extended use of the contraceptive implant.