Abstract
Objective: To implement a training protocol on intrauterine device (IUD) insertion for resident physicians to improve women’s access to this method. Methods: The staff identified poor access to family planning, in Vila Lobato health center, specially to IUD, there were only 15 IUD insertions in 2015. This implementation research evaluated and identified the barriers of access to IUD use. Then, stakeholders and staff defined the access flow of patients to the health unit and, eventually, the training provided to resident physicians in gynecology and obstetrics (GO) and family medicine (FM). This is a retrospective cohort of the IUD insertions performed by residents between 2016 and 2018. Results : 252 copper IUDs were inserted from 2016 to 2018 and there was a progressive increase in the number of insertions (45 in 2016, 80 in 2017, and 126 in 2018). Thirty-four (16.4%) inadequate insertions and 15 (8.6%) expulsions were observed. There was no case of uterine perforation. Conclusion: The implementation of the protocol on IUD insertion for residents in the primary care setting increased the local number of IUD insertion and might be a strategy to improve the access to the contraceptive method.
Highlights
Access to effective contraceptive methods is a strategy to reduce unplanned pregnancy (Dibaba et al, 2013; Khan et al, 2019) and long-acting reversible contraceptives (LARC) is a cost-effective way to decrease the incidence of spontaneous abortion, ectopic pregnancy, inherent complications in pregnancy, maternal and perinatal mortality (Dibaba et al, 2013; Trussell et al, 2013)
The present study evaluates whether the implementation of intrauterine device (IUD) insertion training for resident physicians can improve the local access by women to this contraceptive method
Of the 229 IUD inserted by resident physicians, 159 patients returned to follow up after 12 months and 22 medical records were not found or had incomplete information (Figure 1)
Summary
Access to effective contraceptive methods is a strategy to reduce unplanned pregnancy (Dibaba et al, 2013; Khan et al, 2019) and long-acting reversible contraceptives (LARC) is a cost-effective way to decrease the incidence of spontaneous abortion, ectopic pregnancy, inherent complications in pregnancy, maternal and perinatal mortality (Dibaba et al, 2013; Trussell et al, 2013). There is a greater number of users in Asia, especially among Chinese and Korean women, whereas in South America, only 5.5% of women use this contraceptive method. Physicians regardless of their specialty are trained to insert IUD (Buhling, Zite, et al, 2014) and in some places, this practice is conducted by nurses (Ouyang et al, 2019). Many professionals do not offer or recommend IUD for nulliparous women (Buhling, Hauck, et al, 2014) and do not conduct this practice in primary care setting. Due to misconceptions, myths, or religious matters, many women do not use IUD because they think it has an abortive effect (Martínez et al, 2019)
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