The Incidence of Intrauterine Device Provision in a Military Tertiary Care Facility From 2008-2014 Correlated to Contemporary Contraception Guidelines.

Abstract

To compare the incidence of intrauterine device (IUD) provision within the beneficiary population of a military tertiary care facility from 2008 to 2014 and in correlation with the publication of landmark contemporary guidelines for contraceptive use. This was a retrospective observational study conducted in a military tertiary care facility using coding data to examine the trend in IUD provision correlated with published contraceptive practice guidelines from November 2008 to December 2014. The incidence of device provision was calculated per 1,000 female beneficiaries more than the age of 14 per month. The primary outcome was the mean monthly incidence of IUD in correlation with publication of the U.S. Medical Eligibility Criteria for Contraceptive Use (2010) and the Practice Guidelines from the American College of Obstetricians and Gynecologists (2011). For the subset of provisions that occurred by Family Medicine providers, the American Academy of Family Physicians (2012) was the second comparison clinical guideline. A total of 3,950 IUDs were placed during the study period. There was a statistically significant increase in the overall mean monthly incidence of IUD placement from 0.48 (SE 0.04) before guideline publication to 1.96 (SE 0.07) after the publications (analysis of variance, p < 0.01). Each publication was associated with a statistically significant sequential increase in the incidence of IUD provision. The incidence of provision remained elevated above baseline levels (range 0.93-3.03) for the 34 studied months after the 2011 American College of Obstetricians and Gynecologists Practice Guideline. The incidence of IUD provision significantly increased during the study period and in association with published guidelines guiding contraceptive management.