Women's Health and Contraceptive Practices of Army Physician Assistants.

Abstract

Women's roles continue to increase within the U.S. Army. Medical readiness contributes to individual readiness and supports the Army's warfighting mission. Army physician assistants are often the first-line medical providers for Soldiers and their practices, including women's health practices, should support optimal Soldier readiness. Our objective was to survey Army physician assistants' knowledge and practices related to female reproductive health care. This was a descriptive survey-based study of Army physician assistants conducted from February to June 2017. This study was an addendum to a prior study examining women's health care knowledge and skills among physicians serving as general medical officers. Surveys were distributed via e-mail. The survey was anonymous and included 22 questions describing provider knowledge and practices in the areas of family planning and women's health screening. Out of 198 distributed surveys, 100 (51%) were returned. Most respondents were male (67%), 75% practiced in a troop-based medical clinic, and 73% had current or past practice experience in a military operational/deployed environment. The majority of respondents indicated that they provide family planning services to their reproductive-aged female patients. Combined hormonal contraceptives and depo-medroxyprogesterone had the highest percentage of respondents who reported comfort discussing the method. The highest percentage of respondents indicated discomfort discussing the copper intrauterine device and emergency contraception. Only 10, 17, and 33% of respondents were trained to place the copper intrauterine device, levonorgestrel intrauterine device, and etonogestrel contraceptive implant, respectively. Most respondents offered cervical cancer (74%) and chlamydia (91%) screening to their female patients. Most study respondents practiced in a troop-based primary care clinic and most reported experience as a deployed health care providers. Although most respondents indicated comfort discussing combined hormonal contraception and depo medroxyprogesterone, fewer reported comfort discussing long-acting reversible and emergency contraception. Only a minority of respondents reported prior training to place the copper or levonorgestrel intrauterine device or contraceptive implant and, of those trained, most had not placed a device for which they were trained in the preceding 12 months. Chlamydia and cervical cancer screening were offered by most respondents but was not universally offered among the respondents. These findings are consistent with our previous study evaluating women's health knowledge among general medical officers and highlight a need for improved training in the field of women's health for physician assistants serving the active duty population.