Outpatient surgical miscarriage management: current practice among family medicine residents and faculty in Washington state

Abstracts / Contraception 80 (2009) 194–226 effective systems exist to provide services to low-income women, those systems should be incorporated into and covered under new plans. Lessons learned from Massachusetts's experience should inform other state or national health care reform. O15 HOME VS. CLINIC-BASED SCREENING FOR SEXUALLY TRANSMITTED INFECTIONS: PATIENT PREFERENCE AND COMPLETION RATES Graseck A Washington University School of Medicine, St. Louis, MO, USA

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than GA by US [95% CI: 0.77–1.23 weeks, t(458)=8.596, pb.001]. The discrepancy was moderately correlated with GA by US (r=0.185, pb.001) such that higher gestational ages were associated with larger discrepancies between LMP and US. Age, parity, previous abortion, recreational drug use and contraceptive method at the time of conception were not significant predictors of the discrepancy between GA by US and LMP (all pN.05). Conclusions: Women seeking abortion on average underreport their gestational age by 1 week based on last menstrual period (LMP) compared to US. This is an equal and opposite effect to that in women carrying a pregnancy to term, who on average overestimate their gestational age by LMP. Clinicians referring, counseling and offering abortions services to women should be aware of the potential underestimation of gestational dating by reported last menstrual period.

Secura G, Allsworth J, Peipert J P2 Objectives: The purpose of this study is to determine completion rates and acceptability of home screening for sexually transmitted infections (STIs) compared with clinic-based screening. Method: The first 399 women enrolled in the Contraceptive CHOICE Project were screened at 12 months of follow-up for Chlamydia trachomatis and Neisseria gonorrhoeae using strand displacement analysis of selfcollected vaginal swabs. In a telephone interview, participants were given a choice of no-cost screening with swabs mailed to the participant's home (home-based) or available at area family planning clinics without an appointment (clinic-based). The clinic-based group also included women who elected to screen with their regular provider according to the clinician's normal practice. We analyzed the results of screening, including patient preference and the proportion of completed tests by testing method. Results: Women were more likely to choose to screen for STIs at home than at a clinic or with their own medical provider (75.7% vs. 16.3% vs. 8.0%, pb.001). Women choosing clinic testing were more likely to be black than white [RR, 1.68; 95% confidence interval (CI), 1.18–2.39]. The groups did not differ in other demographic characteristics, STI risk factors, or access to health care. Women who chose home-based testing were more likely to complete a test compared with all clinic-based testers (63.5% vs. 16.5%; RR, 3.87; 95% CI, 2.46–6.11). Overall, 209 women completed screening (50.7%). Conclusions: Women overwhelmingly preferred to screen for STIs at home. Women who chose home-screening were more likely to complete screening than those who intended to test at a clinic.

POSTER ABSTRACT PRESENTATIONS Friday, October 2, 2009 P1 WOMEN SEEKING ABORTION UNDERREPORT GESTATIONAL AGE BY AN AVERAGE OF 1 WEEK BASED ON LAST MENSTRUAL PERIOD COMPARED TO ULTRASOUND DATING

ADVANCED PRACTICE CLINICIANS AS ABORTION PROVIDERS: PRELIMINARY FINDINGS FROM THE CALIFORNIA PRIMARY CARE INITIATIVE Taylor D University of California, San Francisco, San Francisco, CA, USA Battistelli M, Nobel K, Weitz T Objectives: A California Health Workforce Pilot Project initiated a study in 2007 to train and evaluate advanced practice clinicians (APCs) (CNMs, NPs and PAs) as abortion providers and to understand the health system improvements necessary for increasing access to early abortion care. This presentation reports selected findings from the first year of the project. Method: This multisite prospective evaluation of 60 APCs will be trained to competency in early aspiration abortion procedures and followed for 1– 2 years. APC data are compared with an equal number of procedures performed by physicians from the same facility (total study includes 12,000 patient procedures) and with published standards. Data are collected on patient outcomes (safety, satisfaction, access to care) and clinician outcomes (competency, satisfaction) across the periabortion care continuum. Results: Preliminary results from 10 APCs, 12 MDs and 1557 patient procedures indicate no clinically or statistically significant difference between APCs and MDs for patient complications or satisfaction. Total abortion-related complication diagnoses are 1.2% using an intensive postabortion follow-up system. Patients report high satisfaction rates (mean 9.4; scale 0–10) whether they were seen by an APC or an MD. Conclusions: California APCs provide all aspects of early pregnancy care besides aspiration abortion. Preliminary evidence demonstrates that postabortion problems can be treated promptly and hospital visits avoided when more clinicians are available. Substantial data on abortion provision by APCs are essential to improving patient access to abortion care and to translate evidence into policy, professional education and clinical practice.

P3

Norman W University of British Columbia, Vancouver, B.C., Canada Bergunder J, Eccles L Objectives: Several large trials report gestational dating by last menstrual period (LMP) overestimates gestational age (GA) vs. ultrasound (US) by approximately 1 week. Previous studies examined only term pregnancies. We hypothesize an opposite tendency in women seeking abortion. Method: Retrospective review of randomly selected charts with GA at time of abortion up to 20 weeks from January 1, 2002 to June 30, 2008 at two abortion clinics in Vancouver, BC. Results: Mean GA by US was 14.7 weeks (S.D. 3.9) (n=459). Paired t test was highly significant revealing GA by LMP (mean 13.7, S.D. 4.2) as 1.0 week less

OUTPATIENT SURGICAL MISCARRIAGE MANAGEMENT: CURRENT PRACTICE AMONG FAMILY MEDICINE RESIDENTS AND FACULTY IN WASHINGTON STATE Darney B University of Washington, Seattle, WA, USA Kimball J, VanDerhei D, Stevens N, Prager S Objectives: Outpatient surgical miscarriage management (MM) is safe and may improve patient satisfaction and decrease costs compared to operating room management. Family medicine physicians who offer outpatient surgical MM could increase access to safe, rapid and cost-effective uterine

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Abstracts / Contraception 80 (2009) 194–226

evacuation, but practice patterns are unclear. This study characterized current MM practice in family medicine residency settings in Washington state. Method: We administered a Web-based survey to faculty and residents at all 10 family medicine residency sites in Washington State. We asked about training and current MM practice, especially outpatient surgical management via manual vacuum aspiration (MVA). We used conditional logistic regression to examine relationships between practice and training, adjusted for residency site. Results: 270 family medicine physicians completed the survey (94 faculty, 176 residents; 75.8% response rate). Although 54.2% of faculty and 40.9% of residents are familiar with MVA, only about 25% of faculty and residents report receiving MVA training. Among those who offer MM (52.6%; n=142) using any technique (surgical, medical or expectant), 74.6% refer out patients needing surgery (66.6% of faculty; 83.6% of residents). Familiarity with MVA (OR=3.2, p=.003) and having received training in outpatient surgical MM (OR=4.4, pb.001) were each associated with currently performing surgical MM. Conclusions: Family medicine physicians offer MM, but many have not received MVA training and refer out women needing surgery. Training family medicine faculty and residents in MVA could increase the number of physicians offering safe, rapid uterine evacuation and improve access to care. P4 PATTERNS OF CONTRACEPTIVE USE BEFORE AND AFTER AN ABORTION: RESULTS FROM A LARGE NATIONALLY REPRESENTATIVE SURVEY OF WOMEN UNDERGOING AN ABORTION IN FRANCE Moreau C INSERM U 822, Le Kremlin Bicetre, France Trussell J, Desfreres J, Bajos N Objectives: Using a large national sample of women undergoing an abortion in France, we explore women's contraceptive paths before and after an abortion. Method: The data is drawn from a national representative survey of 7541 women undergoing an elective abortion in Metropolitan France. We compared women's contraceptive situation before and after the abortion and investigated the factors associated with the prescription of a highly effective method after the procedure. Results: Thirty four percent of women were not using contraception in the month they conceived. A third of women reported the same contraceptive situation before and after the abortion, 54% switched to more effective methods while 14% changed to less effective methods or no method at all. After the abortion, 76.5% of women were prescribed a highly effective method. Younger women and those who had their abortion in a physician's private office were twice as likely to receive a prescription for a highly effective method. Conclusions: A majority of abortions in France are due to contraceptive failures. Most women switch to more effective methods after the abortion. This is especially true for women who undergo their abortion in a physicians private office, an encouraging indicator in the evaluation of the recent policy change allowing medication abortions to be performed outside of hospital facilities in France.

marriage and first birth. However, the birth control strategies employed by this population are not clearly understood. Method: Minimal data on contraceptive use exist; however, data from the Israeli Central Bureau of Statistics recently became available on legal abortions between 1995 through 2005. Abortions rates were estimated over time comparing Ethiopians and other Israelis. Results: Abortion rates between the Ethiopians and other Israelis were similar except for those aged 15–24 years. Ethiopian young adults had abortions up to four times the rate of other young Israelis over the decade. Abortions rates among young Ethiopians born in Israel drastically decreased between 1995 and 2000 but were still twice that of other young adults. Conclusions: Ethiopian adolescents in Israel appear to be using abortion as a form of birth control. These findings spur the following questions and we maintain subsequent research is a priority. Are Ethiopian adolescents accessing health care; do they have a means to be prescribed contraception? Among those that see doctors, what is the quality of patient–doctor communication, do doctors have a commitment to cultural effectiveness? What are the attitudes and customs of these young adults and their parents regarding childbearing and birth control? Research into these areas may provide further insight into the constellation of factors that have influenced fertility changes among this immigrant population. P6 IMPACT OF FORMAL FAMILY PLANNING TRAINING ON OB/GYN RESIDENTS' SKILLS IN UTERINE ASPIRATION AND CONTRACEPTION PROVISION Steinauer J University of California, San Francisco, San Francisco, CA, USA Hawkins M, Perencevich A, Patel G, Simonson K, Landy U Objectives: The purpose of this study was to assess the impact of formal, optout family planning training on clinical competence in uterine evacuation and contraception skills among Ob/Gyn residents at 34 programs. Method: The Kenneth J. Ryan Residency Training Program provides technical and financial support to support Ob/Gyn residencies to integrate abortion and contraception training. Since 2005 Residents have completed Web-based surveys before and after their rotation. Residents report clinical and didactic exposure to elective and therapeutic abortion procedures and contraceptive methods. Residents also rate their competence using a five-point Likert scale, 5 indicating “very competent,” and 1 indicating “not at all competent.” Paired t tests were used to compare mean scores pre and post rotation. Results: To date, 400 prerotation and 321 postrotation resident surveys have been collected. Skill

Number performed

Self-assessed competence

Prerotation Postrotation Prerotation Postrotation P5 CHANGES IN FERTILITY AMONG YOUNG ETHIOPIAN IMMIGRANTS IN ISRAEL: ABORTION LEVELS OVER A DECADE Feldman B Hebrew University, Jerusalem, Israel Shtarkshall R, Baynesan F Objectives: Ethiopian immigrants have arrived in Israel in large numbers over the past 20 years. There was a notable decline in Ethiopian immigrants' fertility levels from the early 1990s onward accompanied by a delayed age at

Pregnancy options 16.7 counseling Medication abortion 2 Manual uterine 4.5 aspiration Electric uterine 9.5 aspiration IUD insertion 13

35

3.2

4.3*

8.9 16.3

2.3 2.4

4.0* 4.1*

32.1

2.7

4.3*

27.4

3.5

4.4*

* pb.001. Conclusions: Participation in a formal, opt-out family planning rotation resulted in increased clinical exposure to contraception and uterine evacuation and significant increases in reported competence in these skills.