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Family planning provider attitudes and practices related to provision of contraceptive methods among women with various characteristics and medical conditions
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Abstracts / Contraception 82 (2010) 183–216
factors and systems barriers that influence the contraceptive choices of women in our obstetric/gynecology practice. Method: We designed an institutional review board approved anonymous prospective descriptive survey administered to women presenting to our obstetric/gynecology practice and family planning center. Descriptive and bivariate analysis was conducted to identify factors and economic barriers associated with contraceptive choices. Results: Three hundred eighty-four subjects completed the survey, 36% from residents' practice, 22% from family planning and 41% from faculty practice. There were no significant differences among the populations. Of factors cited as the most important in choosing current contraceptive method, recommendation by heath care provider was most frequent (46%), followed by used for years (15%), family recommendation (14%), friends (7%) and Internet and advertising (2%). Cost was cited as a barrier in 35% of subjects and bi-variate analysis revealed that depo-provera (p=.001) and condom (p=.05) users were significantly more likely to report cost as a barrier. Age was associated with use of less effective methods (p=.001). Women who reported that high co-pays prevented them from filling a contraceptive prescription were more likely to report cost as a barrier (p=.002). Conclusions: In our population, women report advice of their clinician as the most important factor in their contraceptive choices; cost and high co-pays were cited as systems barriers. Our results inform interventions needed to improve contraceptive utilization and patients' negotiation of health care systems. P26
FAMILY PLANNING PROVIDER ATTITUDES AND PRACTICES RELATED TO PROVISION OF CONTRACEPTIVE METHODS AMONG WOMEN WITH VARIOUS CHARACTERISTICS AND MEDICAL CONDITIONS Tyler C Centers for Disease Control and Prevention, Atlanta, GA, USA Zapata L, Whiteman M, Marchbanks P, Curtis K Objectives: To characterize family planning provider attitudes of safety and practices regarding contraceptive methods for women with specific characteristics and medical conditions included in the 2010 US Medical Eligibility Criteria for Contraceptive Use. Method: Between December 2009 and February 2010, a survey on contraceptive provision was mailed to a random sample of 4000 US family planning providers. The sample included 2000 publicly funded title×clinics obtained from the Office of Population Affairs and 2000 office-based physicians, including those specializing in obstetrics/gynecology, family medicine, and adolescent medicine, obtained from the American Medical Association Physician Masterfile. Surveys included questions on contraceptive method availability and attitudes of safety and practices regarding contraceptive methods. Data presented are interim results through February 2010 for the Copper Intrauterine Device (Cu-IUD). Results: Our response rate is 52.3% (office-based physicians=36.4%; public clinics=66.7%). Fewer than half of providers consider the Cu-IUD very safe or safe for immediately postpartum women (25.8%) or those with uterine fibroids (44.1%), while most consider the Cu-IUD very safe or safe for adolescents (59.3%), HIV-positive women (55.2%), obese women (81.1%) and nulliparous women (73.7%). However, only 24.5% of providers prescribed or referred Cu-IUDs for nulliparous women in the past year. The most common reasons for not providing Cu-IUDs to nulliparous women were patient preference (79.0%) and unavailability of Cu-IUDs (33.2%). Conclusions: Results indicate gaps between provider attitudes regarding contraceptive method safety and actual practices over the past year. Future interventions are needed to ensure the availability of highly effective contraceptive methods such as the Cu-IUD.
P27 MEDICAL STUDENT INTRAUTERINE CONTRACEPTION KNOWLEDGE AND ATTITUDES: EVALUATION OF OBSTETRIC AND GYNECOLOGY CLERKSHIP TRAINING Bartz D Brigham and Women's Hospital, Boston, MA, USA Tang J, Maurer R Objectives: Modern intrauterine contraception (IUC) is safe and highlyreliable. However, studies demonstrate that many clinician populations surveyed have incorrect knowledge about the safety of IUC and often harbor negative attitudes towards IUC. Here we set out to determine whether this misinformation and poor acceptance of IUC is being propagated to medical students in training. Method: In this cross-sectional analysis, students at seven geographically and curriculum diverse US medical schools were surveyed at the start and completion of their Ob/Gyn clinical clerkship. The pre-and post-clerkship surveys queried prior IUC training, IUC knowledge, and IUC attitudes. A knowledge score was created by summating the 10 knowledge-based items, and a summated attitudes score was created from 14 clinical vignettes. Subject knowledge and attitudes were compared pre-and post-clerkship using the paired t test. Results: One hundred six students returned completed paired surveys (response rate 82%). The pre-clerkship mean knowledge score (5.4±1.7) increased significantly at post-clerkship assessment (7.2±1.7). The difference was 1.8±2.0 (pb.0001). The mean attitude score also increased significantly from the pre- (4.7±4.3) to the post-clerkship (8.2±3.6) survey. The difference was 3.5±4.8 (pb.0001). No difference in score improvement was seen by univariate analysis of subject specialty of interest, prior IUC training or amount of IUC exposure during the clerkship. Conclusions: US medical student IUC knowledge and attitudes are improved through the Ob/Gyn clerkship. However, the scores for both are low before the clerkship, particularly for attitudes, and improve only modestly, indicating room for improvement in medical student IUC curricula. P28 ASSOCIATION OF AGE AND LARC METHOD CHOICE IN THE CONTRACEPTIVE CHOICE PROJECT Mestad R Washington University, St. Louis, MO, USA Secura G, Allsworth J, Madden T, Zhao Q, Peipert J Objectives: To determine if age is associated with long acting reversible contraceptive (LARC) method choice among adolescents and young women. Method: The Contraceptive CHOICE Project is a longitudinal study of 10,000 women promoting the use of long-acting, reversible methods of contraception and evaluating user continuation and satisfaction with reversible methods of contraception. Using data obtained from the baseline questionnaire of the first 2500 participants, we assessed whether age was associated with LARC vs. non-LARC method choice between women 25 years and younger and those older than 25 years. We then assessed whether age was associated with specific LARC method choice among our adolescent participants, and whether the contraceptive implant has a higher acceptance rate than intrauterine contraception (IUC) in participants aged 14–17 vs. 18–20 years. Results: Sixty-one percent of participants aged ≤25 years chose a LARC method compared to 77% of participants N25 years (RR=0.8, 95% CI 0.76– 0.84). Among participants aged 14–17 years, 60% chose a LARC method, while 57% of subjects age 18–20 years chose a LARC method. Of adolescents choosing LARC methods, 63% of participants aged ≤17 years chose 2the
Abstracts / Contraception 82 (2010) 183–216
factors and systems barriers that influence the contraceptive choices of women in our obstetric/gynecology practice. Method: We designed an institutional review board approved anonymous prospective descriptive survey administered to women presenting to our obstetric/gynecology practice and family planning center. Descriptive and bivariate analysis was conducted to identify factors and economic barriers associated with contraceptive choices. Results: Three hundred eighty-four subjects completed the survey, 36% from residents' practice, 22% from family planning and 41% from faculty practice. There were no significant differences among the populations. Of factors cited as the most important in choosing current contraceptive method, recommendation by heath care provider was most frequent (46%), followed by used for years (15%), family recommendation (14%), friends (7%) and Internet and advertising (2%). Cost was cited as a barrier in 35% of subjects and bi-variate analysis revealed that depo-provera (p=.001) and condom (p=.05) users were significantly more likely to report cost as a barrier. Age was associated with use of less effective methods (p=.001). Women who reported that high co-pays prevented them from filling a contraceptive prescription were more likely to report cost as a barrier (p=.002). Conclusions: In our population, women report advice of their clinician as the most important factor in their contraceptive choices; cost and high co-pays were cited as systems barriers. Our results inform interventions needed to improve contraceptive utilization and patients' negotiation of health care systems. P26
FAMILY PLANNING PROVIDER ATTITUDES AND PRACTICES RELATED TO PROVISION OF CONTRACEPTIVE METHODS AMONG WOMEN WITH VARIOUS CHARACTERISTICS AND MEDICAL CONDITIONS Tyler C Centers for Disease Control and Prevention, Atlanta, GA, USA Zapata L, Whiteman M, Marchbanks P, Curtis K Objectives: To characterize family planning provider attitudes of safety and practices regarding contraceptive methods for women with specific characteristics and medical conditions included in the 2010 US Medical Eligibility Criteria for Contraceptive Use. Method: Between December 2009 and February 2010, a survey on contraceptive provision was mailed to a random sample of 4000 US family planning providers. The sample included 2000 publicly funded title×clinics obtained from the Office of Population Affairs and 2000 office-based physicians, including those specializing in obstetrics/gynecology, family medicine, and adolescent medicine, obtained from the American Medical Association Physician Masterfile. Surveys included questions on contraceptive method availability and attitudes of safety and practices regarding contraceptive methods. Data presented are interim results through February 2010 for the Copper Intrauterine Device (Cu-IUD). Results: Our response rate is 52.3% (office-based physicians=36.4%; public clinics=66.7%). Fewer than half of providers consider the Cu-IUD very safe or safe for immediately postpartum women (25.8%) or those with uterine fibroids (44.1%), while most consider the Cu-IUD very safe or safe for adolescents (59.3%), HIV-positive women (55.2%), obese women (81.1%) and nulliparous women (73.7%). However, only 24.5% of providers prescribed or referred Cu-IUDs for nulliparous women in the past year. The most common reasons for not providing Cu-IUDs to nulliparous women were patient preference (79.0%) and unavailability of Cu-IUDs (33.2%). Conclusions: Results indicate gaps between provider attitudes regarding contraceptive method safety and actual practices over the past year. Future interventions are needed to ensure the availability of highly effective contraceptive methods such as the Cu-IUD.
P27 MEDICAL STUDENT INTRAUTERINE CONTRACEPTION KNOWLEDGE AND ATTITUDES: EVALUATION OF OBSTETRIC AND GYNECOLOGY CLERKSHIP TRAINING Bartz D Brigham and Women's Hospital, Boston, MA, USA Tang J, Maurer R Objectives: Modern intrauterine contraception (IUC) is safe and highlyreliable. However, studies demonstrate that many clinician populations surveyed have incorrect knowledge about the safety of IUC and often harbor negative attitudes towards IUC. Here we set out to determine whether this misinformation and poor acceptance of IUC is being propagated to medical students in training. Method: In this cross-sectional analysis, students at seven geographically and curriculum diverse US medical schools were surveyed at the start and completion of their Ob/Gyn clinical clerkship. The pre-and post-clerkship surveys queried prior IUC training, IUC knowledge, and IUC attitudes. A knowledge score was created by summating the 10 knowledge-based items, and a summated attitudes score was created from 14 clinical vignettes. Subject knowledge and attitudes were compared pre-and post-clerkship using the paired t test. Results: One hundred six students returned completed paired surveys (response rate 82%). The pre-clerkship mean knowledge score (5.4±1.7) increased significantly at post-clerkship assessment (7.2±1.7). The difference was 1.8±2.0 (pb.0001). The mean attitude score also increased significantly from the pre- (4.7±4.3) to the post-clerkship (8.2±3.6) survey. The difference was 3.5±4.8 (pb.0001). No difference in score improvement was seen by univariate analysis of subject specialty of interest, prior IUC training or amount of IUC exposure during the clerkship. Conclusions: US medical student IUC knowledge and attitudes are improved through the Ob/Gyn clerkship. However, the scores for both are low before the clerkship, particularly for attitudes, and improve only modestly, indicating room for improvement in medical student IUC curricula. P28 ASSOCIATION OF AGE AND LARC METHOD CHOICE IN THE CONTRACEPTIVE CHOICE PROJECT Mestad R Washington University, St. Louis, MO, USA Secura G, Allsworth J, Madden T, Zhao Q, Peipert J Objectives: To determine if age is associated with long acting reversible contraceptive (LARC) method choice among adolescents and young women. Method: The Contraceptive CHOICE Project is a longitudinal study of 10,000 women promoting the use of long-acting, reversible methods of contraception and evaluating user continuation and satisfaction with reversible methods of contraception. Using data obtained from the baseline questionnaire of the first 2500 participants, we assessed whether age was associated with LARC vs. non-LARC method choice between women 25 years and younger and those older than 25 years. We then assessed whether age was associated with specific LARC method choice among our adolescent participants, and whether the contraceptive implant has a higher acceptance rate than intrauterine contraception (IUC) in participants aged 14–17 vs. 18–20 years. Results: Sixty-one percent of participants aged ≤25 years chose a LARC method compared to 77% of participants N25 years (RR=0.8, 95% CI 0.76– 0.84). Among participants aged 14–17 years, 60% chose a LARC method, while 57% of subjects age 18–20 years chose a LARC method. Of adolescents choosing LARC methods, 63% of participants aged ≤17 years chose 2the