Emergency contraception provision: a survey of Michigan physicians from five medical specialties.
OBJECTIVE
Despite the controversy over expanding delivery options for emergency contraceptive pills (ECP), little is known about physicians' attitudes toward over-the-counter (OTC) provision of ECP, and prior research on physicians' practices often has focused on a single specialty. This study examined the attitudes and practices regarding advance provision and OTC status of ECP among physicians in five medical specialties likely to encounter patients in need of ECP.


METHODS
A mail survey of a random sample of 850 Michigan physicians in family/general medicine, internal medicine, obstetrics/gynecology, pediatrics, and emergency medicine was conducted. Respondents' ECP-related attitudes and practices were assessed, and differences by physician characteristics were examined using chi-square tests and multivariable logistic regression analyses.


RESULTS
Two hundred seventy-one physicians responded to the survey (response rate = 32%), with 42% of them favoring OTC provision of ECP and 40% opposing it. Half of respondents never routinely initiated discussions about ECP with their sexually active, female patients, and 77% of respondents did not routinely offer advance prescriptions. After adjusting for other factors, including medical specialty, older physicians ( > or =50 years) were significantly more likely than their younger counterparts to support OTC provision of ECP (OR = 2.9, 95% CI 1.7-4.9) or offer advance prescriptions (OR = 2.5, 95% CI 1.1-5.8). Physicians with a specialty in obstetrics/gynecology were 3.5 times (95% CI 1.3-9.8) as likely as physicians in family/general medicine to offer advance prescriptions for ECP, and female physicians were 2.5 (95% CI 1.05-6.0) times as likely as male physicians to offer advance prescriptions. Graduation from a medical school within the United States and practicing in a private practice were marginally associated with a lower likelihood of supporting OTC status of ECP (OR = 0.5, 95% CI: 0.2-1.0; and OR equals; 0.6, 95% CI 0.3-1.1, respectively).


CONCLUSIONS
Certain physician characteristics were significantly associated with their ECP-related attitudes and practices. The majority of physicians surveyed in this study did not offer advance prescriptions for ECP, and few had initiated discussions on ECP with patients, which may pose critical barriers to patients' timely access.
Xu
Xiao
X
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan 48109, USA. xiaox@med.umich.edu
Vahratian
Anjel
A
Patel
Divya A
DA
McRee
Annie-Laurie
AL
Ransom
Scott B
SB
D000328:Adult; D001291:Attitude of Health Personnel; D016001:Confidence Intervals; D044363:Contraception, Postcoital / Q000706:statistics & numerical data*; D003281:Contraceptives, Postcoital / Q000627:therapeutic use*; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006176:Gynecology / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D009774:Obstetrics / Q000706:statistics & numerical data; D016017:Odds Ratio; D010372:Pediatrics / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations
D003281:Contraceptives, Postcoital