Challenges in translating evidence to practice: the provision of intrauterine contraception.
OBJECTIVE
Intrauterine contraception is used by many women worldwide, however, it is rarely used in the United States. Although available at no cost from the state family planning program for low-income women in California, only 1.3% of female patients obtain intrauterine contraceptives annually. This study assessed knowledge and practice patterns of practitioners regarding intrauterine contraception.


METHODS
We conducted a survey among physicians, nurse practitioners, and physician assistants (n=1,246) serving more than 100 contraceptive patients per year in the California State family planning program. The response rate was 65% (N=816). We used multiple logistic regression to measure the association of knowledge with clinical practice among different provider types.


RESULTS
Forty percent of providers did not offer intrauterine contraception to contraceptive patients, and 36% infrequently provided counseling, although 92% thought their patients were receptive to learning about the method. Regression analyses showed younger physicians and those trained in residency were more likely to offer insertions. Fewer than half of clinicians considered nulliparous women (46%) and postabortion women (39%) to be appropriate candidates. Evidence-based views of the types of patients who could be safely provided with intrauterine contraception were associated with more counseling and method provision, as well as with knowledge of bleeding patterns for the levonorgestrel-releasing intrauterine system and copper devices.


CONCLUSIONS
Prescribing practices reflected the erroneous belief that intrauterine contraceptives are appropriate only for a restricted set of women. The scientific literature shows intrauterine contraceptives can be used safely by many women, including postabortion patients. Results revealed a need for training on updated insertion guidelines and method-specific side effects, including differences between hormonal and nonhormonal devices.


METHODS
III.
Bixby Center for Reproductive Health Research & Policy, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California 94118, USA. harperc@obgyn.ucsf.edu
Cynthia C
CC
Harper
Maya
M
Blum
Heike Thiel
HT
de Bocanegra
Philip D
PD
Darney
J Joseph
JJ
Speidel
Michael
M
Policar
Eleanor A
EA
Drey
D000028:Abortion, Induced; D000367:Age Factors; D002140:California; D003376:Counseling; D003625:Data Collection; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D007434:Intrauterine Devices; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D010298:Parity; D010823:Physician Assistants; D010820:Physicians; D011247:Pregnancy