title: The impact of contraceptive counseling in primary care on contraceptive use.
abstract: BACKGROUND
  Whether contraceptive counseling improves contraceptive use is unknown.
  
  
  OBJECTIVE
  To evaluate the association between contraceptive counseling provided by primary care physicians and patients' contraceptive use.
  
  
  METHODS
  All women aged 18-50 who visited one of four primary care clinics between October 2008 and April 2010 were invited to complete surveys about their visit. Seven to 30 days post visit, participants completed a survey assessing pregnancy intentions, receipt of contraceptive counseling, and use of contraception at last sexual intercourse. Survey data were linked to medical record data regarding contraceptive prescriptions prior to and during the clinic visit. Women were classified as in need of contraceptive counseling if they were sexually active, were not pregnant or trying to get pregnant, and had no evidence of contraceptive use prior to their index clinic visit.
  
  
  RESULTS
  Fifty percent (n = 386) of women were in need of contraceptive counseling at the time of their visit. Those who received contraceptive counseling from a primary care provider were more likely to report use of hormonal contraception when they last had sex (unadjusted OR: 3.83, CI: 2.25-6.52), even after adjusting for age, race, education, income, marital status, pregnancy intentions, and prior pregnancy (adjusted OR: 2.68, CI: 1.48-4.87). Counseling regarding specific types of contraception was associated with an increased use of those methods. For example, counseling regarding hormonal contraceptives was associated with a greater likelihood of use of hormonal methods (adjusted OR: 4.78, CI: 2.51-9.12) and counseling regarding highly effective reversible methods was highly associated with use of those methods (adjusted OR: 18.45, CI: 4.88-69.84). These same relationships were observed for women with prior evidence of contraceptive use.
  
  
  CONCLUSIONS
  Contraceptive counseling in primary care settings is associated with increased hormonal contraceptive use at last intercourse. Increasing provision of contraceptive counseling in primary care may reduce unintended pregnancy.
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
authors.forename: Jessica K
authors.initials: JK
authors.lastname: Lee
authors.forename: Sara M
authors.initials: SM
authors.lastname: Parisi
authors.forename: Aletha Y
authors.initials: AY
authors.lastname: Akers
authors.forename: Sonya
authors.initials: S
authors.lastname: Borrero
authors.forename: Sonya
authors.initials: S
authors.lastname: Borrerro
authors.forename: Eleanor Bimla
authors.initials: EB
authors.lastname: Schwarz
mesh_terms: D000293:Adolescent; D000328:Adult; D003267:Contraception / Q000379:methods / Q000523:psychology*; D003268:Contraception Behavior / Q000523:psychology*; D037001:Directive Counseling / Q000379:methods* / Q000592:standards; D005193:Family Planning Services / Q000379:methods* / Q000592:standards; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010414:Pennsylvania; D011247:Pregnancy; D011275:Pregnancy, Unwanted / Q000523:psychology; D012736:Sex Education; D011795:Surveys and Questionnaires