title: Evidence-based IUD practice: family physicians and obstetrician-gynecologists.
abstract: OBJECTIVE
  Family physicians and obstetrician-gynecologists provide much of contraceptive care in the United States and have a shared goal in preventing unintended pregnancy among patients. We assessed their competency to offer women contraceptives of the highest efficacy levels.
  
  
  METHODS
  We conducted a national probability survey of family physicians and obstetrician-gynecologists (n=1,192). We measured counseling and provision practices of intrauterine contraception and used multivariable regression analysis to evaluate the importance of evidence-based knowledge to contraceptive care.
  
  
  RESULTS
  Family physicians reported seeing fewer contraceptive patients per week than did obstetrician-gynecologists and were less likely to report sufficient time for counseling. While 95% of family physicians believed patients were receptive to learning about intrauterine contraception, fewer than half offered counseling or the method. Only half were trained to competence to offer intrauterine contraception, while virtually all obstetrician-gynecologists were. Both family physicians and obstetrician-gynecologists were unlikely to have adequate knowledge of the women who would be good candidates for intrauterine contraception-as gauged by the Centers for Disease Control and Prevention Medical Eligibility Criteria for contraception-and consequently did not offer the method to a wide range of eligible patients.
  
  
  CONCLUSIONS
  Most family physicians providing contraceptive care were not offering methods with top-tier effectiveness, although they reported interest in updating contraceptive skills through training. Obstetrician-gynecologists had technical skills to offer intrauterine contraception but still required education on patient selection. Greater hands-on training opportunities for family physicians, and complementary education on eligible method candidates for obstetrician-gynecologists, can increase access to intrauterine contraception by women seeking contraceptive care.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco 94118, USA. harperc@obgyn.ucsf.edu
authors.forename: Cynthia C
authors.initials: CC
authors.lastname: Harper
authors.forename: Jillian T
authors.initials: JT
authors.lastname: Henderson
authors.forename: Tina R
authors.initials: TR
authors.lastname: Raine
authors.forename: Suzan
authors.initials: S
authors.lastname: Goodman
authors.forename: Philip D
authors.initials: PD
authors.lastname: Darney
authors.forename: Kirsten M
authors.initials: KM
authors.lastname: Thompson
authors.forename: Christine
authors.initials: C
authors.lastname: Dehlendorf
authors.forename: J Joseph
authors.initials: JJ
authors.lastname: Speidel
mesh_terms: D002983:Clinical Competence; D000075202:Contraindications; D003376:Counseling / Q000592:standards; D055317:Evidence-Based Practice; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006176:Gynecology / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D007434:Intrauterine Devices / Q000600:supply & distribution; D008297:Male; D008875:Middle Aged; D009774:Obstetrics / Q000706:statistics & numerical data; D012044:Regression Analysis; D014481:United States