title: Intrauterine contraception: impact of provider training on participant knowledge and provision.
abstract: BACKGROUND
  In California's Medicaid family planning expansion, the Family Planning, Access, Care and Treatment (Family PACT) Program, only 1.9% of contracepting women received intrauterine contraception (IUC) in 2006. Ten skills-based IUC provider trainings were offered from 2007 to 2010.
  
  
  OBJECTIVE
  The objective was to evaluate the impact of these trainings on participant knowledge of the broad range of appropriate IUC candidates and measure changes in IUC provision following training.
  
  
  METHODS
  We evaluated changes in provider knowledge using a nine-item IUC Candidate Selection Scale on pre- and posttraining surveys. Changes in provision of IUC following the training were measured using Family PACT claims data. We compared changes in insertions posttraining to pretraining levels as well as to matched comparison sites that did not send trainees.
  
  
  RESULTS
  Most participants at the training were advanced practice clinicians (70%) specializing in general primary care (77%) and practicing at community clinics (45%). Training participants increased their understanding of appropriate candidates (mean change in raw summary score=8.6, p<.001), from an average of 58% correct responses to 81%. Provider sites that participated in training provided a mean of 4.6 more women with IUC following training than during baseline (p<.01), an increase of 25% compared to only 7% increase among comparison sites. The impact of the training differed by practice size such that the largest and smallest clinics both changed IUC provision the most and had the largest differences over comparison sites.
  
  
  CONCLUSIONS
  This study shows that skills-based training is an important strategy for the increase of IUC provision.
authors.affiliation: Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, USA. carrie.lewis@dhcs.ca.gov
authors.forename: Carrie
authors.initials: C
authors.lastname: Lewis
authors.forename: Philip
authors.initials: P
authors.lastname: Darney
authors.forename: Heike
authors.initials: H
authors.lastname: Thiel de Bocanegra
mesh_terms: D002140:California; D002983:Clinical Competence; D005193:Family Planning Services; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007434:Intrauterine Devices / Q000706:statistics & numerical data*; D058007:Physicians, Primary Care / Q000193:education*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods
keywords: Family PACT; Long-acting reversible contraception (LARC); Medi-Cal; Medicaid; Program evaluation