title: Evidence-based selection of candidates for the levonorgestrel intrauterine device (IUD).
abstract: BACKGROUND
  Recent evidence-based guidelines expanded the definition of appropriate candidates for the levonorgestrel-releasing intrauterine system (LNG-IUS). We investigated correlates of evidence-based selection of candidates for the LNG-IUS by physicians who offer insertion.
  
  
  METHODS
  We conducted a mixed-mode (online and mail) survey of practicing family physicians and obstetrician-gynecologists in Seattle.
  
  
  RESULTS
  A total of 269 physicians responded to the survey (44% response rate). Of the 217 respondents who inserted intrauterine devices, half or fewer routinely recommended the LNG-IUS to women who are nulliparous, younger than 20 years old, or have a history of sexually transmitted infections (STIs). In multivariable analyses, training/resident status was positively associated with recommending the LNG-IUS to women <20 years old (adjusted odds ratio [aOR], 3.6; 95% confidence interval [CI], 1.6-8.0) and women with history of STI (aOR, 3.7; 95% CI, 1.6-8.4). Perceived risk of infection or infertility was negatively associated with recommending the LNG-IUS to nulliparous women (aOR, 0.2; 95% CI, 0.1-0.5) and women with a history of STI (aOR, 0.3; 95% CI, 0.1-0.8).
  
  
  CONCLUSIONS
  Many family physicians and obstetrician-gynecologists who insert the LNG-IUS are overly restrictive in selecting candidates, although those who train residents are more likely to follow evidence-based guidelines. Interventions that address negative bias and perceptions of risks, in addition to improving knowledge, are needed to promote wider use of the LNG-IUS.
authors.affiliation: the Departments of Obstetrics and Gynecology and Family Medicine and the Departments of Epidemiology and Department of Health Services, School of Public Health, University of Washington, Seattle; the Departments of Medical Informatics and Clinical Epidemiology and Obstetrics and Gynecology, Oregon Health & Science University, Portland.
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Callegari
authors.forename: Blair G
authors.initials: BG
authors.lastname: Darney
authors.forename: Emily M
authors.initials: EM
authors.lastname: Godfrey
authors.forename: Olivia
authors.initials: O
authors.lastname: Sementi
authors.forename: Rebecca
authors.initials: R
authors.lastname: Dunsmoor-Su
authors.forename: Sarah W
authors.initials: SW
authors.lastname: Prager
mesh_terms: D003271:Contraceptive Agents, Female / Q000008:administration & dosage; D003625:Data Collection; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000706:statistics & numerical data*; D016912:Levonorgestrel / Q000008:administration & dosage; D008297:Male; D018579:Patient Selection
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel
keywords: Contraception; Evidence-based Medicine; Graduate Education; Intrauterine Devices