title: Impact of years of clinical experience on perceived contraindications and barriers to the use of LARC: a survey of family planning providers.
abstract: BACKGROUND
  Despite their efficacy in preventing unintended pregnancies, intrauterine devices (IUDs) are still relatively underutilized by American women. Although cost of these methods is clearly a barrier to use, IUDs have had a long and sometimes controversial history, and earlier versions were removed from the market.
  
  
  METHODS
  This study explores the degree to which the length of licensure for providers is related to their attitudes toward or fears about these methods. Data come from a 2012 survey of 114 clinicians in Colorado and Iowa, collected as part of two, statewide initiatives to reduce unintended pregnancy. Providers were asked about service barriers to prescribing these methods and for which patients they perceived them to be suitable and safe.
  
  
  RESULTS
  The most experienced clinicians were the least concerned about uterine perforation and history of the Dalkon Shield, but were more likely to fear a lawsuit over complications. More experienced clinicians were also less approving of Copper T IUDs for all 11 subgroups of women, including nulliparous women and those with histories of sexually transmitted infections. They were also less approving of hormonal IUDs for 10 groups of women, including those with histories of ectopic pregnancies. However, clinicians with the most recent licensure were more conservative in their approval of single rod implants than were the providers with the most years since licensure.
  
  
  CONCLUSIONS
  This paper explores potential reasons for these findings and suggests trainings to recognize and overcome these barriers so as to promote consistent and accurate practice across clinicians, regardless of years of experience.
authors.affiliation: Philliber Research Associates, Accord, New York. Electronic address: aphilliber@philliberresearch.com.
authors.forename: Ashley E
authors.initials: AE
authors.lastname: Philliber
authors.affiliation: Philliber Research Associates, Accord, New York.
authors.forename: Heather
authors.initials: H
authors.lastname: Hirsch
authors.affiliation: Philliber Research Associates, Accord, New York.
authors.forename: Louis
authors.initials: L
authors.lastname: Mortillaro
authors.affiliation: Philliber Research Associates, Accord, New York.
authors.forename: Rita
authors.initials: R
authors.lastname: Turner
authors.affiliation: Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, California.
authors.forename: Abigail
authors.initials: A
authors.lastname: Arons
authors.affiliation: Philliber Research Associates, Accord, New York.
authors.forename: Susan
authors.initials: S
authors.lastname: Philliber
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003120:Colorado; D000075202:Contraindications; D005193:Family Planning Services; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D007434:Intrauterine Devices; D007484:Iowa; D008137:Longitudinal Studies; D008875:Middle Aged; D010465:Perception; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D000078329:Workforce