title: Providing Long-Acting Reversible Contraception in an Academic Family Medicine Center.
abstract: OBJECTIVE
  Providing long-acting reversible contraception (LARC), which includes the intrauterine device (IUD) and the implant, falls within the scope of family medicine. The study objective was to describe 12-month rates of LARC continuation, LARC elective removal, and IUD expulsion in an academic family medicine center in New Jersey.
  
  
  METHODS
  We conducted a retrospective electronic chart review of 219 LARC insertions that occurred from June 2009--May 2012. Life table analyses were used to determine 12-month rates of LARC continuation, elective removal, and IUD expulsion. To explore differences in outcomes based upon training level (faculty versus trainees), we conducted Cox proportional hazard models.
  
  
  RESULTS
  Of 219 LARC insertions, faculty performed 100 (45.7%), and trainees (residents and students) performed 119 (54.3%). The 12-month continuation rate for all devices was 78%. The elective removal rate at 12 months was 17%; trainee-placed devices were more likely to be electively removed than faculty-placed devices (HR 2.43, 95% CI=1.05--5.62). The IUD expulsion rate at 12 months was 7.0%; expulsion rates did not differ by level of training.
  
  
  CONCLUSIONS
  These data provide support for the fact that family physicians in an academic setting can provide LARC with continuation, elective removal, and IUD expulsion rates similar to those observed in outpatient specialist clinics without resident training. Potential causes for the higher removal rate associated with trainee-inserted devices should be further explored.
authors.affiliation: Department of Family and Community Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Amico
authors.forename: Justine
authors.initials: J
authors.lastname: Wu
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D003271:Contraceptive Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects; D004343:Drug Implants / Q000008:administration & dosage* / Q000009:adverse effects; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007434:Intrauterine Devices / Q000009:adverse effects / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012189:Retrospective Studies
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants