title: IUD services among primary care practices in New York City.
abstract: OBJECTIVE
  Intrauterine devices (IUDs) are one of the most effective forms of reversible contraception and can reduce unintended pregnancy rates. We explored practice characteristics associated with IUD services across a network of primary care practices in New York City during 2010-2013.
  
  
  METHODS
  Data were extracted from electronic health records (EHRs) for 253 primary care practices participating in an EHR quality improvement program in New York City. We used diagnostic and procedure codes to count IUD insertions and removals among females aged 10-49 years during 2010-2013. Logistic regression models predicted the likelihood of IUD insertion, removal or no activity for 2013, based on practice characteristics. We stratified trends in IUD services over time by practice type and specialty.
  
  
  RESULTS
  From 2010 to 2013, the proportion of practices that inserted IUDs increased slightly from 4.7% to 6.3% (p=0.17), and the proportion removing IUDs increased from 8.3% to 12.3% (p<0.01). More than 60% of obstetricians/gynecologists and midwives performed insertions or removals each year; fewer than 10% of internal medicine and pediatric providers did so. Community health centers had higher odds of performing removals than independent practices (adjusted odds ratio=10.24, 95% confidence interval: 3.37-31.17). Practices seeing >66% female patients had higher odds of performing both insertions and removals.
  
  
  CONCLUSIONS
  From 2010 to 2013, IUD services increased but remained low among primary care practices in this network. Provider training and system readiness programs should include independent primary care practices, which rarely provide IUDs, to ensure that women can receive IUDs or IUD service referrals in the primary care setting.
  
  
  CONCLUSIONS
  Much of primary care in the United States takes place in independent practices with one or two providers. Our study of a major urban area found that these types of practices are much less likely to offer IUD services than community health centers. Ensuring that small practices know where to refer women for IUD insertion and removal services is warranted to ensure women's access to IUDs.
authors.affiliation: Primary Care Information Project, NYC Department of Health and Mental Hygiene, 42-09 28th Street, CN-52, Long Island City, Queens, NY, 11101. Electronic address: ljacobson1@health.nyc.gov.
authors.forename: Laura
authors.initials: L
authors.lastname: Jacobson
authors.affiliation: Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, 60 Haven Avenue, Room 2D, New York, NY, 10032. Electronic address: svg2108@cumc.columbia.edu.
authors.forename: Samantha
authors.initials: S
authors.lastname: Garbers
authors.affiliation: Montefiore Medical Center, 3544 Jerome Ave, Bronx, NY, 10467. Electronic address: hhelmy@montefiore.org.
authors.forename: Hannah
authors.initials: H
authors.lastname: Helmy
authors.affiliation: Office of State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop E70, Atlanta, GA, 30341-3717. Electronic address: vtt2@cdc.gov.
authors.forename: Hope
authors.initials: H
authors.lastname: Roobol
authors.affiliation: Research Department, Planned Parenthood Federation of America, 434 West 33 Street, New York, NY, USA. Electronic address: julia.kohn@ppfa.org.
authors.forename: Julia E
authors.initials: JE
authors.lastname: Kohn
authors.affiliation: Research Division, Guttmacher Institute, 125 Maiden Lane, New York, NY, 10038. Electronic address: mkavanaugh@guttmacher.org.
authors.forename: Megan L
authors.initials: ML
authors.lastname: Kavanaugh
mesh_terms: D003151:Community Health Centers; D005260:Female; D006176:Gynecology; D006801:Humans; D007388:Internal Medicine; D007434:Intrauterine Devices / Q000706:statistics & numerical data*; D008880:Midwifery; D009519:New York City; D009774:Obstetrics; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011320:Primary Health Care / Q000706:statistics & numerical data*
keywords: IUD; Intrauterine device; LARC; Long-acting reversible contraception; Primary care