title: Patient or Clinician: Duration of Use of Intrauterine Devices Based on Who Initiated Discussion of Placement.
abstract: BACKGROUND
  Although safe and effective, intrauterine devices (IUDs) are underutilized in the United States. The objective of this study was to determine whether patient- and clinician-initiated discussions were associated with the duration of Mirena (52 mg levonorgestrel-releasing) IUD use.
  
  
  METHODS
  Retrospective chart review identified Mirena IUDs that were placed and removed for reasons other than the desire for pregnancy from January 1, 2005, to January 1, 2012, at 1 academic center (n = 148). Multivariable linear regression examined the independent association between duration of use and source of discussion initiation.
  
  
  RESULTS
  IUDs placed after patient-initiated discussions were used for 473 days longer than those placed after clinician-initiated discussions (P < .001).
  
  
  CONCLUSIONS
  Patient-initiated discussions of Mirena IUDs are associated with a significantly longer duration of use. Patient influences outside the clinical encounter may be important in optimizing use.
authors.affiliation: From the Department of Family Medicine (TC, MAP, KJG), the Institute for Health Policy and Innovation (TC, MHM), Department of Obstetrics & Gynecology (MHM, KJG), and the Robert Wood Johnson Foundation Clinical Scholars Program (MHM), the University of Michigan, Ann Arbor; the Providence Family Medicine Residency, Southfield, MI (KSS); and the Department of Family Medicine, Boulder Medical Center, Boulder, CO (HBV). tachang@med.umich.edu.
authors.forename: Tammy
authors.initials: T
authors.lastname: Chang
authors.affiliation: From the Department of Family Medicine (TC, MAP, KJG), the Institute for Health Policy and Innovation (TC, MHM), Department of Obstetrics & Gynecology (MHM, KJG), and the Robert Wood Johnson Foundation Clinical Scholars Program (MHM), the University of Michigan, Ann Arbor; the Providence Family Medicine Residency, Southfield, MI (KSS); and the Department of Family Medicine, Boulder Medical Center, Boulder, CO (HBV).
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Moniz
authors.affiliation: From the Department of Family Medicine (TC, MAP, KJG), the Institute for Health Policy and Innovation (TC, MHM), Department of Obstetrics & Gynecology (MHM, KJG), and the Robert Wood Johnson Foundation Clinical Scholars Program (MHM), the University of Michigan, Ann Arbor; the Providence Family Medicine Residency, Southfield, MI (KSS); and the Department of Family Medicine, Boulder Medical Center, Boulder, CO (HBV).
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Plegue
authors.affiliation: From the Department of Family Medicine (TC, MAP, KJG), the Institute for Health Policy and Innovation (TC, MHM), Department of Obstetrics & Gynecology (MHM, KJG), and the Robert Wood Johnson Foundation Clinical Scholars Program (MHM), the University of Michigan, Ann Arbor; the Providence Family Medicine Residency, Southfield, MI (KSS); and the Department of Family Medicine, Boulder Medical Center, Boulder, CO (HBV).
authors.forename: Kathryn Sage
authors.initials: KS
authors.lastname: Shaffer
authors.affiliation: From the Department of Family Medicine (TC, MAP, KJG), the Institute for Health Policy and Innovation (TC, MHM), Department of Obstetrics & Gynecology (MHM, KJG), and the Robert Wood Johnson Foundation Clinical Scholars Program (MHM), the University of Michigan, Ann Arbor; the Providence Family Medicine Residency, Southfield, MI (KSS); and the Department of Family Medicine, Boulder Medical Center, Boulder, CO (HBV).
authors.forename: Heather B
authors.initials: HB
authors.lastname: Vance
authors.affiliation: From the Department of Family Medicine (TC, MAP, KJG), the Institute for Health Policy and Innovation (TC, MHM), Department of Obstetrics & Gynecology (MHM, KJG), and the Robert Wood Johnson Foundation Clinical Scholars Program (MHM), the University of Michigan, Ann Arbor; the Providence Family Medicine Residency, Southfield, MI (KSS); and the Department of Family Medicine, Boulder Medical Center, Boulder, CO (HBV).
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Gold
mesh_terms: D000328:Adult; D003142:Communication; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects; D003376:Counseling; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000009:adverse effects / Q000706:statistics & numerical data*; D016912:Levonorgestrel / Q000008:administration & dosage; D016014:Linear Models; D008499:Medical Records; D057240:Patient Preference / Q000523:psychology / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel
keywords: Intrauterine Devices; Physician–Patient Relations; Social Networks