title: Aspiration Abortion With Immediate Intrauterine Device Insertion: Comparing Outcomes of Advanced Practice Clinicians and Physicians.
abstract: BACKGROUND
  Immediate postabortion intrauterine device (IUD) insertion is a safe, effective strategy to prevent subsequent unplanned pregnancy. Oregon is one of 5 US states where advanced practice clinicians perform aspiration abortions. This study compares outcomes of first-trimester aspiration abortion with immediate IUD insertion between advanced practice clinicians and physicians.
  
  
  METHODS
  We conducted a historical cohort study of first-trimester aspiration abortions with immediate IUD insertion performed at our center from 2009 to 2011. We extracted demographic and clinical data from patient charts. Immediate complications including excessive blood loss, perforation, and reaspirations were recorded at the time of procedure. We used descriptive statistics and multivariable logistic regression to test for differences in outcomes by clinician type.
  
  
  RESULTS
  Data were available on 669 of the 1134 combined procedures. Advanced practice clinicians performed 224 of these. There were no significant differences in immediate outcomes. The only immediate complications were reaspirations; 1.8% (4/224) in the advanced practice clinician group, and 2.0% (9/445) in the physician group (P = .83).
  
  
  CONCLUSIONS
  We found no differences in outcomes between provider type for immediate IUD insertion after first-trimester aspiration abortion. This study helps reinforce that advanced practice clinicians can provide immediate postaspiration abortion IUD insertions with similar outcomes to those of physicians. Many countries do not allow advanced practice clinicians to perform this service, but a change in policy could help address family planning provider shortages.
authors.forename: Eva
authors.initials: E
authors.lastname: Patil
authors.forename: Blair
authors.initials: B
authors.lastname: Darney
authors.forename: Kaebah
authors.initials: K
authors.lastname: Orme-Evans
authors.forename: Ethan H
authors.initials: EH
authors.lastname: Beckley
authors.forename: Linn
authors.initials: L
authors.lastname: Bergander
authors.forename: Mark
authors.initials: M
authors.lastname: Nichols
authors.forename: Paula H
authors.initials: PH
authors.lastname: Bednarek
mesh_terms: D000028:Abortion, Induced / Q000379:methods; D000293:Adolescent; D000328:Adult; D057179:Advanced Practice Nursing; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005194:Family Practice; D005260:Female; D006176:Gynecology; D006801:Humans; D007434:Intrauterine Devices; D016015:Logistic Models; D008875:Middle Aged; D009721:Nurse Midwives; D009722:Nurse Practitioners; D009774:Obstetrics; D009922:Oregon; D017063:Outcome Assessment, Health Care; D010823:Physician Assistants; D010820:Physicians; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D012189:Retrospective Studies; D055815:Young Adult
keywords: advanced practice clinician; aspiration abortion; postabortion intrauterine device