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Challenges in Translating Evidence to Practice: The Provision of Intrauterine Contraception

Harper, Cynthia C. PhD; Blum, Maya MPH; de Bocanegra, Heike Thiel PhD, MPH; Darney, Philip D. MD, MSc; Speidel, J Joseph MD, MPH; Policar, Michael MD; Drey, Eleanor A. MD, EdM

doi: 10.1097/AOG.0b013e318173fd83
Original Research

OBJECTIVE: Intrauterine contraception is used by many women worldwide, however, it is rarely used in the United States. Although available at no cost from the state family planning program for low-income women in California, only 1.3% of female patients obtain intrauterine contraceptives annually. This study assessed knowledge and practice patterns of practitioners regarding intrauterine contraception.

METHODS: We conducted a survey among physicians, nurse practitioners, and physician assistants (n=1,246) serving more than 100 contraceptive patients per year in the California State family planning program. The response rate was 65% (N=816). We used multiple logistic regression to measure the association of knowledge with clinical practice among different provider types.

RESULTS: Forty percent of providers did not offer intrauterine contraception to contraceptive patients, and 36% infrequently provided counseling, although 92% thought their patients were receptive to learning about the method. Regression analyses showed younger physicians and those trained in residency were more likely to offer insertions. Fewer than half of clinicians considered nulliparous women (46%) and postabortion women (39%) to be appropriate candidates. Evidence-based views of the types of patients who could be safely provided with intrauterine contraception were associated with more counseling and method provision, as well as with knowledge of bleeding patterns for the levonorgestrel-releasing intrauterine system and copper devices.

CONCLUSION: Prescribing practices reflected the erroneous belief that intrauterine contraceptives are appropriate only for a restricted set of women. The scientific literature shows intrauterine contraceptives can be used safely by many women, including postabortion patients. Results revealed a need for training on updated insertion guidelines and method-specific side effects, including differences between hormonal and nonhormonal devices.

LEVEL OF EVIDENCE: III

Results of a survey show the need for provider training on updated intrauterine insertion guidelines and side effects, including important differences between hormonal and nonhormonal devices.

From the Bixby Center for Reproductive Health Research & Policy, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California.

Supported by funds from the State of California, Department of Health Services, contract 05-45122, and the William and Flora Hewlett Foundation. All analyses, interpretations, or conclusions are those of the authors and not of the funders.

The authors thank Debbie Postlethwaite, RNP, MPH, for her detailed review of the survey and Debbie Weiss, MPH, for her contributions to the survey and provider interviews.

Corresponding author: Cynthia C. Harper, PhD, Assistant Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, Box 0744 UCSF, 3333 California St., Ste. 335, San Francisco, CA 94118; e-mail: harperc@obgyn.ucsf.edu.

Financial Disclosure The authors have no potential conflicts of interest to disclose.

© 2008 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.