Document Detail


Copper intrauterine device for emergency contraception: clinical practice among contraceptive providers.
MedLine Citation:
PMID:  22270272     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The copper intrauterine device (IUD) is the most effective emergency contraceptive available but is largely ignored in clinical practice. We examined clinicians' recommendations of the copper IUD for emergency contraception in a setting with few cost obstacles.
METHODS: We conducted a survey among clinicians (n=1,246; response rate 65%) in a California State family planning program, where U.S. Food and Drug Administration-approved contraceptives are available at no cost to low-income women. We used multivariable logistic regression to measure the association of intrauterine contraceptive training and evidence-based knowledge with having recommended the copper IUD for emergency contraception.
RESULTS: The large majority of clinicians (85%) never recommended the copper IUD for emergency contraception, and most (93%) required two or more visits for an IUD insertion. Multivariable analyses showed insertion skills were associated with having recommended the copper IUD for emergency contraception, but the most significant factor was evidence-based knowledge of patient selection for IUD use. Clinicians who viewed a wide range of patients as IUD candidates were twice as likely to have recommended the copper IUD for emergency contraception. Although more than 93% of obstetrician-gynecologists were skilled in inserting the copper IUD, they were no more likely to have recommended it for emergency contraception than other physicians or advance practice clinicians.
CONCLUSION: Recommendation of the copper IUD for emergency contraception is rare, despite its high efficacy and long-lasting contraceptive benefits. Recommendation would require clinic flow and scheduling adjustments to allow same-day IUD insertions. Patient-centered and high-quality care for emergency contraception should include a discussion of the most effective method.
LEVEL OF EVIDENCE: III.
Authors:
Cynthia C Harper; J Joseph Speidel; Eleanor A Drey; James Trussell; Maya Blum; Philip D Darney
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  119     ISSN:  1873-233X     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-01-24     Completed Date:  2012-06-11     Revised Date:  2014-09-22    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  220-6     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
California
Clinical Competence*
Contraception, Postcoital*
Data Collection
Evidence-Based Medicine
Family Practice / education,  statistics & numerical data
Female
Gynecology / education,  statistics & numerical data
Health Knowledge, Attitudes, Practice*
Humans
Intrauterine Devices, Copper*
Logistic Models
Male
Middle Aged
Multivariate Analysis
Obstetrics / education,  statistics & numerical data
Patient Selection
Physician's Practice Patterns / statistics & numerical data*
Women's Health Services / statistics & numerical data
Grant Support
ID/Acronym/Agency:
24HD047879/HD/NICHD NIH HHS; R24 HD047879/HD/NICHD NIH HHS; R24 HD047879-01/HD/NICHD NIH HHS
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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