A study of physician recommendations for reversible contraceptive methods using standardized patients.
ABSTRACT Health care providers may influence patients' choice of contraceptive method, yet little is known about the recommendations they make to their patients.
In 2007-2008, a total of 468 physicians at four family medicine and obstetrics and gynecology meetings were randomly assigned to view one of 18 videos of a patient seeking contraceptive advice; the patients were standardized for most relevant behaviors and characteristics, but differed by race and ethnicity, socioeconomic status and gynecologic history. Participants provided their demographic and practice characteristics and completed a survey about their contraceptive recommendations for the patient. Multivariate logistic regression analyses were conducted to identify associations between physician characteristics and recommendations for specific contraceptive methods.
The most frequently recommended methods were the pill (89%) and ring (80%), followed by the levonor-gestrel IUD (64%), patch (56%), injectable (49%) and copper IUD (45%). Oral contraceptives were more likely to be recommended by private practice physicians than by academic physicians (odds ratio, 2.9). Recommendations for the ring were less common among family physicians and those 56 or older than among obstetrician-gynecologists and those 35 or younger (0.6 and 0.3, respectively), and more common among physicians in private practice than among those in academia (2.4). The patch and injectable were more commonly recommended by family physicians than by obstetrician-gynecologists (2.6 and 2.5, respectively). Both IUD types were recommended less often by physicians 36 or older than by younger ones (0.2-0.5).
The advice women receive about contraception may vary according to the characteristics of their provider. Research on the reasons for these differences is needed.
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ABSTRACT: Many prescription medications have limited information regarding safety for use during pregnancy. In order to inform research on safer medication use during pregnancy, we examined prescription medication use among women in the United States. We analyzed data from the 1999-2006 National Health and Nutrition Examination Survey (NHANES) to estimate the prevalence of prescription medication use in the past 30 days among pregnant women and non-pregnant women of childbearing age (15-44 years) and to ascertain the most commonly reported prescription medications by women in these groups. We assessed how the most commonly reported medications differed among groups defined by selected demographic characteristics, including age, race/ethnicity, and markers of socioeconomic status. Prescription medication use in the past 30 days was reported by 22 % of pregnant women and 47 % of non-pregnant women of childbearing age. The most commonly reported prescription medications by NHANES participants differed somewhat by pregnancy status; allergy and anti-infective medications were more common among pregnant women, while oral contraceptives were more common among non-pregnant women. Use of prescription medication for asthma and thyroid disorders was reported by both groups. Although prescription medication use in the previous 30 days was less common among pregnant women than non-pregnant women, its use was reported among almost 1 in 4 pregnant women. Many of the most common medications reported were for the treatment of chronic medical conditions. Given the potential impact of medications on the developing fetus, our data underscore the importance of understanding the safety of these medications during pregnancy.Maternal and Child Health Journal 10/2014; 19(5). DOI:10.1007/s10995-014-1611-z · 2.24 Impact Factor
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ABSTRACT: Objective: To describe the influence of socioeconomic characteristics on the choice of the contraceptive method used among women in Spain in 2006. Methods: This is a cross-sectional study of women aged 15-49 who reported the contraceptive method used during the first sexual intercourse (n = 3352) and during the 4 weeks prior to the interview (n = 2672). Data were analyzed taking into account women's socioeconomic characteristics. Results: The mostly used method during the first sexual intercourse was the condom. Women from developing countries more frequently used the pill than native-born Spanish women. The condom was also the most commonly used method in the 4 weeks prior to the interview. The use of other contraceptive methods increased with age. Being older and having children were both associated with an increased use of permanent methods. Conclusions: The choice of a specific contraceptive method seems to be more strongly influenced by women's stage of life than by socioeconomic characteristics.Gaceta Sanitaria 02/2013; 27(1):64-67. · 1.25 Impact Factor
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ABSTRACT: Objective To evaluate the attitude toward contraceptive methods of gynaecologists who, in Germany, are the sole prescribers of contraceptives. Methods An anonymous questionnaire was sent to 9545 gynaecologists inquiring about factors involved in their prescription of contraceptives, the contraceptives they preferred, and those they would recommend to their daughter, if they had one. Results The response rate of this survey was 21% (N = 2016). The combined oral contraceptive (COC) was the most commonly prescribed method followed by the levonorgestrel-releasing intrauterine system (LNG-IUS), the vaginal ring, the progestin-only pill (POP), the patch, and the progestin-only injectables. Of the respondents 51% would never prescribe the patch and 45% would never prescribe the hormonal implant at all; 61% would choose the LNG-IUS for themselves/for their partner; 18% would opt for a COC and 8% for the vaginal ring. Concerning their imaginary daughter, 71% would prefer a COC, 26% the ring, and 9% the LNG-IUS. The first counselling session lasted 13.8 ± 4.9 min, and the provision of information on the occasion of following visits 6.6 ± 3.2 min. Conclusion The contraceptives most prescribed by German gynaecologists were COCs, followed by the LNG-IUS, the vaginal ring, and POPs. The spectrum of contraceptives preferred for personal use differed in some ways from those prescribed to patients. Reasons for this discrepancy should be investigated.The European Journal of Contraception and Reproductive Health Care 08/2014; DOI:10.3109/13625187.2014.945164 · 1.84 Impact Factor