Public and Private Providers’ Involvement in Improving their Patients’ Contraceptive Use

ArticleinContraception 78(1):42-51 · August 2008with5 Reads
DOI: 10.1016/j.contraception.2008.03.009 · Source: PubMed
Abstract
This study measured differences in the provision of care between public and private providers of contraceptive services, what problems using contraception these providers perceived their patients to have and providers' views on how to improve their patients' method use. A nationally representative mixed-mode survey (mail, Internet and fax) of private family practice and obstetrician/gynecologist physicians who provided contraceptive care in 2005 was conducted. A parallel survey was administered to public contraceptive care providers in community health centers, hospitals, Planned Parenthood clinics and other sites during the same period. Descriptive and multivariate analyses were conducted across both surveys. A total of 1256 questionnaires were completed for a response rate of 62%. A majority of providers surveyed believed that over 10% of their contraceptive clients experienced ambivalence about avoiding pregnancy, underestimated the risk of pregnancy and failed to use contraception for one or more months when at risk for unintended pregnancy. Implementation of protocols to promote contraceptive use ranged widely among provider types: a full 78% of Panned Parenthood clinics offered quick-start pill initiation, as did 47% of public health departments. However, 38% of obstetrician-gynecologists, 27% of "other public" clinics and only 13% of family physicians did so. Both public and private providers reported that one of the most important things they could do to improve patients' contraceptive method use was to provide more and better counseling. At least 46% of private providers and at least 21% of public providers reported that changing insurance reimbursement to allow more time for counseling was very important. Strategies to improve contraceptive use for all persons in need in the United States have the potential to be more effective if the challenges contraceptive providers face and the differences between public and private providers are taken into account.
    • "In addition, women who receive effective counseling that includes the benefits and potential side effects of LARCs, are more likely to be satisfied with and continue these methods [11]. Furthermore, eighty-five percent of private and public sector family planning providers identified a need for improved contraceptive counseling to enhance contraceptive method utilization [15]. Arrowsmith, Aicken, Saxena, and Majeed [16] completed a systematic review of the literature on ways to increase the use of the copper IUD. "
    [Show abstract] [Hide abstract] ABSTRACT: Unintended pregnancies are an important public health issue. Long-acting reversible contraceptive methods (LARCs) are reliable, safe, highly effective methods for most women; however they are underutilized in the United States. Shared decision aids were added to usual care in five public health family planning clinics in the Southeastern United States, staffed by advance practice nurses and registered nurses. All five sites showed an increase in the use of LARCs during the time period that shared decision aids were used (results statistically significant to p < 0.001). It is important for women to make informed choices about contraception, and shared decision aids can be utilized to support this decision making. This resource has been adopted for statewide use in all public health clinics, and implications for practice suggest that the use of shared decision aids is an effective method to support informed patient decision making and acceptance of LARC methods of contraception.
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    • "Women also reported that mood change was the most important side effects they have experienced during pill use. Unfortunately most warning notes on the pill packages do not address or acknowledge about mood changes adequately while this is an important issue for ensuring that women will continue to use pills in order to prevent at least unwanted pregnancies [16,17]. In fact, discontinuity of oral contraceptive pills might jeopardize women's health in general and reproductive health in particular [18,19]. "
    File · Data · Dec 2013 · Preventive Medicine
    • "The Centers for Disease Control and Prevention (CDC) points to the importance of increasing access to LARC methods to reach the Healthy People 2020 objective of reduced unintended pregnancy (Centers for Disease Control and Prevention, 2013b; US Department of Health and Human Services, 2012). While almost all contraceptive providers currently offer women oral contraceptives and condoms (Landry et al., 2008), these methods have high discontinuation and typical-use failure rates, especially among underserved populations, where failure of oral contraceptives can be as high as 16 pregnancies per 100 person-years (Kost et al., 2008; Raine et al., 2011; Vaughan et al., 2008). LARC methods have extremely low typical use failure rates (b1%), similar to perfect use failure rates from clinical trials, because the methods require no user action for effectiveness () CA, 94118, USA. "
    [Show abstract] [Hide abstract] ABSTRACT: Nurse practitioners (NPs) provide frontline care in women's health, including contraception, an essential preventive service. Their importance for contraceptive care will grow, with healthcare reforms focused on affordable primary care. This study assessed practice and training needs to prepare NPs to offer high-efficacy contraceptives - IUDs and implants. A US nationally representative sample of nurse practitioners in primary care and women's health was surveyed in 2009 (response rate 69%, n=586) to assess clinician knowledge and practices, guided by the CDC US Medical Eligibility Criteria for Contraceptive Use. Two-thirds of women's health NPs (66%) were trained in IUD insertions, compared to 12% of primary care NPs. Contraceptive counseling that routinely included IUDs was low overall (43%). Nurse practitioners used overly restrictive patient eligibility criteria, inconsistent with CDC guidelines. Insertion training (aOR=2.4, 95%CI: 1.10 5.33) and knowledge of patient eligibility (aOR=2.9, 95%CI: 1.91 4.32) were associated with IUD provision. Contraceptive implant provision was low: 42% of NPs in women's health and 10% in primary care . Half of NPs desired training in these methods. Nurse practitioners have an increasingly important position in addressing high unintended pregnancy in the U.S., but require specific training in long-acting reversible contraceptives.
    Full-text · Article · Oct 2013
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