Challenges in Translating Evidence to Practice The Provision of Intrauterine Contraception

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 intrauter-ine contraceptives annually. This study assessed knowl-edge and practice patterns of practitioners regarding intrauterine contraception. METHODS: We conducted a survey among physicians, nurse practitioners, and physician assistants (n1,246) serving more than 100 contraceptive patients per year in the California State family planning program. The re-sponse rate was 65 % (N816). 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 intra-uterine 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 nul-liparous 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 knowl-edge of bleeding patterns for the levonorgestrel-releas-ing intrauterine system and copper devices. CONCLUSION: Prescribing practices reflected the errone-ous 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 re-vealed a need for training on updated insertion guidelines and method-specific side effects, including differences be-tween hormonal and nonhormonal devices