Increasing Long Acting Reversible Contraception Use in Primary Care: Removing the Barriers

Problem: Unintended pregnancy is a serious public health concern. About half of all pregnancies in the United States are unintended (Guttmacher Institute, 2016). This project lead by a Doctor of Nursing Practice (DNP) student at the University of San Francisco, will showcase the development, implementation, and evaluation of a LARC training program aimed at improving confidence in counseling, competence in insertion, and evaluation increased rates of LARC usage in primary care, directed at reducing unintended pregnancy rates. This program expands upon the Healthy People 2020 goals dedicated to family planning and emphasis on increased utilization of the most effective forms of contraception available (U.S. Department of Health and Human Services [HHS], 2017). Methods: In an effort to reduce barriers to LARC in the primary care setting and augment reproductive training standards at the academic level, an in-person four-hour training session was created to deliver hands-on LARC insertion practice with uterine simulators along with didactic training addressing common myths/misconceptions about LARC, and a practice toolkit for students to use in future contraceptive counseling sessions. Results: A total of 31 FNP providers participated in the LARC hands-on workshop. Data analysis demonstrated over 90% of participants increased their confidence in LARC insertion 32% showed increased knowledge about LARC in general as well as increased confidence in selecting LARC eligible candidates following this intervention. After four weeks, 16% of participants successfully inserted an IUD device. Conclusion: Overall, hands-on training is an evidence-based, cost effective way to promote competence at the academic and practice level to assist providers with LARC promotion, contraceptive counseling, and decreasing the unintended pregnancy rate