Increasing Provider Competency: A Quality Improvement Project Applying Best Practice Protocol for Contraception Counseling and LARC Insertion to Females of Reproductive Age in Primary Care

Background: Long-acting reversible contraception (LARC) including intrauterine devices (IUDs) are safe, effective, and economical methods of preventing unintended pregnancy and their associated poor outcomes. Barriers to use, such as lack of awareness, knowledge, and provider competency in counseling and insertion can be mitigated. The Doctor of Nursing Practice (DNP) student undertook this quality improvement (QI) project to explore the benefits of IUDs, mitigate identified barriers, and to improve community health. Purpose: The purpose of the QI project was to investigate and create best-evidence protocols for counseling patients to select the most effective forms of contraception and to educate primary care providers in proper insertion techniques for IUDs. Methods: The QI project included small-group training in best-evidence counseling strategies and IUD insertion to primary care providers (PCPs), including demonstration, hands-on practice, role-playing, and teach-back using training devices. Pre- and post-training surveys and open-ended questionnaires were used to analyze provider perception of competence at both counseling and insertion. Results: Providers expressed comfort with contraception counseling before and after training. Providers did not feel ready to begin inserting IUDs after training on a simulation model. Interpretation/Discussion: Despite feeling very comfortable with effective contraception counseling and and practicing with training devices, providers are unwilling to insert IUDs without hands-on training on actual patients. Opportunities for this training is limited in the area, which is preventing providers from offering IUD insertion service. Conclusion/Implications: By promoting the superior effectiveness of IUDs over less effective contraception, and by increasing access to LARC, PCPs can help to prevent unintended pregnancy. Keywords: Intrauterine device, pregnancy, unplanned, long-acting reversible contraception, unintended pregnancy, primary care, counseling