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Intrauterine Device Training, Attitudes, and Practices Among U.S. Health Care Providers: Findings from a Nationwide Survey

Published:September 18, 2022DOI:https://doi.org/10.1016/j.whi.2022.08.002

      Abstract

      Background

      Provider training in intrauterine device (IUD) procedures is a key strategy for improving evidence-based IUD care. We examined the influence of IUD training on IUD attitudes and practices among U.S. family planning providers.

      Methods

      In 2019, we conducted a cross-sectional survey of U.S. family planning providers. We performed logistic regression to examine associations between training in routine IUD placement and specific IUD safety attitudes, confidence performing IUD procedures, and specific IUD practices.

      Results

      Among 1,063 physicians and advanced practice clinicians, 85.1% reported training in routine IUD placement. Overall, IUD training was associated with accurately stating IUDs are safe for queried groups, including patients immediately postpartum (prevalence ratio [PR] 4.22; 95% confidence interval [CI] 1.29–13.85). Trained providers reported higher confidence in routine IUD placement for parous (PR 7.71; 95% CI 1.31–45.3) and nulliparous (PR 7.12; 95% CI 1.17–43.5) women and in IUD removal (PR 2.06; 95% CI 1.12–3.81). Among providers with IUDs available onsite, IUD training was associated with frequent same-day IUD provision for adults (PR 7.32; 95% CI 2.16–24.79) and adolescents (PR 7.63; 95% CI 2.22–26.24). Trained providers were also less likely to routinely use misoprostol before IUD placement for nulliparous (PR 0.19; 95% CI 0.11–0.33) and parous women (PR 0.07; 95% CI 0.03–0.16).

      Conclusion

      Training in routine IUD placement was associated with evidence-based IUD safety attitudes, confidence in performing IUD procedures, and clinical practices aligned with Centers for Disease Control and Prevention contraception guidance. Expanding IUD training might increase evidence-based care and patient access to the full range of contraception, including IUDs.
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      References

        • American Association for Public Opinion Research (AAPOR)
        Standard definitions: final dispositions of case codes and outcome rates for surveys.
        (Available:)
        • American Medical Association
        AMA Physician Masterfile.
        (Available:)
        • Amico J.R.
        • Bennett A.H.
        • Karasz A.
        • Gold M.
        "She just told me to leave it": Women's experiences discussing early elective IUD removal.
        Contraception. 2016; 94: 357-361
        • Amico J.R.
        • Bennett A.H.
        • Karasz A.
        • Gold M.
        "I wish they could hold on a little longer": physicians' experiences with requests for early IUD removal.
        Contraception. 2017; 96: 106-110
        • Amico J.R.
        • Heintz C.
        • Bennett A.H.
        • Gold M.
        Access to IUD removal: Data from a mystery-caller study.
        Contraception. 2020; 101: 122-129
        • Biggs M.A.
        • Arons A.
        • Turner R.
        • Brindis C.D.
        Same-day LARC insertion attitudes and practices.
        Contraception. 2013; 88: 629-635
        • Biggs M.A.
        • Harper C.C.
        • Brindis C.D.
        California Family Planning Health Care Providers' Challenges to Same-Day Long-Acting Reversible Contraception Provision.
        Obstetrics & Gynecology. 2015; 126: 338-345
        • Biggs M.A.
        • Tome L.
        • Mays A.
        • Kaller S.
        • Harper C.C.
        • Freedman L.
        The fine line between informing and coercing: community health center clinicians' approaches to counseling young people about IUDs.
        Perspectives on Sexual and Reproductive Health. 2020; 52: 245-252
        • Black K.
        • Lotke P.
        • Buhling K.J.
        • Zite N.B.
        A review of barriers and myths preventing the more widespread use of intrauterine contraception in nulliparous women.
        The European Journal of Contraception & Reproductive Health Care. 2012; 17: 340-350
        • Brandi K.
        • Fuentes L.
        The history of tiered-effectiveness contraceptive counseling and the importance of patient-centered family planning care.
        American Journal of Obstetrics and Gynecology. 2020; 222: S873-S877
        • Buhling K.J.
        • Zite N.B.
        • Lotke P.
        • Black K.
        Worldwide use of intrauterine contraception: a review.
        Contraception. 2014; 89: 162-173
        • Castleberry N.M.
        • Stark L.
        • Schulkin J.
        • Grossman D.
        Implementing best practices for the provision of long-acting reversible contraception: a survey of obstetrician-gynecologists.
        Contraception. 2019; 100: 123-127
        • Chelvakumar M.
        • Jabbarpour Y.
        • Coffman M.
        • Jetty A.
        • Shaw J.G.
        Long-acting reversible contraception (LARC) provision by family physicians: Low but on the rise.
        The Journal of the American Board of Family Medicine. 2019; 32: 10-12
        • Committee on Adolescence
        Contraception for adolescents.
        Pediatrics. 2014; 134: e1244-e1256
        • Committee on Practice Bulletins-Gynecology Long-Acting Reversible Contraception Work Group
        Practice Bulletin No. 186: Long-Acting Reversible Contraception: Implants and Intrauterine Devices.
        Obstetrics & Gynecology. 2017; 130: e251-e269
        • Curtis K.M.
        • Jatlaoui T.C.
        • Tepper N.K.
        • Zapata L.B.
        • Horton L.G.
        • Jamieson D.J.
        • Whiteman M.K.
        U.S. selected practice recommendations for contraceptive use, 2016.
        Morbidity and Mortality Weekly Reports Recommendations and Reports. 2016; 65: 1-66
        • Curtis K.M.
        • Tepper N.K.
        • Jatlaoui T.C.
        • Berry-Bibee E.
        • Horton L.G.
        • Zapata L.B.
        • Whiteman M.K.
        U.S. medical eligibility criteria for contraceptive use, 2016.
        Morbidity and Mortality Weekly Reports Recommendations and Reports. 2016; 65: 1-103
        • Daniels K.
        • Abma J.C.
        Current Contraceptive Status Among Women Aged 15–49: United States, 2017–2019.
        NCHS Data Brief. 2020; 388: 1-8
        • Dean G.
        • Schwarz E.B.
        Intrauterine Devices.
        in: Hatcher R.A. Nelson A.L. Trussell J. Cwiak C. Cason P. Policar M.D. Edelman A.B. Aiken A.R. Marrazzo J.M. Kowal D. Contraceptive technology. 21st ed. Ayer Company Publishers, Inc, New York2018: 157-193
        • DeSisto C.L.
        • Estrich C.
        • Kroelinger C.D.
        • Goodman D.A.
        • Pliska E.
        • Mackie C.N.
        • Rankin K.M.
        Using a multi-state Learning Community as an implementation strategy for immediate postpartum long-acting reversible contraception.
        Implementation Science. 2017; 12: 1-9
        • Fridy R.L.
        • Maslyanskaya S.
        • Lim S.
        • Coupey S.M.
        Pediatricians' knowledge and practices related to long-acting reversible contraceptives for adolescent girls.
        Journal of Pediatric and Adolescent Gynecology. 2018; 31: 394-399
        • Harper C.C.
        • Blum M.
        • de Bocanegra H.T.
        • Darney P.D.
        • Speidel J.J.
        • Policar M.
        • Drey E.A.
        Challenges in translating evidence to practice: the provision of intrauterine contraception.
        Obstetrics & Gynecology. 2008; 111: 1359-1369
        • Harper C.C.
        • Stratton L.
        • Raine T.R.
        • Thompson K.
        • Henderson J.T.
        • Blum M.
        • Speidel J.J.
        Counseling and provision of long-acting reversible contraception in the US: national survey of nurse practitioners.
        Preventive Medicine. 2013; 57: 883-888
        • Holt K.
        • Reed R.
        • Crear-Perry J.
        • Scott C.
        • Wulf S.
        • Dehlendorf C.
        Beyond same-day long-acting reversible contraceptive access: a person-centered framework for advancing high-quality, equitable contraceptive care.
        American Journal of Obstetrics and Gynecology. 2020; 222: S878
        • Jones J.
        • Mosher W.
        • Daniels K.
        Current contraceptive use in the United States, 2006–2010, and changes in patterns of use since 1995.
        National Health Statistics Report. 2012; 60: 1-25
        • Krempasky C.
        • Harris M.
        • Abern L.
        • Grimstad F.
        Contraception across the transmasculine spectrum.
        American Journal of Obstetrics and Gynecology. 2020; 222: 134-143
        • Kroelinger C.D.
        • Romero L.
        • Lathrop E.
        • Cox S.
        • Morgan I.
        • Frey M.T.
        • Barfield W.D.
        Meeting summary: state and local implementation strategies for increasing access to contraception during Zika preparedness and response—United States, September 2016.
        MMWR Morbidity and Mortality Weekly Report. 2017; 66: 1230
        • Lopez L.M.
        • Bernholc A.
        • Zeng Y.
        • Allen R.H.
        • Bartz D.
        • O'Brien P.A.
        • Hubacher D.
        Interventions for pain with intrauterine device insertion.
        Cochrane Database of Systematic Reviews. 2015; 7: CD007373
        • Luchowski A.T.
        • Anderson B.L.
        • Power M.L.
        • Raglan G.B.
        • Espey E.
        • Schulkin J.
        Obstetrician-gynecologists and contraception: practice and opinions about the use of IUDs in nulliparous women, adolescents and other patient populations.
        Contraception. 2014; 89: 572-577
        • Mueller T.
        • Tevendale H.D.
        • Fuller T.R.
        • House L.D.
        • Romero L.M.
        • Brittain A.
        • Varanasi B.
        Teen pregnancy prevention: Implementation of a multicomponent, community-wide approach.
        Journal of Adolescent Health. 2017; 60: S9-S17
        • Nisen M.B.
        • Peterson L.E.
        • Cochrane A.
        • Rubin S.E.
        US family physicians' intrauterine and implantable contraception provision: results from a national survey.
        Contraception. 2016; 93: 432-437
        • Office of Population Affairs
        Quality family planning.
        (Available:)
        • Ouyang M.
        • Peng K.
        • Botfield J.R.
        • McGeechan K.
        Intrauterine contraceptive device training and outcomes for healthcare providers in developed countries: A systematic review.
        PLoS One. 2019; 14: e0219746
        • Peipert J.F.
        • Madden T.
        • Allsworth J.E.
        • Secura G.M.
        Preventing unintended pregnancies by providing no-cost contraception.
        Obstetrics & Gynecology. 2012; 120: 1291-1297
        • Peipert J.F.
        • Zhao Q.
        • Allsworth J.E.
        • Petrosky E.
        • Madden T.
        • Eisenberg D.
        • Secura G.
        Continuation and satisfaction of reversible contraception.
        Obstetrics & Gynecology. 2011; 117: 1105-1113
        • Philliber A.E.
        • Hirsch H.
        • Brindis C.D.
        • Turner R.
        • Philliber S.
        The use of ACOG guidelines: Perceived contraindications to IUD and implant use among family planning providers.
        Maternal and Child Health Journal. 2017; 21: 1706-1712
        • Ricketts S.
        • Klingler G.
        • Schwalberg R.
        Game change in Colorado: Widespread use of long-acting reversible contraceptives and rapid decline in births among young, low-income women.
        Perspectives on Sexual and Reproductive Health. 2014; 46: 125-132
        • Schubert F.D.
        • Herbitter C.
        • Fletcher J.
        • Gold M.
        IUD knowledge and experience among family medicine residents.
        Family Medicine. 2015; 47: 474-477
        • Tyler C.P.
        • Whiteman M.K.
        • Zapata L.B.
        • Curtis K.M.
        • Hillis S.D.
        • Marchbanks P.A.
        Health care provider attitudes and practices related to intrauterine devices for nulliparous women.
        Obstetrics & Gynecology. 2012; 119: 762-771
        • Winner B.
        • Peipert J.F.
        • Zhao Q.
        • Buckel C.
        • Madden T.
        • Allsworth J.E.
        • Secura G.M.
        Effectiveness of long-acting reversible contraception.
        New England Journal of Medicine. 2012; 366: 1998-2007
        • Zapata L.B.
        • Jatlaoui T.C.
        • Marchbanks P.A.
        • Curtis K.M.
        Medications to ease intrauterine device insertion: a systematic review.
        Contraception. 2016; 94: 739-759
        • Zapata L.B.
        • Morgan I.A.
        • Curtis K.M.
        • Folger S.G.
        • Whiteman M.K.
        Changes in US health care provider attitudes related to contraceptive safety before and after the release of National Guidance.
        Contraception. 2019; 100: 413-419

      Biography

      Jennifer A. Reeves, MD, MPH, is an obstetrician-gynecologist, who specializes in Complex Family Planning, and a guest researcher with the Division of Reproductive Health at the Centers for Disease Control and Prevention. Her research interests include contraceptive access and abortion surveillance.

      Biography

      Lauren B. Zapata, PhD, is an Epidemiologist with the Division of Reproductive Health at the Centers for Disease Control and Prevention. She is also a Commander in the United States Public Health Service. Her research interests include improving access to quality family planning services and promoting maternal and child health.

      Biography

      Kathryn M. Curtis, PhD, is a Health Scientist with the Division of Reproductive Health at the Centers for Disease Control and Prevention. Her main areas of research include contraceptive safety, effectiveness, and guidelines development.

      Biography

      Maura K. Whiteman, PhD, is an Epidemiologist with the Division of Reproductive Health at the Centers for Disease Control and Prevention. Her research interests include contraceptive safety, prevention of unintended and teen pregnancy, and improving access to quality family planning services.