US family physicians' intrauterine and implantable contraception provision

Results from a national survey

Mollie B. Nisen, Lars E. Peterson, Anneli Cochrane, Susan E. Rubin

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective: Establish a current cross-sectional national picture of intrauterinedevice (IUD) and implant provision by US family physicians and ascertain individual, clinical site and scope of practice level associations with provision. Study design: Secondary analysis of data from 2329 family physicians recertifying with the American Board of Family Medicine in 2014. Results: Overall, 19.7% of respondents regularly inserted IUDs, and 11.3% regularly inserted and/or removed implants. Family physicians provided these services in a wide range of clinical settings. In bivariate analysis, almost all of the individual, clinical site and scope of practice characteristics we examined were associated with provision of both methods. In multivariate analysis, the scope of practice characteristics showed the strongest association with both IUD and implant provision. For IUDs, this included providing prenatal care with [adjusted odds ratio (aOR) 3.26, 95% confidence interval (95% CI)=.1.93-5.49] or without (aOR = 3.38, 95% CI = 1.88-6.06) delivery, performance of endometrial biopsies (aOR = 16.51, 95% CI = 11.97-22.79) and implant insertion and removal (aOR = 8.78, 95% CI = 5.79-13.33). For implants, it was providing prenatal care and delivery (aOR = 1.77, 95% CI = 1.15-2.74), office skin procedures (aOR = 3.07, 95% CI = 1.47-6.42), endometrial biopsies (aOR = 3.67, 95% CI = 2.41-5.59) and IUD insertion (aOR = 8.58, 95% CI = 5.70-12.91). Conclusions: While a minority of family physicians regularly provided IUDs and/or implants, those who provided did so in a broad range of outpatient settings. Individual and clinical site characteristics were not largely predictive of provision. This connotes potential for family physicians to increase IUD and implant access in a variety of settings. Provision of both methods was strongly associated with scope of practice variables including performance of certain office procedures as well as prenatal and/or obstetrical care. Implications: These data provide a baseline from which to analyze change in IUD and implant provision in family medicine, identify gaps in care and ascertain potential leverage points for interventions to increase long-acting reversible contraceptive provision by family physicians. Interventions may be more successful if they first focus on sites and/or family physicians who already provide prenatal care, obstetrical care, skin procedures and/or endometrial biopsies.

Original languageEnglish (US)
JournalContraception
DOIs
StateAccepted/In press - Sep 3 2015

Fingerprint

Family Physicians
Contraception
Odds Ratio
Confidence Intervals
Prenatal Care
Biopsy
Medicine
Skin Care
Surveys and Questionnaires
Contraceptive Agents
Outpatients
Multivariate Analysis
Skin

Keywords

  • Contraceptive implants
  • Family physicians
  • Intrauterine contraceptive device
  • IUD
  • LARC
  • Long-acting reversible contraception
  • Primary care

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

Cite this

US family physicians' intrauterine and implantable contraception provision : Results from a national survey. / Nisen, Mollie B.; Peterson, Lars E.; Cochrane, Anneli; Rubin, Susan E.

In: Contraception, 03.09.2015.

Research output: Contribution to journalArticle

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abstract = "Objective: Establish a current cross-sectional national picture of intrauterinedevice (IUD) and implant provision by US family physicians and ascertain individual, clinical site and scope of practice level associations with provision. Study design: Secondary analysis of data from 2329 family physicians recertifying with the American Board of Family Medicine in 2014. Results: Overall, 19.7{\%} of respondents regularly inserted IUDs, and 11.3{\%} regularly inserted and/or removed implants. Family physicians provided these services in a wide range of clinical settings. In bivariate analysis, almost all of the individual, clinical site and scope of practice characteristics we examined were associated with provision of both methods. In multivariate analysis, the scope of practice characteristics showed the strongest association with both IUD and implant provision. For IUDs, this included providing prenatal care with [adjusted odds ratio (aOR) 3.26, 95{\%} confidence interval (95{\%} CI)=.1.93-5.49] or without (aOR = 3.38, 95{\%} CI = 1.88-6.06) delivery, performance of endometrial biopsies (aOR = 16.51, 95{\%} CI = 11.97-22.79) and implant insertion and removal (aOR = 8.78, 95{\%} CI = 5.79-13.33). For implants, it was providing prenatal care and delivery (aOR = 1.77, 95{\%} CI = 1.15-2.74), office skin procedures (aOR = 3.07, 95{\%} CI = 1.47-6.42), endometrial biopsies (aOR = 3.67, 95{\%} CI = 2.41-5.59) and IUD insertion (aOR = 8.58, 95{\%} CI = 5.70-12.91). Conclusions: While a minority of family physicians regularly provided IUDs and/or implants, those who provided did so in a broad range of outpatient settings. Individual and clinical site characteristics were not largely predictive of provision. This connotes potential for family physicians to increase IUD and implant access in a variety of settings. Provision of both methods was strongly associated with scope of practice variables including performance of certain office procedures as well as prenatal and/or obstetrical care. Implications: These data provide a baseline from which to analyze change in IUD and implant provision in family medicine, identify gaps in care and ascertain potential leverage points for interventions to increase long-acting reversible contraceptive provision by family physicians. Interventions may be more successful if they first focus on sites and/or family physicians who already provide prenatal care, obstetrical care, skin procedures and/or endometrial biopsies.",
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AU - Peterson, Lars E.

AU - Cochrane, Anneli

AU - Rubin, Susan E.

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N2 - Objective: Establish a current cross-sectional national picture of intrauterinedevice (IUD) and implant provision by US family physicians and ascertain individual, clinical site and scope of practice level associations with provision. Study design: Secondary analysis of data from 2329 family physicians recertifying with the American Board of Family Medicine in 2014. Results: Overall, 19.7% of respondents regularly inserted IUDs, and 11.3% regularly inserted and/or removed implants. Family physicians provided these services in a wide range of clinical settings. In bivariate analysis, almost all of the individual, clinical site and scope of practice characteristics we examined were associated with provision of both methods. In multivariate analysis, the scope of practice characteristics showed the strongest association with both IUD and implant provision. For IUDs, this included providing prenatal care with [adjusted odds ratio (aOR) 3.26, 95% confidence interval (95% CI)=.1.93-5.49] or without (aOR = 3.38, 95% CI = 1.88-6.06) delivery, performance of endometrial biopsies (aOR = 16.51, 95% CI = 11.97-22.79) and implant insertion and removal (aOR = 8.78, 95% CI = 5.79-13.33). For implants, it was providing prenatal care and delivery (aOR = 1.77, 95% CI = 1.15-2.74), office skin procedures (aOR = 3.07, 95% CI = 1.47-6.42), endometrial biopsies (aOR = 3.67, 95% CI = 2.41-5.59) and IUD insertion (aOR = 8.58, 95% CI = 5.70-12.91). Conclusions: While a minority of family physicians regularly provided IUDs and/or implants, those who provided did so in a broad range of outpatient settings. Individual and clinical site characteristics were not largely predictive of provision. This connotes potential for family physicians to increase IUD and implant access in a variety of settings. Provision of both methods was strongly associated with scope of practice variables including performance of certain office procedures as well as prenatal and/or obstetrical care. Implications: These data provide a baseline from which to analyze change in IUD and implant provision in family medicine, identify gaps in care and ascertain potential leverage points for interventions to increase long-acting reversible contraceptive provision by family physicians. Interventions may be more successful if they first focus on sites and/or family physicians who already provide prenatal care, obstetrical care, skin procedures and/or endometrial biopsies.

AB - Objective: Establish a current cross-sectional national picture of intrauterinedevice (IUD) and implant provision by US family physicians and ascertain individual, clinical site and scope of practice level associations with provision. Study design: Secondary analysis of data from 2329 family physicians recertifying with the American Board of Family Medicine in 2014. Results: Overall, 19.7% of respondents regularly inserted IUDs, and 11.3% regularly inserted and/or removed implants. Family physicians provided these services in a wide range of clinical settings. In bivariate analysis, almost all of the individual, clinical site and scope of practice characteristics we examined were associated with provision of both methods. In multivariate analysis, the scope of practice characteristics showed the strongest association with both IUD and implant provision. For IUDs, this included providing prenatal care with [adjusted odds ratio (aOR) 3.26, 95% confidence interval (95% CI)=.1.93-5.49] or without (aOR = 3.38, 95% CI = 1.88-6.06) delivery, performance of endometrial biopsies (aOR = 16.51, 95% CI = 11.97-22.79) and implant insertion and removal (aOR = 8.78, 95% CI = 5.79-13.33). For implants, it was providing prenatal care and delivery (aOR = 1.77, 95% CI = 1.15-2.74), office skin procedures (aOR = 3.07, 95% CI = 1.47-6.42), endometrial biopsies (aOR = 3.67, 95% CI = 2.41-5.59) and IUD insertion (aOR = 8.58, 95% CI = 5.70-12.91). Conclusions: While a minority of family physicians regularly provided IUDs and/or implants, those who provided did so in a broad range of outpatient settings. Individual and clinical site characteristics were not largely predictive of provision. This connotes potential for family physicians to increase IUD and implant access in a variety of settings. Provision of both methods was strongly associated with scope of practice variables including performance of certain office procedures as well as prenatal and/or obstetrical care. Implications: These data provide a baseline from which to analyze change in IUD and implant provision in family medicine, identify gaps in care and ascertain potential leverage points for interventions to increase long-acting reversible contraceptive provision by family physicians. Interventions may be more successful if they first focus on sites and/or family physicians who already provide prenatal care, obstetrical care, skin procedures and/or endometrial biopsies.

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KW - Intrauterine contraceptive device

KW - IUD

KW - LARC

KW - Long-acting reversible contraception

KW - Primary care

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