Translating evidence to clinical practice: The provision of intrauterine contraception in California

Intrauterine contraception (IUC) is used by many women worldwide, from 25% in Europe to 35% in other regions. In the U.S., use is 2%, and in California, where it is available at no cost from the state family planning program, only 1.3% of female clients obtain IUCs. This study hypothesized that clinician awareness about current guidelines and devices increases IUC use. We conducted a mail survey among physicians and midlevel providers (n=1,246) serving 100 or more contraceptive clients per year in the California Family PACT program. The response rate was 65% (n=816). We used multivariate logistic regression analysis to measure the association of knowledge with clinical practice. Only 60% of contraceptive providers offered IUCs and 36% rarely gave counseling, although 92% thought their clients were receptive to learning about the method. Multivariate results showed younger clinicians were more likely to offer insertions, and those who received training in residency (OR 1.9***). Only half of clinicians, in accordance with current evidence, considered nulliparous and post-abortion women as appropriate IUC candidates; evidence-based views were associated with more counseling (OR=2.3***) and insertions (OR 1.8***). Accurate knowledge was also associated with counseling (OR 1.9***) and insertions (OR 3.4***), although over 20% attributed hormonal side effects, including headaches and acne, to ParaGard, a non-hormonal method. Prescribing practices reflected erroneous beliefs that IUCs have limited use and are for a small segment of contraceptive clients. Results show the need for provider training on updated IUC insertion guidelines and on important differences between hormonal and non-hormonal devices.