265024 A Culture of Change: Clinicians' experiences and barriers to Long-Acting and Reversible Contraception (LARC) provision in two states

Monday, October 29, 2012

M. Antonia Biggs, PhD , Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA
Abigail Arons, MPH , Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA
Claire Brindis, DrPH , Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA
Despite a wide range of available contraceptive options, unintended pregnancy rates remain high. Starting in 2007, 48 family planning agencies in Colorado (n=31) and Iowa (n=17) received funding to reduce unintended pregnancies by increasing provision of long-acting and reversible contraception (LARC). We surveyed 159 clinicians working at these clinics regarding their provision of LARC services. Three years into their funding cycle, although all agencies increased the capacity of their clinicians to insert LARC , a significant minority of clinicians had not been trained to insert IUDs (20%) or Implanon (30%). Most clinicians felt comfortable inserting LARC (74% for ParaGard, 73% for Mirena, 70% for Implanon) and this did not differ significantly by age or number of years as a licensed practitioner. However, comfort varied by provider type; Physician Assistants (45%) were less comfortable inserting LARCs than physicians (83%) or Certified Nurse Midwives (100%). While clinicians report that this funding has enabled them to reduce barriers to providing LARC, including the cost to the patient (57%), the cost of the devices and stocking issues (42%), and the need to refer the patient for such services (16%), they still perceived barriers related to lack of training (28% to 37%), low patient interest (28% to 38%), and cost to patients (34% to 35%). Over half of clinicians felt that ParaGard (56%), Mirena (52%), and Implanon (56%) are underused by their patients. Thus, while dedicated funding has helped to remove barriers to LARC provision among clinicians, many challenges persist.

Learning Areas:
Public health or related research

Learning Objectives:
1. To describe clinician’s LARC delivery practices in Colorado and Iowa. 2. To list the barriers clinicians experience delivering LARC services. 3. To describe how clinician characteristics influence LARC delivery practices.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a senior researcher at the Bixby Center for Global Reproductive Health at the University of California, San Francisco. As a researcher for the Colorado and Iowa Initiatives to Reduce Unintended Pregnancy, I analyzed the data included in this abstract. I hold a B.A. in Psychology from the University of Wisconsin and an M.A. and Ph.D. in Psychology from Boston University.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3292.0: PRSH Posters: Family Planning