267678 Intrauterine contraception (IUC): Impact of provider training on candidate selection and method provision

Monday, October 29, 2012 : 9:00 AM - 9:20 AM

Carrie Lewis, MPH , Bixby Center for Global Reproductive Health, University of California, San Francisco, Sacramento, CA
Heike Thiel de Bocanegra, PhD, MPH , Academic Coordinator and Director, UCSF Family PACT Evaluation, University of California, San Francisco, Sacramento, CA
Philip Darney, MD, MSc , Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA
Intrauterine contraception (IUC) is a highly effective long-acting contraceptive method but utilization in the United States remains low. Reasons for low IUC utilization rates include lack of training on device insertion and prevalence of overly strict criteria defining appropriate candidates such as avoiding insertions to nulliparous or adolescent clients. From 2006/2007 to 2009/2010, the California Office of Family Planning offered nine IUC skills training sessions, including hands-on practica, to clinician providers enrolled in the state's Medicaid 1115 Family Planning Waiver program, Family PACT. A total of 249 Family PACT clinicians attended. The majority were physician-extenders (69%), practicing in public clinics (65%) as general primary care providers (67%), and were licensed an average of 17 years. We analyzed change on three dimensions: knowledge of appropriate candidate selection, overall IUC insertion rates before and after the training, and increase in IUC insertion rates to nulliparous and adolescent clients. Summary scores on the nine-item IUC Candidate knowledge scale changed from an average of 23.2 on the pretest to 26.3 on the posttest (p<0.05); Cronbach's alpha was 0.787 pretest and 0.753 on the posttest. Participants showed significant change in candidate knowledge for eight of the patient categories in our scale; mean change on the individual 5-point items ranged from 0.61 to 1.22; all p values <0.05. Provision of IUCs increased at sites where staff participated in training by an average of 13.4 insertions in the 6-month period following attendance (p<0.05). The provision of IUCs can be increased through skills-based IUC insertion training.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
Participants will be able to: 1. Explain current IUC insertion candidate selection guidelines 2. Identify three groups of family planning clients who are often overlooked as appropriate IUC candidates 3. Describe the impact that IUC method and insertion training for practicing clinicians can have on IUC knowledge and insertion rates

Keywords: Contraception, Family Planning

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have over 17 years of experience in health care services evaluation and research, including the last 5 years as senior evaluation manager on the UCSF evaluation contract for the Family PACT Program. My work has focused on women's health, family planning, and the delivery of health care funded through public and private insurance sources.
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.