Same-Day Insertion Might Boost IUD Use

By Will Boggs MD

March 27, 2014

NEW YORK (Reuters Health) - Most OB-GYNs do not offer same-day IUD insertion or contraceptive implants, according to a survey of American College of Obstetricians and Gynecologists (ACOG) Fellows.

However, those who do perform IUD insertion in a single visit reported inserting a greater number of IUDs in the last year, leading researchers to conclude that barriers to use of long-acting reversible contraception "could be reduced if more obstetrician-gynecologists . . . provided same-day IUD insertion."

Implant education would also be helpful, they say.

"Based on the results of our survey, it is clear that increased ob-gyn education and training about long-acting reversible contraception leads to increased provision of long-acting reversible contraception (LARC)," Dr. Eve Espey from University of New Mexico in Albuquerque told Reuters Health. "Cost and reimbursement issues also hinder both the provision and uptake of LARC methods, as IUDs and implants have the highest up-front costs of all reversible contraceptive methods."

"These upfront costs can both be prohibitive for patients and can limit the ability of physician offices to stock adequate supply," Dr. Espey said. "That's why ACOG supports efforts to lower the upfront costs, to increase coverage of LARC methods, and to improve appropriate reimbursement for device costs and payment for physician services."

The copper and levonorgestrel IUDs and single-rod contraceptive implants (i.e., long-acting reversible contraception (LARC)) are the most effective reversible contraceptive methods, but fewer than 8% of women using a contraceptive use an IUD and fewer than 1% use an implant.

Reasoning that the availability of trained clinicians and their willingness to provide LARCs are prerequisites to increased use, Dr. Espey and colleagues sought to determine obstetrician-gynecologists' practice related to LARC. They also examined training in, knowledge of, and beliefs about LARC methods.

The researchers sent eight-page surveys to 3000 Fellows and Junior Fellows of ACOG, of which 1552 (51.7%) were returned.

After exclusion of returned surveys from those who did not indicate obstetrics and gynecology as their primary specialty, there were 1221 surveys in the final sample.

The vast majority of respondents provided hormonal IUD (91.8%) and/or copper IUD (87.8%), but only 51.3% provided the single-rod implant, according to a report online February 19th in Contraception.

Among OB-GYNs who insert IUDs, only 7% provide postpartum IUD insertion and 10.9% provide immediate post-abortion or post-miscarriage IUD insertion.

Only 13.3% offered same-day IUD insertion, and most (77.3%) indicated that two visits were typically required. Respondents who offered same-day IUD insertion provided more IUDs in the last year (54 vs 40; p<.001).

Respondents also inserted more IUDs in the past year if they were younger, had inserted more IUDs during residency training, had more patient visits per week, also inserted contraceptive implants, and considered unintended pregnancy a serious problem in their practice.

Only 60.5% of respondents who provided the single-rod implant reported insertion of any implants within the past year, and the average number of implants in the last year was only 8.1.

Respondents were more likely to have inserted implants in the past year if they had continuing education concerning implants in the past two years, if they believed that unintended pregnancy is a serious problem in their practice, and if they had inserted more implants during residency. A belief that the implant is more likely than other contraceptive methods to lead to a lawsuit was a significant deterrent to implant insertion.

"We recognize that different women have different needs, and patient choice should be the principal factor in prescribing one method of contraception over another," Dr. Espey said. "However, because LARC methods are the most effective reversible contraceptives, are safe and appropriate for most women, and have the highest rates of continuation and satisfaction, the College has recommended that LARC be offered as first-line contraceptive methods and encouraged as options for most women. The major advantage of LARCs compared with other reversible contraceptive methods is that they do not require ongoing effort on the part of the user for long-term and effective use."

"LARC methods are the most effective reversible contraceptives and are safe and appropriate options for most women," Dr. Espey concluded. "By taking steps to help increase women's adoption of LARC, for example by routinely offering these methods and by including LARC in our continuing education activities, we have the opportunity to provide women with a wider range of options for enhanced reproductive life planning."


Contraception 2014.


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