Emergency contraception: A multispecialty survey of clinician knowledge and practices

Abstract

Objectives To assess knowledge and provision of emergency contraception (EC), particularly the most effective methods. Study Design A web-based survey was distributed to a cross-sectional convenience sample of healthcare providers across specialties treating reproductive-aged women. The survey was sent to 3,260 practicing physicians and advanced practice clinicians in 14 academic centers between February 2013 and April 2014. We analyzed responses by provider specialty using multivariable logistic regression. Results The final sample included 1,684 providers (response rate = 51.7%). Ninety-five percent of the respondents had heard of levonorgestrel (LNG) EC. Among reproductive health specialists, 81% provide levonorgestrel EC in their practice, although only half (52%) had heard of ulipristal acetate (UPA) and very few provide it (14%). The majority in family medicine (69%) and emergency medicine (74%) provide levonorgestrel, in contrast to 42% of internists and 55% of pediatricians. However, the more effective methods (UPA and copper IUD) were little known and rarely provided outside of reproductive health specialties; 18% of internists and 14% of emergency medicine providers had heard of UPA and 4% provide it. Only 22% of emergency providers and 32% of pediatricians had heard of the copper IUD used as EC. Among reproductive health specialists, only 36% provide copper IUD as EC in their practice. Specialty, provider type and proportion of women of reproductive age in the practice were related to knowledge and provision of some forms of EC. Conclusions Awareness and provision of the most effective EC methods, UPA and the copper IUD (which are provider-dependent), are substantially lower than for LNG EC, especially among providers who do not focus on reproductive health. Implications In our sample of 1,684 healthcare providers from diverse specialties who treat reproductive-aged women, knowledge and provision of the most effective forms of emergency contraception (ulipristal acetate and the copper IUD) are far lower than for levonorgestrel EC. Women should be offered the full range of EC methods.

Introducing a “same day referral” program for post-coital IUD insertion in Ontario: A mixed-methods study with pharmacists

“…Although pharmacists in both components of our study had relatively limited knowledge of the IUD as EC, a finding that is consistent with other studies of health professionals in North America [25], our participants expressed considerable interest in participating in such an initiative. Importantly, pharmacists saw themselves as being well-positioned to offer these types of referrals and identified that this type of program would meet a demonstrable need.…”

“…Further, in recent years there has been a plethora of efforts in North America to expand access to long-acting, reversible contraception [21][22][23]. Misinformation among providers, a dearth of trained providers, high up-front costs, and lack of awareness among women have limited the availability and accessibility of IUDs, both as ongoing methods of contraception and as EC [24][25][26]. Yet research also suggests that when women are informed about the IUD as EC, demand increases [27].…”

Pharmacy access to ulipristal acetate in Hawaii: is a prescription enough?

“…Recently published data by Batur et al demonstrates near universal awareness of LNG ECP as an emergency contraception method amongst providers across specialties caring for women of reproductive age, while familiarity with UPA is at 50% for reproductive health providers and 15% for emergency medicine [8]. Increased education of clinicians, pharmacists and patients regarding the range of ECPs available and the important differences between them may assist in increasing demand for UPA, as well as motivation for prescribers to partner with pharmacies in navigating distribution and other systems-based barriers.…”

Access to Emergency Contraception in the Over-the-Counter Era

“…Although UPA is preferable in most situations because it is more effective than LNG (Glasier et al, 2010), UPA can be difficult to access. UPA EC is a prescription-only product, and awareness and provision of this option are low among healthcare providers (Batur et al, 2016). In addition, availability of UPA in pharmacies may be extremely limited: in a recent study of all pharmacies in Hawaii, only 2.6% had UPA immediately available, while 82.4% had LNG EC in stock (Bullock et al, 2015).…”