copper intrauterine device for emergency contraception
TRANSCRIPT
-
8/12/2019 Copper Intrauterine Device for Emergency Contraception
1/23
-
8/12/2019 Copper Intrauterine Device for Emergency Contraception
2/23
The copper-releasing intrauterine device(IUD) can be used safely for emergency
contraception up to 5 days afterunprotected intercourse
The copper IUD not only confers greater
protection from the one act of unprotectedintercourse, but also offers protection for at
least 10 years.9
Surveys of women seeking emergencycontraception or pregnancy testing have
shown that more than 10% would accept acopper IUD.12,13
-
8/12/2019 Copper Intrauterine Device for Emergency Contraception
3/23
Although offering the copper IUD for emergencycontraception is still an innovative approach in the
United States, there are some contraceptiveproviders who do make it available to their patients.
This study assessed clinicians professional training,skills, knowledge, and practices to identify factors
that were associated with having recommended thecopper IUD for emergency contraception.
-
8/12/2019 Copper Intrauterine Device for Emergency Contraception
4/23
We conducted a survey among clinicians (n1,246;response rate 65%) in a California State familyplanning program, where U.S. Food and DrugAdministration- approved contraceptives are
available at no cost to low-income women.
The survey included in the sample all cliniciansserving 100 or more female contraceptive patientsper year; a self-administered written survey was
sent to 1,246 clinicians, identified by unique studyidentification numbers.
-
8/12/2019 Copper Intrauterine Device for Emergency Contraception
5/23
this analysis using logistic regression toassess the recommendation of the copper
IUD for emergency contraception
An information letter was sent, and then 2
weeks later the survey was mailed with acover letter. A reminder postcard was sentlater that week, and another survey wassent to nonrespondents after 4 weeks.
-
8/12/2019 Copper Intrauterine Device for Emergency Contraception
6/23
We asked clinicians whether the followingwomen were suitable candidates:
Nulliparous
immediate postpartum
immediate postabortion
Adolescents
history of ectopic pregnancy
sexually transmitted disease in past 2 years
pelvic inflammatory disease in past 5 years,
-
8/12/2019 Copper Intrauterine Device for Emergency Contraception
7/23
We asked clinicians whether the followingwomen were suitable candidates:
pelvic inflammatory disease in past 5 years
current bacterial vaginosis
human immunodeficiency virus positivity
-
8/12/2019 Copper Intrauterine Device for Emergency Contraception
8/23
The outcome variable we
assessed was clinicianrecommendation of the copper
IUD for emergency
contraception to patients
-
8/12/2019 Copper Intrauterine Device for Emergency Contraception
9/23
The majority of contraceptive providers (85%)reported that they had never recommended the
copper IUD for emergency contraception
A total of 15% of clinicians had recommended the
IUD for emergency contraception: 13% hadrecommended the method one to 10 times, andonly 1.7% had recommended the method more
than 10 times.
-
8/12/2019 Copper Intrauterine Device for Emergency Contraception
10/23
Table 1. Clinician Recommendation of the Copper Intrauterine Device for
Emergency Contraception (n=788)
-
8/12/2019 Copper Intrauterine Device for Emergency Contraception
11/23
Table 1. Clinician Recommendation of the Copper Intrauterine Device for
Emergency Contraception (n=788)
-
8/12/2019 Copper Intrauterine Device for Emergency Contraception
12/23
Multivariable analyses showed insertion skills
were associated with having recommended the
copper IUD for emergency contraception, but the
most significant factor was evidence-based
knowledge of patient selection for IUD use.
-
8/12/2019 Copper Intrauterine Device for Emergency Contraception
13/23
Table 2. Copper Intrauterine Device for Emergency Contraception Recommended
by Clinician: Multivariable Logistic Regression Results (Odds Ratios)
-
8/12/2019 Copper Intrauterine Device for Emergency Contraception
14/23
Clinicians who viewed a wide range
of patients as IUD candidates were
twice as likely to have recommended
the copper IUD for emergency
contraception.
-
8/12/2019 Copper Intrauterine Device for Emergency Contraception
15/23
Although more than 93% of
obstetriciangynecologists were
skilled in inserting the copper IUD,
they were no more likely to have
recommended it for emergencycontraception than other physicians
or advance practice clinicians.
-
8/12/2019 Copper Intrauterine Device for Emergency Contraception
16/23
These data showed that contraceptive providersinfrequently recommend the copper IUD foremergency contraception to their patients.
certain factors shown to be associated with provisionof the most effective reversible contraceptives inprevious research, including younger age, training asa physician, training during residency or core training,
a specialty in obstetrics-gynecology or womenshealth or both, high contraceptive patient volume, ahigh level of knowledge of method attributes and sideeffects, and an expansive view of intrauterinecontraception candidates
-
8/12/2019 Copper Intrauterine Device for Emergency Contraception
17/23
The ob-gyns, who were the clinicians with thehighest skill levels in contraception, were not any
more likely than other clinicians to haverecommended the copper IUD as emergencycontraception, despite their extensive training in
copper IUD insertions
These results indicate a need to emphasize theuse of the copper IUD for emergencycontraception in clinician training and education
-
8/12/2019 Copper Intrauterine Device for Emergency Contraception
18/23
Skill levels inserting thecopper IUD were
important for both generalprovision and for the
purposes of emergency
contraception
One of the most importantelements to include ineducational efforts for
clinicians, including those
in the obstetrics-gynecology specialty,
would be an emphasis onthe wider range of
candidates who qualify for
use of intrauterinecontraception according to
the Centers for DiseaseControl medical eligibility
criteria
-
8/12/2019 Copper Intrauterine Device for Emergency Contraception
19/23
Limitation
the providers were asked whether theyrecommended the copper IUD for emergency
contraception.
-
8/12/2019 Copper Intrauterine Device for Emergency Contraception
20/23
Limitation
the providers were asked whether theyrecommended the copper IUD for emergency
contraception.
-
8/12/2019 Copper Intrauterine Device for Emergency Contraception
21/23
These data showed important missed
opportunities among contraceptive
providers, including highly trained ob-gyns,
for offering women at risk for unintended
pregnancy the most effective method
available for emergency contraception, the
copper IUD.
-
8/12/2019 Copper Intrauterine Device for Emergency Contraception
22/23
An emphasis during clinician training on the use
of the copper IUD for emergency contraception
may help to address high unintended pregnancy
rates. The study also showed the relevance of updating
contraceptive providers on the evidence and
more expansive current criteria for intrauterine
contraception candidates as set out by Centersfor Disease Control medical eligibility criteria.
-
8/12/2019 Copper Intrauterine Device for Emergency Contraception
23/23