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Training contraceptive providers to offer intrauterine devices and implants in contraceptive care: a cluster randomized trial.
Am J Obstet Gynecol 2018; 218(6):597.e1-597.e7AJ

Abstract

BACKGROUND

US unintended pregnancy rates remain high, and contraceptive providers are not universally trained to offer intrauterine devices and implants to women who wish to use these methods.

OBJECTIVE

We sought to measure the impact of a provider training intervention on integration of intrauterine devices and implants into contraceptive care.

STUDY DESIGN

We measured the impact of a continuing medical education-accredited provider training intervention on provider attitudes, knowledge, and practices in a cluster randomized trial in 40 US health centers from 2011 through 2013. Twenty clinics were randomly assigned to the intervention arm; 20 offered routine care. Clinic staff participated in baseline and 1-year surveys assessing intrauterine device and implant knowledge, attitudes, and practices. We used a difference-in-differences approach to compare changes that occurred in the intervention sites to changes in the control sites 1 year later. Prespecified outcome measures included: knowledge of patient eligibility for intrauterine devices and implants; attitudes about method safety; and counseling practices. We used multivariable regression with generalized estimating equations to account for clustering by clinic to examine intervention effects on provider outcomes 1 year later.

RESULTS

Overall, we surveyed 576 clinic staff (314 intervention, 262 control) at baseline and/or 1-year follow-up. The change in proportion of providers who believed that the intrauterine device was safe was greater in intervention (60% at baseline to 76% at follow-up) than control sites (66% at both times) (adjusted odds ratio, 2.48; 95% confidence interval, 1.13-5.4). Likewise, for the implant, the proportion increased from 57-77% in intervention, compared to 61-65% in control sites (adjusted odds ratio, 2.57; 95% confidence interval, 1.44-4.59). The proportion of providers who believed they were experienced to counsel on intrauterine devices also increased in intervention (53-67%) and remained the same in control sites (60%) (adjusted odds ratio, 1.89; 95% confidence interval, 1.04-3.44), and for the implant increased more in intervention (41-62%) compared to control sites (48-50%) (adjusted odds ratio, 2.30; 95% confidence interval, 1.28-4.12). Knowledge scores of patient eligibility for intrauterine devices increased at intervention sites (from 0.77-0.86) 6% more over time compared to control sites (from 0.78-0.80) (adjusted coefficient, 0.058; 95% confidence interval, 0.003-0.113). Knowledge scores of eligibility for intrauterine device and implant use with common medical conditions increased 15% more in intervention (0.65-0.79) compared to control sites (0.67-0.66) (adjusted coefficient, 0.15; 95% confidence interval, 0.09-0.21). Routine discussion of intrauterine devices and implants by providers in intervention sites increased significantly, 71-87%, compared to in control sites, 76-82% (adjusted odds ratio, 1.97; 95% confidence interval, 1.02-3.80).

CONCLUSION

Professional guidelines encourage intrauterine device and implant competency for all contraceptive care providers. Integrating these methods into routine care is important for access. This replicable training intervention translating evidence into care had a sustained impact on provider attitudes, knowledge, and counseling practices, demonstrating significant changes in clinical care a full year after the training intervention.

Authors+Show Affiliations

Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA.Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA.Planned Parenthood Northern California, Concord, CA.Planned Parenthood Federation of America Inc., New York, NY.Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA.Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA.Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA. Electronic address: cynthia.harper@ucsf.edu.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29577915

Citation

Thompson, Kirsten M J., et al. "Training Contraceptive Providers to Offer Intrauterine Devices and Implants in Contraceptive Care: a Cluster Randomized Trial." American Journal of Obstetrics and Gynecology, vol. 218, no. 6, 2018, pp. 597.e1-597.e7.
Thompson KMJ, Rocca CH, Stern L, et al. Training contraceptive providers to offer intrauterine devices and implants in contraceptive care: a cluster randomized trial. Am J Obstet Gynecol. 2018;218(6):597.e1-597.e7.
Thompson, K. M. J., Rocca, C. H., Stern, L., Morfesis, J., Goodman, S., Steinauer, J., & Harper, C. C. (2018). Training contraceptive providers to offer intrauterine devices and implants in contraceptive care: a cluster randomized trial. American Journal of Obstetrics and Gynecology, 218(6), pp. 597.e1-597.e7. doi:10.1016/j.ajog.2018.03.016.
Thompson KMJ, et al. Training Contraceptive Providers to Offer Intrauterine Devices and Implants in Contraceptive Care: a Cluster Randomized Trial. Am J Obstet Gynecol. 2018;218(6):597.e1-597.e7. PubMed PMID: 29577915.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Training contraceptive providers to offer intrauterine devices and implants in contraceptive care: a cluster randomized trial. AU - Thompson,Kirsten M J, AU - Rocca,Corinne H, AU - Stern,Lisa, AU - Morfesis,Johanna, AU - Goodman,Suzan, AU - Steinauer,Jody, AU - Harper,Cynthia C, Y1 - 2018/03/23/ PY - 2017/12/13/received PY - 2018/03/06/revised PY - 2018/03/16/accepted PY - 2018/3/27/pubmed PY - 2019/5/21/medline PY - 2018/3/27/entrez KW - continuing education KW - contraception KW - contraceptive implant KW - intrauterine device KW - provider training intervention SP - 597.e1 EP - 597.e7 JF - American journal of obstetrics and gynecology JO - Am. J. Obstet. Gynecol. VL - 218 IS - 6 N2 - BACKGROUND: US unintended pregnancy rates remain high, and contraceptive providers are not universally trained to offer intrauterine devices and implants to women who wish to use these methods. OBJECTIVE: We sought to measure the impact of a provider training intervention on integration of intrauterine devices and implants into contraceptive care. STUDY DESIGN: We measured the impact of a continuing medical education-accredited provider training intervention on provider attitudes, knowledge, and practices in a cluster randomized trial in 40 US health centers from 2011 through 2013. Twenty clinics were randomly assigned to the intervention arm; 20 offered routine care. Clinic staff participated in baseline and 1-year surveys assessing intrauterine device and implant knowledge, attitudes, and practices. We used a difference-in-differences approach to compare changes that occurred in the intervention sites to changes in the control sites 1 year later. Prespecified outcome measures included: knowledge of patient eligibility for intrauterine devices and implants; attitudes about method safety; and counseling practices. We used multivariable regression with generalized estimating equations to account for clustering by clinic to examine intervention effects on provider outcomes 1 year later. RESULTS: Overall, we surveyed 576 clinic staff (314 intervention, 262 control) at baseline and/or 1-year follow-up. The change in proportion of providers who believed that the intrauterine device was safe was greater in intervention (60% at baseline to 76% at follow-up) than control sites (66% at both times) (adjusted odds ratio, 2.48; 95% confidence interval, 1.13-5.4). Likewise, for the implant, the proportion increased from 57-77% in intervention, compared to 61-65% in control sites (adjusted odds ratio, 2.57; 95% confidence interval, 1.44-4.59). The proportion of providers who believed they were experienced to counsel on intrauterine devices also increased in intervention (53-67%) and remained the same in control sites (60%) (adjusted odds ratio, 1.89; 95% confidence interval, 1.04-3.44), and for the implant increased more in intervention (41-62%) compared to control sites (48-50%) (adjusted odds ratio, 2.30; 95% confidence interval, 1.28-4.12). Knowledge scores of patient eligibility for intrauterine devices increased at intervention sites (from 0.77-0.86) 6% more over time compared to control sites (from 0.78-0.80) (adjusted coefficient, 0.058; 95% confidence interval, 0.003-0.113). Knowledge scores of eligibility for intrauterine device and implant use with common medical conditions increased 15% more in intervention (0.65-0.79) compared to control sites (0.67-0.66) (adjusted coefficient, 0.15; 95% confidence interval, 0.09-0.21). Routine discussion of intrauterine devices and implants by providers in intervention sites increased significantly, 71-87%, compared to in control sites, 76-82% (adjusted odds ratio, 1.97; 95% confidence interval, 1.02-3.80). CONCLUSION: Professional guidelines encourage intrauterine device and implant competency for all contraceptive care providers. Integrating these methods into routine care is important for access. This replicable training intervention translating evidence into care had a sustained impact on provider attitudes, knowledge, and counseling practices, demonstrating significant changes in clinical care a full year after the training intervention. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/29577915/Training_contraceptive_providers_to_offer_intrauterine_devices_and_implants_in_contraceptive_care:_a_cluster_randomized_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(18)30222-9 DB - PRIME DP - Unbound Medicine ER -