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The Impact of Years of Experience on Perceived Contraindications and Barriers to the Use of LARC

The Impact of Years of Experience on Perceived Contraindications and Barriers to the Use of LARC. Ashley Philliber, Heather Hirsch, Louis Mortillaro, Rita Turner and Susan Philliber Philliber Research Associates. 16 Main Street Accord, NY 12404 845-626-2126 Fax 845-626-3206.

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The Impact of Years of Experience on Perceived Contraindications and Barriers to the Use of LARC

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  1. The Impact of Years of Experience on Perceived Contraindications and Barriers to the Use of LARC Ashley Philliber, Heather Hirsch, Louis Mortillaro, Rita Turner and Susan Philliber Philliber Research Associates 16 Main Street Accord, NY 12404 845-626-2126 Fax 845-626-3206

  2. Presenter Disclosures Ashley Philliber No relationships to disclose The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

  3. The Famous Dalkon Shield® --maternal deaths --PID --recalls and bankruptcy --lawsuits --withdrawal from the market • Norplant ® --also withdrawn from the market Historical Events and LARC

  4. Not enough training • Provider discomfort • Fear of litigation Other potential barriers

  5. Colorado and Iowa • Title X clinics mostly • Part of a larger evaluation • Analysis by years since licensure Sample of 95 Providers, 2012

  6. 1-9 years N = 35 • 10-19 years N = 35 • 20+ years N = 25 We examined patterns and significance around: training, comfort, perceptions of barriers for various groups of women Years Since Licensure

  7. Clinical Training by Years as a Licensed Practitioner Training by Years as Practitioner * p < .05

  8. Comfort Level by Years as a Licensed Practitioner Comfort Level

  9. Other concerns

  10. Other concerns

  11. Other concerns

  12. Diabetes • Obesity • Smokers • Those with history of hypertension • Young adults aged 20-29 • Women at or below poverty levels • Unmarried women • Nulliparous women Clinicians almost unanimous in thinking methods suitable and safe for--

  13. Teenagers and • Women with fibroids Implanon®judged suitable and safe for--

  14. Immediate post partum • Immediate post abortion • History of ectopic pregnancy • History of PID • Menorrhagia • Dysmenorrhea • Iron deficiency anemia • History infertility Some groups on which there is disagreement

  15. For ParaGard® * p < .05

  16. For Mirena® * p < .01

  17. For Implanon®

  18. On 64% of these comparisons by years since licensure, across ParaGard®, Mirena®and Implanon® : --those with licenses for the longest period of time were the least likely to believe these methods were suitable and safe for various groups of women So overall--

  19. Those with longer licensure were significantly less sure about the suitability and safety of-- --ParaGard® and Mirena® for women with a history of ectopic pregnancy --ParaGard® for women with dysmenorrhea Overall--

  20. The clinicians with only 1-9 years as licensed practitioners were significantly less likely to believe ParaGard® and Mirena® were suitable and safe for— -- immediate post abortion insertion. Overall--

  21. There are differences by years of licensure --for 13 of 20 subgroups of women, those licensed for the greatest number of years showed the lowest approval for ParaGard® --for 11 of 20 groups, these older clinicians were least likely to approve Mirena® --They were not so disapproving of Implanon® Across the three methods-

  22. --clinicians are not unanimous on best practice in dispensing these methods • --clinicians may have different views depending on their years in practice on who the best candidates are for LARC • --the mixed histories of these methods in earlier decades may have left a legacy of distrust It would appear that women seeking LARC should be aware that

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