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Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI

Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI. Britt Lunde, MD MPH The Mount Sinai School of Medicine. Importance of Effective Contraception. Goal: increase proportion of intended pregnancies by 10% (from 51% to 56%).

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Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI

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  1. Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI Britt Lunde, MD MPH The Mount Sinai School of Medicine

  2. Importance of Effective Contraception Goal: increase proportion of intended pregnancies by 10% (from 51% to 56%) www.healthypeople.gov/2020

  3. Unintended Pregnancy in the US Finer, 2011

  4. Intended Pregnancies are Healthier… • For Women • Adequate Prenatal care • Smoking • Domestic violence • Depression • And babies • Birth defects • Birth weight • Childhood health • Educational attainment CDC MMWR 2007 Cheng, Contracept 2009 Logan, Child Trends 2007

  5. Why Long Acting Reversible Contraception? Pregnancy rate in first year of use

  6. Rural Areas:Decreased Access to Long Acting Reversible Contraception (LARC)? • Majority of rural physicians practice primary care • IUD provision associated with gynecologist on site • Patient recommendations vary by specialty • 1995 rural Idaho majority providing LARC COGME 18th Report, Sept 2007 Cope, J Gen Inter Med 2006 Rosenblatt, Am J Public Health 1995

  7. Rural Women’s Access to Care

  8. Study Objectives • Rural Primary Care Physicians • Current provision of LARC • Perceived barriers to provision • Opportunities for further support and education

  9. Methods • Cross sectional survey of physicians • Family Medicine and Internal Medicine • RUCA code ≥4 for practice zip code in IL and WI • Development of survey • WI Research and Education Network • UIC Survey Research Lab • Pilot interviews with rural physicians

  10. Web vs. Mail Survey • Physicians have low response rates • Web surveys have low response rates • Survey literature on mixed-mode: Kellerman, Am J Prev Med, 2001 Millar M, Public Opinion Quarterly, 2011

  11. Response Rates and Characteristics * p<0.05 Gender, specialty no significant difference

  12. Predictors of Placement - IUDs

  13. Predictors of Placement – Contraceptive Implant

  14. Comparing Family Medicine and Internal Medicine Physicians * p<0.05

  15. Perceived Barriers“I can’t get the company to arrange a training nearby” *=p <0.05 % of Physicians

  16. Referral Patterns Distance, miles *=p<0.05

  17. Conclusions and Next Steps • More likely to provide LARC • Female • Practice OB • Training post-residency • Providers’ perceived barriers • Patient interest and knowledge • Not physician’s practice pattern

  18. Provision of Long Acting Reversible Contraception by Rural Primary Care Providers in Illinois and Wisconsinbritt.lunde@mssm.edu Thank you!

  19. References • Centers for Disease Control and Prevention. Preconception and interconception health status of women who recently gave birth to a live-born infant—pregnancy risk assessment monitoring system (PRAMS), United States, 26 Reporting Areas, 2004. MMWR Weekly. 2007 Dec 14;56(SS-10):1-40. • Cheng D, Schwarz E, Douglas E, Horon I. Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors. Contracept 2009;79(3):194-8. • Cope JR, Yano EM, Lee ML, Washington Dl. Determinants of contraceptive availability at medical facilities in the Department of Veterans Affairs. J Gen Intern Med. 2006 Mar;21 Suppl 3:S33-9. • Council on Graduate Medical Education (COGME). Eighteenth report: new paradigms for physician training and improving access to health care. September 2007. • Finer LB and Zolna MR. Unintended pregnancy in the United States: incidence and disparities. Contracept 2011; 84(5):478–85. • Kellerman SE, Herold J. Physician response to surveys; a review of the literature. Am J Prev Med 2001;20(1):61-67. • Logan C, Holcombe E, Manlove J, et al. The consequences of unintended childbearing: A white paper [Internet]. Washington: Child Trends, Inc.; 2007 May. • Millar M and Dillman D. Improving response to web and mixed-mode surveys. Public Opinion Quarterly 2011;75(2):249-269. • Rosenblatt R, Mattis R, and Hart LG. Abortions in rural Idaho: physicians’ attitudes and practices. Am J Public Health 1995;85:1423-5.

  20. Method Use 2006-10 NSFG

  21. Adjusted OR of Sterilization Adjusted for age, parity, relationship status

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