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

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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%). - PowerPoint PPT Presentation
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Britt Lunde, MD MPH The Mount Sinai School of Medicine
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Page 1: Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI

Britt Lunde, MD MPHThe Mount Sinai School of Medicine

Page 2: Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI

Goal: increase proportion of intended pregnancies by 10%

(from 51% to 56%)

www.healthypeople.gov/2020

Page 3: Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI

Finer, 2011

Page 4: Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI

• For Women• Adequate Prenatal care• Smoking• Domestic violence• Depression

• And babies • Birth defects• Birth weight• Childhood health• Educational attainment

CDC MMWR 2007Cheng, Contracept 2009Logan, Child Trends 2007

Page 5: Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI

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Page 6: Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI

• 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 2007Cope, J Gen Inter Med 2006Rosenblatt, Am J Public Health 1995

Page 7: Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI
Page 8: Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI

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

Page 9: Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI

• 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

Page 10: Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI

• Physicians have low response rates• Web surveys have low response rates• Survey literature on mixed-mode:

Kellerman, Am J Prev Med, 2001Millar M, Public Opinion Quarterly, 2011

Mode 1st response

2nd response

Final response

Web 42.3% 7.8% 50.2%

Mail 51.3 1.9 53.2

Choice 47.7 4.6 52.3

Page 11: Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI

Web(n = 538)

Paper(n = 324)

Total(n = 862)

Response rate, % 23.3 14.0 37.3

Age, years ±SD* 46.8 ±10.5 50.9 ±11.2 48.3 ±11.0

Insert IUDs, %* 38.7 27.9 34.6

Insert Implant, %*

10.8 5.4 8.7

Interview, %* 22.7 2.2 15.1

Gender, specialty no significant difference

* p<0.05

Page 12: Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI

All respondents

Place IUDs Adjusted OR

Total sample n=599

34.6

Female (%)Male

34.264.8

50.726.1

2.2 (1.3 – 3.7)ref

Age, mean ±SD 48.3 ±11.0 45.8 ± 10.6 ns

Family Medicine (%)Internal Medicine

80.616.9

42.21.8

4.0 (0.8 – 20.2)ref

Practice Ob (%) 28.3 72.5 7.4 (4.3 – 12.7)

Training post residency (%) in residency

8.250.9

69.455.7

2.1 (1.0 – 4.5)ref

Page 13: Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI

All respondents

Place Implant Adjusted OR

Total sample n=599 8.7

Female (%)Male

34.264.8

14.15.8

1.7 (0.5 – 5.4)ref

Age(mean ± SD)

48.3 ±10.9 43.8 ±10.2 2.3 (1.3 – 4.3)/10 years ↓

Family Medicine (%)Internal Medicine

80.616.9

10.30.9

2.6 (0.2 – 34.4)ref

Practice Ob (%) 28.5 19.9 9.8 (2.8 – 34.3)

Training post residency (%) in residency

9.43.7

71.439.1

9.2 (2.0 – 42.7)ref

Page 14: Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI

Family Medicine(n=483)

Internal Medicine

(101)

Eligible Response rate, %*

29.7 20.9

% female physicians* 36.4 23.8

Prescribe OCPs in practice, %*

93.4 59.4

Referral for IUD, %* Primary care MD Gynecologist

25.557.9

6.177.8

Distance to referral, % in same office <25 miles

49.838.6

57.336.7

* p<0.05

Page 15: Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI

% of Physicians

*=p <0.05

Page 16: Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI

Distance, miles*=p<0.05

Page 17: Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI

• More likely to provide LARC• Female• Practice OB• Training post-residency

• Providers’ perceived barriers• Patient interest and knowledge• Not physician’s practice pattern

Page 18: Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI

Thank you!

Page 19: Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI

• 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.

Page 20: Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI

Method Rural (%) Urban (%)

Sterilization Female Male

47.29.6

35.68.8

IUDImplant

5.00.3

4.90.3

Oral contraceptivesInjectable

24.34.0

24.53.0

Condoms 9.3 15.9

Withdrawal 3.8 4.8

None 8.2 11.8

Page 21: Provision of Long Acting Reversible Contraception by Rural Primary Care Physicians in IL and WI

Adjusted OR

Rural no hs degreeRural hs degreeUrban no hs degreeUrban hs degreeRural and urban, >hs degree

7.9 (4.3 – 14.5)3.4 (2.0 – 5.8)2.0 (1.3 – 3.0)1.8 (1.2 – 2.8)ref

Income <100% of FPL 100-199% ≥200%

1.8 (1.0 – 3.0)1.5 (1.0 – 2.3)ref

Insurance Public None Private

0.8 (0.5 – 1.2)0.8 (0.5 – 1.2)ref

Adjusted for age, parity, relationship status


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