Original research articleEmergency contraception: prescribing practices of general internists compared with other primary care physicians
Introduction
Widespread availability of emergency contraception (EC) could have a tremendous impact in reducing the number of unintended pregnancies and abortions in this country [1]. EC pills, which are combined estrogen-progestin pills or progestin-only pills, are safe and effective for preventing unintended pregnancies. They are more effective when taken as soon as possible after unprotected intercourse. Therefore, it is critical that a woman seeking EC be able to obtain a physician's attention as soon as possible. Obtaining medication can be delayed if the physician is unfamiliar with how to properly evaluate the patient, unable to provide appropriate counseling or uncertain how to prescribe the method.
In order for EC to be accessible, primary care physicians of all specialties need to be familiar with this method. In a 1997 survey, the Kaiser Family Foundation reported that 85% of obstetrician-gynecologists and 50% of family physicians had prescribed EC at least once in the preceding year [2]. Other studies have further characterized the EC prescribing practices of obstetrician-gynecologists, pediatricians, adolescent health specialists and family physicians [2], [3], [4], [5], [6], [7], [8]. Although internal medicine physicians provide primary care for a significant proportion of reproductive-age women [9], little is known about their EC prescribing practices. We sought to compare the EC prescribing practices of general internists with those of other primary care providers of reproductive-age women.
Section snippets
Study subjects
Approval for this study was obtained from the Institutional Review Board for Human Research at the Boston University Medical Center. Board-certified physicians in internal medicine, family medicine and obstetrics-gynecology were identified from the Folio's of Massachusetts Database, a listing of registered physicians in Massachusetts. We retained only physicians who were currently practicing in Massachusetts, not currently in training and not listed as subspecialists. We randomly sampled 200
Results
Of the 600 physicians who were mailed the survey, 55 replied that they were no longer practicing in Massachusetts and 33 questionnaires were returned because of incorrect addresses, leaving 512 subjects eligible for the study. Three-hundred completed surveys were returned for a response rate of 59%. We then excluded 16 respondents because they were either subspecialists or did not indicate their specialty. Another two physicians were excluded because they did not answer the question on EC. The
Discussion
Although general internists provide over 20% of all nonobstetric outpatient care to women of reproductive age [9], their EC prescribing practices have not been described previously. In this anonymous, self-administered survey, general internists were significantly less likely to report ever prescribing EC than family physicians and obstetrician-gynecologists. This finding persisted when controlling for other potential predictors of prescribing EC.
Strengths of this study were the use of a random
References (9)
- et al.
Changes in providers' views and practices about emergency contraception with education
Obstet Gynecol
(2001) - et al.
The effectiveness of postcoital hormonal contraception
Fam Plann Perspect
(1992) - et al.
Are we making progress with emergency contraception? Recent findings on American adults and health professionals
J Am Med Womens Assoc
(1998) - et al.
Emergency contraceptiona national survey of adolescent health experts
Fam Plann Perspect
(1997)
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Professional Right of Conscience
2008, Journal of Midwifery and Women's HealthCitation Excerpt :About half changed their opinions after learning that EC was not the same as medication abortion, but five nurses resigned. In a preintervention study of physicians' prescribing behaviors, Chuang et al.16 reported low rates of EC provision by internists, family physicians, and obstetrician/gynecologists. Recent data are available from a large study of physicians' opinions on the necessity of providing full information and referral for services that a physician is unwilling to provide.17
Assessment of urgent and ongoing contraceptive needs in an OB/GYN urgent care setting
2007, ContraceptionCitation Excerpt :Women continue to face significant barriers accessing emergency contraception (EC). Obtaining prescriptions promptly in time of need can be challenging [1,2]. Having pharmacies willing to fill prescriptions often may not be possible [3].
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