Elsevier

Contraception

Volume 69, Issue 1, January 2004, Pages 43-45
Contraception

Original research article
Emergency contraception: prescribing practices of general internists compared with other primary care physicians

https://doi.org/10.1016/j.contraception.2003.09.003Get rights and content

Abstract

Primary care physicians of all specialties should be familiar with prescribing emergency contraception (EC). We conducted a mail survey of 282 randomly sampled physicians in general internal medicine (31%), family medicine (34%) and obstetrics-gynecology (35%). Experience with prescribing EC significantly differed by specialty (63% of general internists, 76% of family physicians, and 94% of obstetrician-gynecologists, p < 0.0001). Controlling for year of graduation, gender, religion and practice location, family physicians [adjusted odds ratio (OR): 2.5, 95% confidence interval (CI): 1.2–5.2] and obstetrician-gynecologists (adjusted OR: 11.2, 95% CI: 4.0–31.3) were still significantly more likely to have ever prescribed EC than general internists. Efforts to increase awareness and knowledge of EC should be aimed at general internists since they provide primary care for many reproductive age women.

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)

  • L.J. Beckman et al.

    Changes in providers' views and practices about emergency contraception with education

    Obstet Gynecol

    (2001)
  • J. Trussell et al.

    The effectiveness of postcoital hormonal contraception

    Fam Plann Perspect

    (1992)
  • S.F. Delbanco et al.

    Are we making progress with emergency contraception? Recent findings on American adults and health professionals

    J Am Med Womens Assoc

    (1998)
  • M.A. Gold et al.

    Emergency contraceptiona national survey of adolescent health experts

    Fam Plann Perspect

    (1997)
There are more references available in the full text version of this article.

Cited by (13)

  • Professional Right of Conscience

    2008, Journal of Midwifery and Women's Health
    Citation 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, Contraception
    Citation 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].

View all citing articles on Scopus
View full text