Original research articleEmergency contraception: an intervention on primary care providers
Introduction
Emergency contraceptive (EC) pills are combined estrogen-progestin pills or progestin-only pills that reduce the risk of pregnancy when taken after unprotected intercourse [1], [2]. In May 2004, the Food and Drug Administration (FDA) rejected a levonorgestrel EC product for over-the-counter status. As a prescription-only medication, access to EC will continue to be limited until health care providers are knowledgeable and comfortable with prescribing this method of contraception.
Since EC is more effective when taken as soon as possible after unprotected intercourse [2], [3], barriers that impede the timely administration of this method need to be minimized. The health care provider should be able to determine whether the patient is eligible for EC and prescribe it without delay. Since the primary care provider is often a patient's first access to the health care system, all primary care providers should be well informed about EC. Unfortunately, surveys of primary care providers in internal medicine, family medicine and adolescent medicine show that they are not prescribing this form of contraception often [4], [5], [6], [7], [8], [9], [10].
In addition to prescribing at the time of need, health care providers can give advance prescriptions for EC. This is the practice of providing prescriptions for EC to women of reproductive age in advance of need. By having a prescription on hand, a woman has more timely access to EC. Several studies have shown that advance provision of EC is effective in increasing the likelihood of its use in the event of unprotected intercourse without compromising regular contraceptive use [11], [12], [13], [14], [15], [16]. In an effort to increase the practice of providing advance prescriptions, the American College of Obstetricians and Gynecologists (ACOG) has encouraged its members to routinely provide advance prescriptions for EC during health maintenance visits [17]. However, it is not known how often advance prescribing is currently being practiced. A qualitative study of primary care providers suggests that physician misconceptions about EC lead to reluctance to provide advance prescriptions [18].
This study tests the effect of a very simple intervention that could be easily implemented and reach many health care providers. Health care providers frequently attend lectures for continuing medical education. Although passive group education has had mixed results in changing physician behavior [19], [20], we hypothesized that EC may be amenable to such an intervention since providing EC is simple and requires minimal training. This study was designed to evaluate the effect of a single educational intervention about EC on primary care providers.
Section snippets
Methods
The Boston Medical Center's Women's Health Unit sent letters to directors of continuing education programs at hospitals and health centers throughout Massachusetts offering a lecture program on EC designed for an audience of primary care providers. A brief description of the study was included in the letter. The lecture program was then scheduled at responding institutions between August and December 2002. The institutional review board at the Boston Medical Center approved this study.
Attendees
Results
Lectures were conducted for this study between August and December 2002 at seven hospital grand rounds. Of the 86 preintervention surveys collected, 5 respondents were not primary care providers (1 hospitalist and 4 subspecialists) and 1 respondent did not have women patients in his/her practice, leaving 80 surveys eligible for the preintervention analysis. Four providers did not give contact information, 3 had incorrect addresses and 1 person stated on the survey they were unable to stay for
Discussion
We found that a single educational lecture resulted in a greater proportion of providers who give advance prescriptions for EC, and a trend toward an increasing proportion who routinely counsel about EC. Attitudes about EC were also improved following the program. Baseline knowledge scores were high and remained high following the intervention. Adequate knowledge may therefore not be the main barrier to providing EC. Other barriers, such as attitudes and time constraints, may play a larger role.
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