Emergency contraception: an intervention on primary care providers

Abstract

Objective

We studied whether a single educational intervention can change provider knowledge, attitudes and practice patterns with respect to emergency contraception (EC).

Materials and Methods

Primary care providers completed a preintervention survey prior to attending a lecture on EC, and again 6 months later. There were 50 physicians, 4 advanced practice nurses and 2 physician assistants in the final sample (internal medicine 48%, family medicine 34%, obstetrics-gynecology 9%, and pediatrics/adolescent medicine 9%).

Results

Following the intervention, providers were more likely to agree that advance prescriptions should be given, disagree that the number of times EC is dispensed should be restricted and disagree that repeated EC use poses health risks. The proportion of providers who had ever given an advance prescription increased from 18% to 41% (p=.007), and there was a trend toward a greater proportion of providers initiating counseling about EC from 36% to 54% (p=.057).

Conclusions

A simple educational intervention was associated with a change in primary care provider attitudes and practice patterns regarding EC.

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.