Barriers and Facilitators of Extended Use of the Contraceptive Implant: A Cross-Sectional Survey of Clinicians.

Autor: Rigler N; School of Medicine, University of California San Diego, San Diego, California., Averbach S; Division of Complex Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California; Center on Gender Equity and Health, University of California, San Diego, San Diego, California., Sandoval S; Division of Complex Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California., Hildebrand M; Division of Complex Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California., Mody SK; Division of Complex Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California. Electronic address: smody@health.ucsd.edu.
Jazyk: angličtina
Zdroj: Women's health issues : official publication of the Jacobs Institute of Women's Health [Womens Health Issues] 2024 Sep-Oct; Vol. 34 (5), pp. 480-487. Date of Electronic Publication: 2024 May 28.
DOI: 10.1016/j.whi.2024.04.003
Abstrakt: Background: The U.S. Food and Drug Administration (FDA) approved the etonogestrel contraceptive implant for 3 years of use. Evidence suggests that it may be used for up to 5 years for pregnancy prevention, also known as extended use.
Methods: We conducted a national cross-sectional survey among a group of reproductive health clinicians. We developed an online survey using the Consolidated Framework for Implementation Research (CFIR) and distributed it through e-mail listservs and social media groups from May to June 2021. We analyzed results using multivariable logistical regression.
Results: Among the 300 respondents, 195 (65.0%) reported that they always offer extended use, and 50 (16.7%) reported that they sometimes offer extended use. Fifty-five respondents (18.3%) reported that they never offer extended use. After adjusting for age, gender, and clinical setting, we found that complex family planning sub-specialists (adjusted odds ratio [aOR] = 9.32; 95% confidence interval [CI] [1.81, 48.03]) and family medicine physicians (aOR = 4.37, 95% CI [1.58, 12.10]) were significantly more likely to recommend extended use compared with general obstetrics and gynecology (OBGYN) physicians. Clinicians from private practices or health maintenance organizations were significantly less likely to offer extended use than those from academic centers (aOR = 0.19, 95% CI [0.07, 0.51]; aOR = 0.06, 95% CI [0.01, 0.31]). The most common barriers to offering extended use were concerns about pregnancy risk, bleeding, and lack of FDA approval past 3 years. Meanwhile, clinicians identified strong published evidence supporting extended use as a key facilitator for offering it, and they perceived that prior counseling on extended use from a past clinician was a key facilitator for patients to adopt it.
Conclusions: One-third of clinicians in this study did not consistently offer extended use of the contraceptive implant. An opportunity exists to expand access to extended use by focusing on education interventions for clinicians and seeking FDA approval for 5 years of use.
(Copyright © 2024 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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