Aparna Sridhar

Knowledge and Training of Intrauterine Devices Among Primary Care Residents: Implications for Graduate Medical Education.

Nearly half of pregnancies in the United States are unintended, a rate that has increased recently, contrasted with a worldwide decline.1,2 This lack of progress may be due to low adoption of long-acting reversible contraceptives (LARCs). The United States has the lowest rate of intrauterine device (IUD) use of any industrialized country.3,4 Because IUDs have high user satisfaction and effectiveness, increased adoption could lead to reductions in unplanned pregnancies (and fewer adverse outcomes) and prevent abortions.4,5 Both in public and private sectors, primary care providers have an important role in preventing unintended pregnancies. Although many women receive contraceptive counseling and services from obstetrics and gynecology (ob-gyn) specialists, a significant proportion see family practitioners, internists, and pediatricians (caring for adolescents) for one or both.6 The National Ambulatory Medical Care Survey is designed to meet the need for objective, reliable information about the provision and use of ambulatory medical care services in the United States. According to the latest data available from this survey, 11.5 million visits occurred in 2010 for contraception and family planning counseling.7 It is important, therefore, that all provider types be well informed regarding IUDs. A significant proportion of physicians trained in primary care specialties add further training in subspecialties: subspecialist physicians take care of women with complex medical problems that pose a significant risk for pregnancy. Therefore, contraception knowledge is important to medical and pediatrics subspecialists as well. Although the Accreditation Council for Graduate Medical Education requires training in family planning and contraception as part of the core curriculum for internal medicine, pediatrics, family medicine, and ob-gyn residents, structured teaching in the area of contraception is not necessarily a systematic part of this curriculum (B O X).8

Personalized contraceptive counseling: helping women make the right choice

Unintended pregnancy is a significant problem with medical, social, and economic consequences. Half of unintended pregnancies are a result of no contraceptive use; while the other half results from contraceptive inconsistencies, or method failure. Women have an array of contraceptive options to choose from, each of which differs significantly in terms of usage, efficacy, side effects, risks, and noncontraceptive benefits. Determining the best tool for communication is a challenge. In addition, the choice of contraceptive method differs among women with medical problems. Not all contraceptive methods are suitable for women with certain medical problems. In this review, we discuss different methods of counseling and the tools available for sharing contraception information.

An Evaluation of Contraception Education and Health Promotion Applications for Patients

PURPOSE Patients use mobile applications (apps) to obtain information about health, including contraception. Providers and health educators may also use apps designed for patients to aid in patient education during the clinical encounter or recommend apps for patient use. Individuals may have a difficult time remaining updated on the number and quality of available apps. The objective of this study is to identify and evaluate contraception apps for patient education and health promotion, so that providers and health educators may recommend accurate apps to patients. METHODS We systematically searched the Apple iTunes Store using contraception search terms. A master list of apps was created and the apps were divided into categories and subcategories according to intended audience and purpose. Contraception apps for patient education and health promotion were selected and also checked for availability in the Google Play Store. We evaluated these identified apps using an adapted APPLICATIONS scoring system. FINDINGS Forty-eight apps were identified from the original search. Nineteen of these were excluded because they did not open on an iPhone or iPad, were no longer available, or did not contain educational material on contraception. We excluded 11 additional apps that contained inaccurate information. We evaluated 18 apps. The mean score was 10.6 out of 17 possible points with a range of 7 to 15 points. CONCLUSIONS Many apps provide contraception information for patients, but some apps are inaccurate. Few apps provide comprehensive information on all available methods, including effectiveness, side effects, and contraindications.

Long Acting Reversible Contraceptive Uptake in a Student Health Center Following the 2016 Presidential Election [9E]

INTRODUCTION:In the context of recent political changes and concerns regarding the potential repeal of mandated contraception coverage in the United States (U.S.), the media reported a sudden increased interest in long acting reversible contraceptives (LARCs), such as intrauterine devices (IUDs) and

Contraceptive Considerations for Women with Gastrointestinal Disorders.

Gastroenterologists are in a unique position to assist women with chronic gastrointestinal disorders in order to optimize their health prior to pregnancy. Women, whether with chronic conditions or not, and their infants are more likely to be healthy when pregnancies are planned. Achieving a planned pregnancy at the ideal time or preventing pregnancy altogether requires the use of appropriate contraceptives. There is a broad range of contraceptives available to women in the USA, and the majority of women with digestive diseases will be candidates for all effective methods. Guidance from the Centers for Disease Control and Prevention aids clinicians in prescribing appropriate contraceptives to women with medical disorders. This review will focus on contraception for women with inflammatory bowel disease and chronic liver disease, including liver transplant.

Decisional Quality of Women Choosing a Contraceptive Method in an Urban Gynecology Practice [8O]

INTRODUCTION: Women have an array of birth control options to choose from. Little is known about the decisional quality of choices made in reproductive health. METHODS: A cross-sectional survey of women in a high-volume Obstetrics/Gynecology clinic was conducted. Eligible participants were English speaking women of reproductive age that completed a discussion with their provider regarding contraceptive options. Familiarity for contraceptive options was measured using a 5-point Likert scale; Decisional conflict was measured using the SURE (4-item) validated scale. Questionnaire content also included items for satisfaction with care, shared decision making, and health literacy. RESULTS: Participants (N=105) were most familiar with condoms (97%) and the birth control pill (96%), and were least familiar with tubal ligation (36%) and the sponge (34%). Most women chose the birth control pill (44%) as their contraceptive choice. Women with low decisional conflict (84%; SURE=4), stated that they were more likely to stick to their decision (90% versus 73%), and were more satisfied with their decision (98% versus 50%). Those satisfied with their decision were more likely to be younger, not employed full-time (40% versus 69%), more likely to have made a choice of method both before (91% versus 69%) and after seeing the doctor (98% versus 54%), and had lower decisional conflict. CONCLUSION: Increased decisional conflict is associated with lower patient satisfaction and a lowered patient predicted adherence to birth control strategy. Methods to improve decisional conflict, such as shared decision making, may improve decision quality for women choosing from various contraceptive methods.

Mobile Applications for Contraception Information: A Short Overview

The use of modern technological devices such as smartphones and tablets is increasing in the U.S. One in five smartphone owners have a mobile application related to health. Although there are many healthcare applications regarding contraception, little has been published about the content and functionalities of these applications. There is lack of information regarding the accuracy of content of mobile health applications in general and those related to contraception and family planning in particular. At University of California Los Angeles, we reviewed the mobile applications that were listed by searching the iOS platform with keywords related to contraception and family planning. Of 160 applications with contraception related content 16 were primarily geared towards healthcare providers. These included journals, textbooks and reference guides. 144 applications were targeted towards reproductive age men and women and included menstrual cycle trackers (40), birth control reminders (26), games (16), sexual health information applications (40) and applications to locate family planning centers (22). Mobile applications offer guidance for “effective contraception use; however”, it is difficult to track each application’s references and the frequency with which it is updated.. It is thus very important to maintain a healthy sense of skepticism regarding the safety and accuracy of content of these mobile applications.

Contraception and Family Planning: There Is Indeed an App for That [211].

INTRODUCTION: Ninety percent of American adults have cell phones, and half of them download applications (apps). We conducted a review of mobile health apps related to contraception and family planning. The primary objective of our study was to identify the number and type of contraception-related mobile apps and to perform review of content of those apps. METHODS: We searched the iOS mobile platform for the key words related to contraception and family planning between June and July 2014. A total of 289 apps were identified, of which 129 were excluded as a result of a lack of contraception related information. We performed review of the remaining apps to identify themes and categories. RESULTS: Of 160 apps with contraception-related content, 16 (10%) were primarily targeted toward health care providers. These included journals, textbooks, and reference guides. A total of 144 (90%) apps targeted toward patients were menstrual cycle trackers (40), birth control reminders (26), games (16), sexual health information apps (40), and apps to locate family planning centers (22). Only 20 patient apps had comprehensive information about multiple birth control methods. CONCLUSION: Mobile apps are an increasingly used means of accessing medical information. Accurate and comprehensive information about contraception is available in few apps. IMPLICATIONS: We are planning to perform clinical studies to identify the usefulness of such apps in clinical care. These studies may help us to understand the role of mobile health apps as a supplement to clinical care.

Contraception for Women with Gastrointestinal Disorders

Women with gastrointestinal (GI) disease processes are living longer into their reproductive years and their quality of life is improving. Many of the GI disorders can mimic problems in pregnancy and can be associated with poor perinatal outcomes. Women are encouraged to optimize their GI conditions prior to conception for best perinatal outcome. Planned pregnancy after health optimization and maintenance of appropriate therapies is best for both the mother and her intended family. Unplanned pregnancy during an active disease flare, use of teratogenic medications, or need for multiple procedures for untreated disease can exacerbate problems in pregnancy. Contraception is encouraged while undergoing active treatments to allow for return of safer conditions for family building. Most methods of contraception are safe, effective, and acceptable in GI disease with relatively few potential complications. In addition most treatments for GI disease are compatible with pregnancy.

Contraceptive Options for Women with Thrombophilia and Thromboembolic Disease

Thromboembolic diseases, including venous thromboembolism (VTE), are one of the leading causes of maternal mortality in the USA. However, for women at high risk of VTE due to thrombophilia or other risk factors, there is a large unmet need for appropriate contraceptive care. While combined hormonal contraception elevates VTE risk above that of nonusers, the highest risk periods are often during pregnancy and postpartum. Consequently, health care providers caring for women with VTE, or at high risk for VTE, should make every effort to address their contraceptive needs in an individualized and evidence-based fashion. This chapter explores current evidence on the safety of contraceptive use among women at high risk for thromboembolic disease and provides a framework for managing common contraceptive issues as they arise. Despite current research gaps, it is clear that most women under care for a current or a past VTE can safely use several effective contraceptive methods, including long-acting reversible contraception (LARC). Given the low typical-use failure rates of LARC methods, presenting such methods as first-line contraceptive agents should be routine in this population, as it should be for all women. Diligent attention to the contraceptive and preconception planning needs of women in this high-risk population will promote significant strides toward reducing unintended and mistimed pregnancy and its associated morbidity and mortality.