Sarah Pickle

Emergency contraception: A multispecialty survey of clinician knowledge and practices

OBJECTIVES To assess knowledge and provision of emergency contraception (EC), particularly the most effective methods. STUDY DESIGN A web-based survey was distributed to a cross-sectional convenience sample of healthcare providers across specialties treating reproductive-aged women. The survey was sent to 3260 practicing physicians and advanced practice clinicians in 14 academic centers between February 2013 and April 2014. We analyzed responses by provider specialty using multivariable logistic regression. RESULTS The final sample included 1684 providers (response rate=51.7%). Ninety-five percent of the respondents had heard of levonorgestrel (LNG) EC. Among reproductive health specialists, 81% provide LNG EC in their practice, although only half (52%) had heard of ulipristal acetate (UPA) and very few provide it (14%). The majority in family medicine (69%) and emergency medicine (74%) provide LNG, in contrast to 42% of internists and 55% of pediatricians. However, the more effective methods [UPA and copper intrauterine device (IUD)] were little known and rarely provided outside of reproductive health specialties; 18% of internists and 14% of emergency medicine providers had heard of UPA and 4% provide it. Only 22% of emergency providers and 32% of pediatricians had heard of the copper IUD used as EC. Among reproductive health specialists, only 36% provide copper IUD as EC in their practice. Specialty, provider type and proportion of women of reproductive age in the practice were related to knowledge and provision of some forms of EC. CONCLUSIONS Awareness and provision of the most effective EC methods, UPA and the copper IUD (which are provider dependent), are substantially lower than for LNG EC, especially among providers who do not focus on reproductive health. IMPLICATIONS In our sample of 1684 healthcare providers from diverse specialties who treat reproductive-aged women, knowledge and provision of the most effective forms of EC (UPA and the copper IUD) are far lower than for LNG EC. Women should be offered the full range of EC methods.

Prevention of Unintended Pregnancy: A Focus on Long-Acting Reversible Contraception

This article summarizes the literature regarding the epidemiology and prevention of unintended pregnancy in the United States. Because of the Affordable Care Act and its accompanying contraceptive provision, there is a need for more primary care clinicians to provide family planning services. Office-based interventions to incorporate family planning services in primary care are presented, including clinical tools and electronic health record use. Special attention is paid to long-acting reversible contraceptive methods (the subdermal implant and intrauterine devices); these highly effective and safe methods have the greatest potential to decrease the rate of unintended pregnancy, but have been underused.

Cervical Cancer Screening Outcomes in a Refugee Population

Cervical cancer is the second most common cause of female cancer mortality worldwide, accounting for approximately 274,000 deaths annually (Parikh, Brennan, & Boffetta, 2003; World Health Organization, 2002). Of the estimated 500,000 new cases of cervical cancer diagnosed each year, 80% of these occur in developing countries, with the highest rates occurring in Africa, Asia, and Central and South America (de Sanjose et al., 2010; Ferlay et al., 2010; Lipson et al., 1995; Parikh et al., 2003; World Health Organization, 2002, 2011). Human papillomavirus (HPV) has been detected in 99% of cervical cancer cases, and infection with HPV is a prerequisite to the development of invasive cervical cancer (de Sanjose et al., 2010; Dunne et al., 2007; Ferlay et al., 2010; Lipson et al., 1995; Parikh et al., 2003; World Health Organization, 2002, 2011). Seventy percent of cervical cancers are due to high-risk (HR) HPV types 16 and 18, and although there is some geographic variation in the prevalence of HPV, global data suggests that the eight most common high-risk oncogenic HPV genotypes (16, 18, 21, 33, 35, 45, and 52) contribute to over 90% of the cervical cancer in all world regions [de Sanjose, 2010; Dunne, 2007; World Health Organization, 2011].