who provide contraceptive counseling and birth control to adolescents . In order to address this question , we explored WV HCP knowledge of the ACOG and the AAP recommendations of first-line contraception for adolescents , their prescribing behavior , and reasons for not placing LARC .
MATERIALS AND METHODS
An electronic survey using Qualtrics was designed by the authors to assess HCP knowledge and use of LARC and other birth control methods . In the questionnaire , LARC was described as long-acting reversible contraception . The questionnaire was designed to evaluate : ( 1 ) knowledge of recommendations by the ACOG and the AAP , ( 2 ) most commonly prescribed methods of contraception , ( 3 ) the match between perceived ACOG and AAP recommendations and actual prescribing behavior , ( 4 ) prescribing patterns between physicians and advanced care practitioners ( ACP ), ( 5 ) and , most important , reasons for not placing LARC . The survey can be found at : https :// wvu . qualtrics . com / jfe / form / SV _ 5oOyAJidE07PvjT .
The questionnaire was distributed after approval by the West Virginia University ( WVU ) Institutional Review Board . Study participants included statewide HCPs qualified to council in matters of reproductive health whose email addresses were available on distribution lists from the WVU School of Medicine Continuing Education Office . Respondents indicated whether they were obstetricians and gynecologists ( OBGYN ), pediatricians , family doctor / general practitioners , internists , emergency medicine physicians , resident physicians / physicians in training , advanced nurse practitioners , physician assistants , midwives , or other . HCPs were defined as either physicians or ACP .
Data were collected from April 2018 to July 2018 , following the 2015 ACOG and the AAP recommendation , but prior to the May 2018 ACOG / AAP revision . HCPs were contacted using two WVU media platforms : WVU Health Sciences Intranet News and WVU School of Medicine Connections eNews . Additionally , 2,196 contact emails were sent to HCPs by the WVU School of Medicine Continuing Education
Office , Medicine , and Nursing . One followup contact was made via email asking for questionnaire completion approximately two weeks following the initial invitation .
Only individuals who had , within the past month , discussed or prescribed birth control to any female adolescent patient ( defined as 13-19 years old ) completed questions regarding knowledge and birth control prescribing and recommendation behavior . Twelve randomly ordered methods were listed as options for the question , “ What is the first line recommended birth control by the ACOG and the AAP in adolescents ? Please check all that apply .” Options included : LARC , IUD , pills , female condom , spermicide , abstinence only , male condom , implantable , injectables , sponge , patches , rings , and I am not sure .
HCPs were also asked , “ Which birth control method do you most commonly prescribe / recommend to a 13-19 year old adolescent ?” They were provided a randomized list of 11 types of birth control : IUD , implantables , injectable , patches , ring , sponge , female condom , male condom , abstinence only , pills , and other . Providers indicating other most often made clarifying remarks , such as “ I recommend either implant or IUD , I most commonly prescribe oral contraceptive pills ,” and “ I prescribe what that patient is most comfortable using , as well as condoms . I try to steer them to the LARCs .”
HCPs were asked to identify the most important reason for not placing LARC and were provided a list of 13 options :
1 . Do not know how to place 2 . Do not know method of action 3 . Do not know efficacy rate 4 . Morally disagree with LARCs 5 . Concerned about damage to a nulliparous patient
6 . Concerned about pelvic inflammatory disease 7 . Concerned about ectopic pregnancy 8 . Concerned about litigious or malpractice action if there is a complication 9 . Patients concerned about costs 10 . Not covered by insurance 11 . Do not have access to LARC suppliers
12 . Religious objection 13 . I am not medically qualified to prescribe birth control
Parent preference was not included as an option because in the state of WV reproductive rights begin at age 14 . All statistics were calculated using IBM SPSS software . Statistical analysis included frequencies and chi-square goodness-of-fit .
RESULTS
Of the 2,196 HCPs contacted , 132 respondents returned the survey , and 109 completed usable data . Surveys that had significant amounts of missing data were excluded from the study . Responses were confidential and anonymous , as the survey provided no identifiable information about the HCP .
Of the 109 survey responses collected , 60 % of HCPs classified themselves as physicians , while the next most common professions were nurse practitioner ( 18 %), physician assistant ( 13 %), nurse midwife ( 4 %), and other ( 4 %). Unclassified respondents were excluded from analysis for Table 4 . The sample consisted of 20 % men and 80 % women .
HCP KNOWLEDGE : ACOG / AAP RECOMMENDATIONS
HCPs who had discussed birth control with adolescent female patients in the last month were asked , “ What is the first line of birth control recommended by the ACOG / AAP in adolescents ?” The majority of HCPs identified LARC as a first-line ACOG / AAP recommendation , but combination oral contraceptives , implantables , and injectables were also within overlapping confidence intervals of LARC ( Table 1 ). These results indicate that there were no significant statistical differences between these contraceptive methods . There was a statistically significant difference in the number of HCPs selecting male condoms , patches , and rings when compared to those selecting LARC ( non-overlapping confidence intervals , Table 1 ). This indicates that respondents were aware that these methods are not first-line ACOG / AAP recommendation .
A perfect answer would be a response
West Virginia Medical Journal • June 2021 • 31