TABLE 4 . Most frequently prescribed method of contraception by physicians and ACP
Contraceptive Physicians ACP Pills 25 ( 54.3 %) 14 ( 45.2 %) Implantable 10 ( 21.7 %) 7 ( 22.5 %) IUD 5 ( 10.9 %) 2 ( 6.4 %) Injectable 0 ( 0 %) 7 ( 22.5 %) Other 4 ( 8.6 %) 1 ( 3.2 %) Male Condom 1 ( 2.2 %) 0 ( 0 %) Patches 1 ( 2.2 %) 0 ( 0 %) Total 46 31
* ACP , Advanced Care Practitioners
* n = 77 . Classification of respondents was necessary for analysis . Respondents who chose other were excluded .
haviors regarding IUDs were consistent with ACOG / AAP recommendations . While implantables are recommended by ACOG / AAP as first-line birth control , those prescribing implantables tended not to be aware of that recommendation . Based on these results , some HCPs ’ behavior is not in line with ACOG / AAP recommendations .
HCP PRESCRIBING BEHAVIORS BY PROFESSION
Physicians ’ prescribing behavior differs significantly from ACP ( χ2 = 13.30 , df = 6 , p = 0.037 ) explaining about 41 % ( as measured by phi ) of the variance in prescribing behavior . The primary differences between these two groups were that ACP were more likely to offer injectables than physicians ( 22.5 % vs . 0 % respectively ), and ACP were less likely to prescribe combination oral contraceptives than physicians ( 45 % vs . 54 %, respectively ).
HCP BELIEFS REGARDING MOST IMPORTANT REASONS FOR NOT PLACING LARC
Why do HCP place so few LARCs given their high efficacy ? HCPs were asked to drag the most important reason from the list and place it in a box labeled , “ The Most Important Reason .” The most prevalent reason for not prescribing LARCs to adolescents was lack of knowledge regarding how to place them ( n = 18 , 16.5 % of respondents ). Six of the ACP and 12 of the physicians stated that they did not feel they were adequately trained to place LARC . The second most important reason was worry about litigious or malpractice action if there is a malfunction or complication ( n = 5 , 4.6 %).
DISCUSSION
When data collection began in April 2018 , the ACOG and the AAP recommended LARC as first-line contraception . In May 2018 , the ACOG committee opinion concluded that LARCs have higher efficacy , continuation rates , and satisfaction rates compared with short-acting contraception among adolescents who choose to use them , making LARC ideal contraception . However , their recommendation was revised to state that patient choice should be the principle factor driving the use of one method of contraception over another .
The majority of HCPs sampled agreed that they were aware of contraceptive recommendations and the majority of respondents chose LARC as a first-line ACOG / AAP method . Yet , respondents incorrectly identified less effective methods , including combination oral contraceptives and injectables , as first-line recommendations . Table 1 includes the CDC efficacy rates for the various birth control methods . Specifically , the failure rates for LARC are less than 1 %, while combination oral contraceptives and injectables have failure rates of 9 % and 6 %, respectively . There was substantial overlap in the confidence intervals ,
indicating that , as a whole , respondents believed combination oral contraceptives and injectables , along with LARC , are ACOG / AAP first-line recommendations . Yet , combination oral contraceptives and injectables are not ACOG / AAP first-line recommendations . Results indicate that respondents are aware that male condoms , patches , and rings are not first-line ACOG / AAP recommendations , as indicated by a statistically significant separation of confidence intervals . Notably , a perfect answer included LARC , IUD , and implantables because IUDs and implantables are the only two birth control methods that are LARC . This perfect response , which was provided by only 24 % of respondents , indicated that those HCPs have granular knowledge of both the overarching category of LARC and the methods included in that category . Because all other birth control options were not LARC , the selection of any of these methods , whether alone or in addition to LARC , suggests that the HCP is not fully aware of what methods are first-line ACOG / AAP recommendations .
About half ( 50.6 %) of HCPs were most commonly prescribing combination oral contraceptives over the other three listed methods , including two LARC . Markedly , 59 % of HCPs prescribing combination oral contraceptives believed that they were prescribing in line with the ACOG / AAP recommendations . Forty-one percent ( 41 %) knew that combination oral contraceptives were not a first-line recommendation but prescribed them most frequently anyway . Interestingly , prescribing patterns between physicians and ACP varied significantly . Physicians prescribed more combination oral contraceptives and no injectables , whereas ACP prescribed injectables more frequently than combination oral contraceptives . It is clear that some HCPs ’ behavior is inconsistent with the ACOG / AAP recommendations , sometimes providers are aware of this inconsistency , and sometimes they are unaware .
The most common reason that HCPs cited for not using LARC was that they did not know how to insert the contraceptive ( 16.5 %), followed by concerns about litigious action if there is a malfunction or complication ( 4.6 %). These results pro-
West Virginia Medical Journal • June 2021 • 33