vide insight into why physicians who know that combination oral contraceptives are not a first-line ACOG / AAP recommendation , prescribe them . Enhancing HCP training may promote more use of LARC . Contraceptive education , specifically education regarding LARC placement , should be emphasized in all primary care residencies , as well as ACP training . Without acquiring the necessary training during medical education , HCPs will be unable to place LARC during independent practice .
A limitation to this study was that the response rate was low . Results should be interpreted with caution and readers should be aware of possible bias . In this particular study , it is likely that though there was a low response rate , responding HCPs were more passionate and involved in birth control and women ’ s health than those who did not respond . Physician-related survey response rates are notoriously low , and due to the specificity of the questionnaire topic , the authors expected
12 , 13
lower than average response rates . Furthermore , it is likely that our low response rate was due to a lack of time , email fatigue , and other demands of busy HCPs . HCPs who responded have a vested interest in reproductive healthcare , but many lack the specialized education . We find that among this sample , many HCPs were unaware of the types of LARC available
( IUDs and implantables being a form of LARC ), and a significant majority lacked the ability to place them . A final limitation is that our confidence intervals are wide , a function of the small sample size .
Confidentiality and patient preference were not offered as choices for the most important reason HCPs did not place LARC . In 2018 , that recommendation was modified due to concerns about overemphasizing LARC at the expense of sacrificing the adolescent ’ s birth control choice . The assumption is that a patient is more likely to use a method she chooses for herself . Because LARC efficacy rates are significantly higher than other methods of birth control , they have great potential to reduce the teenage pregnancy and birth rates in WV . 4 , 5 In 2018 , ACOG / AAP increased emphasis on the patient ’ s choice of birth control because any form of birth control , even less effective methods , is better than no birth control .
Our results suggest multiple directions for future research . For example , in an open-ended question regarding other reasons that HCPs indicated why they may not prescribe LARC , we found that emergency medicine and urgent care HCPs may explicitly exclude LARC from their toolbox , even though LARC ( specifically copper IUDs ) are a highly effective method of emergency contraception . We did not asses the number of HCPs who were trained in LARC placement or those who had access to or interest in training . This should be addressed in future work . Additionally , further research regarding prescribing behaviors is necessary .
CONCLUSION
The WV National Center of Excellence in Women ’ s Health hypothesized that the major challenges to LARC use would be patient cost and access . Contrary to our expectation that cost and access would be the greatest barrier to LARC , our survey indicates that education and training of HCPs is the most prominent barrier to LARC faced by adolescents in WV . Adolescent pregnancy prevention must be a priority to the state . We recommend programs modeled after the Colorado Project for the state of WV . These programs should be designed to facilitate HCP training and education , as well as improve accessibility to contraception . 9 , 14 , 15 The Colorado Project reduced barriers to LARC for patients by training providers , financing LARC methods , and allowing same day LARC insertion at no cost . 9 , 16 At the end of five years , teenage births and abortions in Colorado were drastically reduced , 9 , 16 which is a noble goal for which to aspire for the state of WV .
REFERENCES
1 . Decide Pt . Teen Birth Rate Comparison , 2017 | Power to Decide . 2019 , https :// powertodecide . org / what-we-do / information / national-state-data / teenbirth-rate .
2 . Joyce C . Abma PD , and Gladys M . Martinez , PhD Sexual Activity and Contraceptive Use Among Teenagers in the United States , 2011 – 2015 . National Health Statistics Report . 2019 ( 104 ).
3 . Prevention CfDCa . Reproductive Health . 2020 , https :// www . cdc . gov / reproductivehealth / contraception / index . htm . Accessed November 19 , 2020 , 2020 .
4 . Parks C , Peipert JF . Eliminating health disparities in unintended pregnancy with long-acting reversible contraception ( LARC ). Am J Obstet Gynecol . 2016,214 ( 6 ): 681-688 .
5 . Secura G . Long-acting reversible contraception : a practical solution to reduce unintended pregnancy . Minerva Ginecol . 2013,65 ( 3 ): 271-277 .
6 . Gynecologists TACoOa . ACOG Strengthens LARC Recommendations - ACOG . 2018 , https :// www . acog . org / About-ACOG / News-Room / News- Releases / 2015 / ACOG-Strengthens- LARC-Recommendations . Accessed 10-13-2020 , 2020 .
7 . Increasing Access to Contraceptive Implants and Intrauterine Devices to Reduce Unintended Pregnancy - ACOG . 2018 , https :// www . acog . org / Clinical-Guidance-and- Publications / Committee-Opinions / Committee-on-Gynecologic-Practice / Increasing-Access-to-Contraceptive- Implants-and-Intrauterine- Devices-to-Reduce-Unintended- Pregnancy ? IsMobileSet = false .
8 . Prevention CfDCa . Morbidity and Mortality Weekly Report ( MMWR ). Centers for Disease Control and Prevention : Centers for Disease Control and Prevention , 2015 .
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