Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-7 (of 7 Records) |
Query Trace: Morgan IA[original query] |
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Required examinations and tests before initiating contraception: provider practices from a national cross-sectional survey
Krashin JW , Zapata LB , Morgan IA , Tepper NK , Jatlaoui TC , Frederiksen BN , Whiteman MK , Curtis KM . Contraception 2021 103 (4) 232-238 OBJECTIVE(S): We estimated the prevalence of requiring specific examinations or tests before providing contraception in a nationwide survey of family planning providers. STUDY DESIGN: We conducted a cross-sectional survey of public-sector health centers and office-based physicians providing family planning services across the United States in 2019 (n=1,395). We estimated the weighted proportion of providers (or their health center or practice) who required blood pressure measurement, pelvic examination (bimanual examination and cervical inspection), Papanicolaou (Pap) smear, clinical breast examination (CBE), and chlamydia and gonorrhea (CT/GC) screening before initiating hormonal or intrauterine contraception (IUC) for healthy women. We performed multivariable regression to identify factors associated with pelvic examination practices aligned with clinical recommendations; these recommendations classify examinations and tests as recommended or unnecessary before initiation of specific contraceptive methods. RESULTS: The overall response rate was 51%. Most providers required blood pressure measurement before initiating each method. Unnecessary CBE, Pap smears, and CT/GC screening were required by 14-33% of providers across methods. Fifty-two to 62% of providers required recommended pelvic examination before IUC placement; however, 16-23% of providers required unnecessary pelvic examinations before non-intrauterine hormonal method initiation. Factors associated with recommendation-aligned pelvic examination practices included having a higher proportion of patients using public funding (Medicaid or other assistance) and more recently completing formal clinical training. CONCLUSIONS: Almost half (47%) of providers did not require necessary pelvic examination before placing IUC. Conversely, many providers required unnecessary examinations and tests before contraception initiation for patients. IMPLICATIONS: Most providers required the few recommended examinations and tests for safe contraceptive provision. Reduction of unnecessary examinations and tests may reduce barriers to contraceptive access. There are also opportunities to increase use of recommended examinations, as up to 48% of providers did not require recommended pelvic examination before IUC. |
Changes in U.S. health care provider attitudes related to contraceptive safety before and after the release of National Guidance
Zapata LB , Morgan IA , Curtis KM , Folger SG , Whiteman MK . Contraception 2019 100 (5) 413-419 OBJECTIVE: The US Medical Eligibility Criteria for Contraceptive Use (USMEC) is the first national guidance containing evidence-based recommendations for contraception. We describe provider attitudes about contraceptive safety before and after the 2010 USMEC release. STUDY DESIGN: We conducted two cross-sectional mailed surveys using different nationwide samples of office-based physicians and Title X clinic providers before (2009-2010) and after (2013-2014) the USMEC release. We compared the proportion of providers reporting select contraceptive methods as safe for women with specific characteristics or medical conditions before and after the USMEC release and conducted multivariable logistic regression to adjust for provider characteristics. RESULTS: For the following select characteristics for which the USMEC classifies specific contraceptive methods as safe (Category 1 or 2), a significantly (p<.05) higher proportion of providers reported the method safe after versus before the USMEC release: intrauterine devices (IUDs) for adolescents (79.8% versus 60.2%), IUDs for women with HIV (72.4% versus 50.6%), depot medroxyprogesterone acetate (DMPA) for women with obesity (89.5% versus 76.1%), and DMPA for women with history of bariatric surgery (87.6% versus 73.9%). These differences remained significant after adjustment for provider characteristics. CONCLUSIONS: While we observed many positive changes in health care provider attitudes related to contraception safety after the USMEC release, gaps remain. Continuing education and evidence-based training for providers, and ensuring office and health center protocols address medical eligibility for contraception for the full range of characteristics included in the USMEC might bridge remaining gaps and increase delivery of high-quality contraception care. IMPLICATIONS: Gaps between evidence and provider attitudes remain that can inform future efforts to improve contraceptive service delivery. |
Health care provider attitudes about the safety of "Quick Start" initiation of long-acting reversible contraception for adolescents
Morgan IA , Zapata LB , Curtis KM , Whiteman MK . J Pediatr Adolesc Gynecol 2019 32 (4) 402-408 STUDY OBJECTIVE: To identify characteristics associated with provider attitudes on the safety of "Quick Start" initiation of long-acting reversible contraception (LARC) for adolescents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We conducted a cross-sectional survey of providers in public-sector health centers and office-based physicians (n = 2056) during 2013-2014. RESULTS: Overall, the prevalence of considering "Quick Start" initiation of LARC for adolescents as safe was 70.9% for implants and 64.5% for intrauterine devices (IUDs). Among public-sector providers, those not trained in implant or IUD insertion had lower odds of perceiving the practice safe (adjusted odds ratio [aOR], 0.32; 95% confidence interval [CI], 0.25-0.41 for implants; aOR 0.42; 95% CI, 0.32-0.55 for IUDs), whereas those practicing at health centers that did not receive Title X funding had lower odds of perceiving the practice safe for IUDs (aOR, 0.77; 95% CI, 0.61-0.98). Among office-based physicians, lack of training in LARC insertion was associated with lower odds of perceiving "Quick Start" initiation to be safe for IUDs (aOR, 0.31; 95% CI, 0.12-0.77). Those specializing in adolescent medicine had higher odds of reporting "Quick Start" initiation of LARC as safe (implants: aOR, 2.21; 95% CI, 1.23-3.98; IUDs: aOR, 3.37; 95% CI, 1.39-8.21) compared with obstetrician-gynecologists. CONCLUSION: Approximately two-thirds of providers considered "Quick Start" initiation of LARC for adolescents safe; however, there were differences according to provider characteristics (eg, Title X funding, training in LARC insertion, specialty). Targeted LARC insertion training and dissemination of evidence-based family planning guidance and implementation into facility and practice-level policies might increase access to "Quick Start" initiation of LARC for adolescents. |
Factors associated with provision of depot medroxyprogesterone acetate to adolescents by U.S. health care providers
Ermias Y , Morgan IA , Curtis KM , Whiteman MK , Horton LG , Zapata LB . Contraception 2019 99 (5) 300-305 OBJECTIVE: Identify factors associated with healthcare providers' frequency of depot medroxyprogesterone acetate (DMPA) provision to adolescents. STUDY DESIGN: We analyzed data from surveys mailed to a nationally representative sample of public-sector providers and office-based physicians (n=1984). We estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of factors associated with frequent DMPA provision to adolescents in the past year. RESULTS: Although most providers (>95%) considered DMPA safe for adolescents, fewer reported frequent provision (89% of public-sector providers; 64% of office-based physicians). Among public-sector providers, factors associated with lower odds of frequent provision included working in settings without Title X funding (aOR 0.44, 95% CI 0.30-0.64), reporting primary care as their primary clinical focus versus reproductive or adolescent health (aOR 0.42, 95% CI 0.28-0.61), and providing fewer patients with family planning services. Among office-based physicians, factors associated with lower odds of frequent provision included specializing in obstetrics/gynecology (aOR 0.50, 95% CI 0.27-0.91) and family medicine (aOR 0.21, 95% CI 0.09-0.47) versus adolescent medicine, completing training>/=15 versus<5years ago (aOR 0.27, 95% CI 0.09-0.83), and reporting that 0-24% of patients pay with Medicaid or other government healthcare assistance versus>/=50% (aOR 0.23, 95% CI 0.09-0.61). The reason most commonly reported by providers for infrequent DMPA provision was patient preference for another method. CONCLUSIONS: While most providers reported frequently providing DMPA to adolescents, training on evidence-based recommendations for contraception, focused on subgroups of providers with lower odds of frequent DMPA provision, may increase adolescents' access to contraception. IMPLICATIONS: Although>95% of providers considered depot medroxyprogesterone (DMPA) a safe contraceptive for adolescents, only 89% of public-sector providers and 64% of office-based physicians reported frequently providing DMPA to adolescents. Provider training on evidence-based recommendations for contraception counseling and provision may increase adolescents' access to DMPA and all methods of contraception. |
Health care provider attitudes and practices related to 'quick start' provision of combined hormonal contraception and depot medroxyprogesterone acetate to adolescents
Morgan IA , Ermias Y , Zapata LB , Curtis KM , Whiteman MK . J Adolesc Health 2018 64 (2) 211-218 PURPOSE: Adolescents may encounter many barriers to initiating contraception. 'Quick Start' is a recommended approach for initiating contraception on the same day as a provider visit. We examined factors associated with health care provider attitudes and practices related to 'Quick Start' provision of combined hormonal contraception (CHC) and depot medroxyprogesterone acetate (DMPA) to adolescents. METHODS: We analyzed weighted survey data from providers in publicly funded health centers and from office-based physicians (n=2,056). Using multivariable logistic regression, we estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of the associations between provider characteristics and frequent (very often or often vs. not often or never) 'Quick Start' provision of CHC and DMPA to adolescents in the past year. RESULTS: The prevalence of considering 'Quick Start' as safe was high for CHC (public-sector providers [87.5%]; office-based physicians [80.2%]) and DMPA (public-sector providers [80.9%]; office-based physicians [78.8%]). However, the prevalence of frequent 'Quick Start' provision was lower, particularly among office-based physicians (CHC: public-sector providers [74.2%]; office-based physicians [45.2%]; DMPA: public-sector providers [71.4%]; office-based physicians [46.9%]). Providers who considered 'Quick Start' unsafe or were uncertain about its safety had lower odds of frequent 'Quick Start' provision compared with those who considered it safe (public-sector providers: CHC aOR=0.09 95% CI 0.06-0.13, DMPA aOR=0.07 95% CI 0.05-0.10; office-based physicians: CHC aOR=0.06 95% CI 0.02-0.22, DMPA aOR=0.07 95% CI 0.02-0.20). CONCLUSIONS: While most providers reported that 'Quick Start' initiation of CHC and DMPA among adolescents is safe, fewer providers reported frequent 'Quick Start' provision in this population, particularly among office-based physicians. |
State-identified implementation strategies to increase uptake of immediate postpartum long-acting reversible contraception policies
Kroelinger CD , Morgan IA , DeSisto CL , Estrich C , Waddell LF , Mackie C , Pliska E , Goodman DA , Cox S , Velonis A , Rankin KM . J Womens Health (Larchmt) 2018 28 (3) 346-356 BACKGROUND: In 2014, the Association of State and Territorial Health Officials (ASTHO) convened a multistate Immediate Postpartum Long-Acting Reversible Contraception (LARC) Learning Community to facilitate cross-state collaboration in implementation of policies. The Learning Community model was based on systems change, through multistate peer-to-peer learning and strategy-sharing activities. This study uses interview data from 13 participating state teams to identify state-implemented strategies within defined domains that support policy implementation. MATERIALS AND METHODS: Semistructured interviews were conducted by the ASTHO team with state team members participating in the Learning Community. Interviews were transcribed and implementation strategies were coded. Using qualitative analysis, the state-reported domains with the most strategies were identified. RESULTS: The five leading domains included the following: stakeholder partnerships; provider training; outreach; payment streams/reimbursement; and data, monitoring and evaluation. Stakeholder partnership was identified as a cross-cutting domain. Every state team used strategies for stakeholder partnerships and provider training, 12 reported planning or engaging in outreach efforts, 11 addressed provider and facility reimbursement, and 10 implemented data evaluation strategies. All states leveraged partnerships to support information sharing, identify provider champions, and pilot immediate postpartum LARC programs in select delivery facilities. CONCLUSIONS: Implementing immediate postpartum LARC policies in states involves leveraging partnerships to develop and implement strategies. Identifying champions, piloting programs, and collecting facility-level evaluation data are scalable activities that may strengthen state efforts to improve access to immediate postpartum LARC, a public health service for preventing short interbirth intervals and unintended pregnancy among postpartum women. |
Addressing intimate partner violence to improve women's preconception health
Morgan IA , Robbins CL , Basile KC . J Womens Health (Larchmt) 2018 27 (10) 1189-1194 Exposure to violence can harm women's overall health and well-being. Data suggest that one in three women in the United States experience some form of violence by an intimate partner in their lifetime. In this commentary, we describe the implications of intimate partner violence (IPV) on women's health, specifically for women of reproductive age. We use a life-course perspective to describe the compounded impact of IPV on preconception health. Preconception health generally refers to the overall health and well-being of women (and men) before pregnancy. This report also discusses primary prevention of IPV and healthcare recommendations, and highlights surveillance systems that capture IPV indicators among women of reproductive age. Ongoing collection of state-level surveillance data may inform the implementation of intervention programs tailored to reproductive age women at risk for IPV. |
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