Original Article

Contraception Initiation in the Emergency Department: A Pilot Study on Providers’ Knowledge, Attitudes, and Practices

Authors: Iyanna Liles, MD, Lisa B. Haddad, MD, MPH, Eva Lathrop, MD, MPH, Abigail Hankin, MD, MPH

Abstract

Objectives: Almost half of all pregnancies in the United States are unintended; these pregnancies are associated with adverse outcomes. Many reproductive-age females seek care in the emergency department (ED), are at risk of pregnancy, and are amenable to contraceptive services in this setting. Through a pilot study, we sought to assess ED providers’ current practices; attitudes; and knowledge of emergency contraception (EC) and nonemergency contraception (non-EC), as well as barriers with respect to contraception initiation.

Methods: ED physicians and associate providers in Georgia were e-mailed a link to an anonymous Internet questionnaire using state professional databases and contacts. The questionnaire included Likert scales with multiple-choice questions to assess study objectives. Descriptive statistics were generated as well as univariate analyses using χ 2 and Fisher exact tests.

Results: A total of 1232 providers were e-mailed, with 119 questionnaires completed. Participants were predominantly physicians (80%), men (59%), and individuals younger than 45 years (59%). Common practices were referrals (96%), EC prescriptions (77%), and non-EC prescriptions (40%). Common barriers were perceived as low likelihood for follow-up (63%), risk of complications (58%), and adverse effects (51%). More than 70% of participants correctly identified the highly effective contraceptive methods, 3% identified the correct maximum EC initiation time, and 42% correctly recognized pregnancy as a higher risk than hormonal contraception use for pulmonary embolism.

Conclusions: Most ED providers in this pilot study referred patients for contraception; however, there was no universal contraceptive counseling and management. Many ED providers in this study had an incorrect understanding of the efficacy, risks, and eligibility associated with contraceptive methods. This lack of understanding may affect patient access and be a barrier to patient care.

 

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References

1. Finer LB, Kost K. Unintended pregnancy rates at the state level. Perspect Sex Reprod Health 2011;43:78-87.
 
2. Kost K. Unintended pregnancy rates at the state level: estimates for 2002, 2004, 2006 and 2008. http://www.guttmacher.org/pubs/StateUP08.pdf. Published September 2013. Accessed December 10, 2013.
 
3. Gipson JD, Koenig MA, Hindin MJ. The effects of unintended pregnancy on infant, child, and parental health: a review of the literature. Stud Fam Plann 2008;39:18-38.
 
4. US Department of Health and Human Services. Healthy People 2020. Family planning. http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=13. Accessed December 10, 2013.
 
5. Institute of Medicine. Clinical preventive services for women: closing the gaps. http://www.nationalacademies.org/hmd/Reports/2011/Clinical-Preventive-Services-for-Women-Closing-the-Gaps.aspx. Published July 19, 2011. Accessed February 29, 2016.
 
6. Frost JJ, Henshaw SK, Sonfield A. Contraceptive needs and services: national and state data, 2008 update. https://www.guttmacher.org/pubs/win/contraceptive-needs-2008.pdf. Published May 2010. Accessed February 24, 2016.
 
7. Jones J, Mosher W, Daniels K. Current contraceptive use in the United States, 2006-2010, and changes in patterns of use since 1995. Natl Health Stat Report 2012;60:1-25.
 
8. National Hospital Ambulatory Medical Care Survey: 2010 emergency department summary tables. National Health Statistics Report. http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2010_ed_web_tables.pdf. Accessed February 29, 2016.
 
9. Mosher WD, Jones J, Abma JC. Intended and unintended births in the United States: 1982-2010. Natl Health Stat Report 2012;55:1-28.
 
10. LaCalle E, Rabin E. Frequent users of emergency departments: the myths, the data, and the policy implications. Ann Emerg Med 2010;56:42-48.
 
11. Todd CS, Plantinga LC, Lichenstein R. Primary care services for an emergency department population: a novel location for contraception. Contraception 2005;71:40-44.
 
12. Keshavarz R, Merchant RC, McGreal J. Emergency contraception provision: a survey of emergency department practitioners. Acad Emerg Med 2002;9:69-74.
 
13. Espey E, Ogburn T, Leeman L, et al. Compliance with mandated emergency contraception in New Mexico emergency departments. J Womens Health (Larchmt) 2009;18:619-623.
 
14. Patel A, Roston A, Tilmon S, et al. Assessing the extent of provision of comprehensive medical care management for female sexual assault patients in US hospital emergency departments. Int J Gynaecol Obstet 2013;123:24-28.
 
15. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. US Selected Practice Recommendations for Contraceptive Use, 2013: adapted from the World Health Organization selected practice recommendations for contraceptive use, 2nd edition. MMWR Recomm Rep 2013;62:1-60.
 
16. Committee on Health Care for Underserved Women. ACOG Committee Opinion Number 542: access to emergency contraception. Obstet Gynecol 2012;120:1250-1253.
 
17. Committee on Gynecologic Practice. ACOG Committee Opinion Number 540: risk of venous thromboembolism among users of drospirenone-containing oral contraceptive pills. Obstet Gynecol 2012;120:1239-1242.
 
18. Goyal M, Zhao H, Mollen C. Exploring emergency contraception knowledge, prescription practices, and barriers to prescription for adolescents in the emergency department. Pediatrics 2009;123:765-770.
 
19. Bakhru A, Mallinger JB, Fox MC. Postexposure prophylaxis for victims of sexual assault: treatments and attitudes of emergency department physicians. Contraception 2010;82:168-173.
 
20. Vukmir RB, Kremen R, Dehart DA, et al. Compliance with emergency department patient referral. Am J Emerg Med 1992;10:413-417.
 
21. Messina FC, McDaniel MA, Trammel AC, et al. Improving specialty care follow-up after an ED visit using a unique referral system. Am J Emerg Med 2013;31:1495-1500.
 
22. Heit JA, Kobbervig CE, James AH, et al. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 2005;143:697-706.
 
23. Lidegaard Ø, Løkkegaard E, Svendsen AL, et al. Hormonal contraception and risk of venous thromboembolism: national follow-up study. BMJ 2009;339:b2890.