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Intrauterine Contraception: Knowledge and Prescribing Practices of Canadian Health Care Providers

Published:March 18, 2019DOI:https://doi.org/10.1016/j.jogc.2018.11.027

      Abstract

      Objective

      Contraception is an important issue in the lives of women, their partners, and society. Canadians and their health care providers play a critical role in contraceptive decision making that influences individuals and Canadian society. The purpose of this study was to gather data on contraception-related knowledge, counselling, and prescribing practices of Canadian health care providers.

      Methods

      This project reported on the outcomes of an educational initiative, designed as a quality improvement initiative (time series level II-3), focused on Canadian health care providers’ contraception-related knowledge, counselling, and prescribing practices. Outcomes were intended to inform the development of tools, resources, and educational programming. Part 1 was an online program to identify educational and knowledge gaps for health care providers. Part 2 was a practice assessment exploring and measuring health care providers’ contraceptive counselling and prescribing practices.

      Results

      A total of 4300 health care providers completed the program between July 6, 2015 and August 30, 2016. Knowledge significantly increased; post-test scores were higher than pretest scores. After completion, all participants felt more comfortable, knowledgeable, and inclined to change their practice around prescribing intrauterine contraception (IUC). The 4300 providers reported on their contraception counselling experiences with 10 patients following participation in Part 1. Forty percent of patients were using oral contraceptives, and 53% were dissatisfied with their current type of contraception. After counselling, patients reported being most comfortable with IUC (55%). Both short- and long-acting types of contraception were most often discussed or offered (74% of the time), followed by long-acting reversible contraception only (21%) and short-acting methods only (5%).

      Conclusion

      This training program filled an education need for patients and gave providers tools to change their behaviour and practice around IUC prescribing. On the basis of these data, a practice assessment model was deemed a successful way to change behaviour.

      Résumé

      Objectif

      La question de la contraception est importante pour les femmes, leurs partenaires et la société. Les décisions en matière de contraception prises par les Canadiennes et leurs fournisseurs de soins de santé ont une influence capitale, individuellement et à l'échelle de la société. L'objectif de cette étude était de rassembler des données sur les connaissances liées à la contraception, le counseling et les pratiques de prescription des fournisseurs de soins de santé canadiens.

      Méthodologie

      Ce projet détaille les résultats d'un programme de formation conçu comme une initiative d'amélioration de la qualité (séries chronologiques, niveau II-3) visant les connaissances sur la contraception, le counseling et les pratiques de prescription des fournisseurs de soins de santé du Canada. Les résultats serviront à la conception d'outils, de ressources et de programmes éducatifs. La première partie était un programme en ligne évaluant les lacunes dans les connaissances des fournisseurs sur le sujet, alors que la deuxième était une évaluation du counseling et des pratiques de prescription en matière de contraception du fournisseur.

      Résultats

      Au total, 4 300 fournisseurs de soins de santé ont participé au programme entre le 6 juillet 2015 et le 30 août 2016. Le niveau de connaissances a significativement augmenté lors des évaluations post-tests, comparativement aux prétests. Après avoir terminé le programme, tous les candidats se sentaient plus à l'aise, avaient de meilleures connaissances et étaient prêts à modifier leurs pratiques de prescription de la contraception intra-utérine (CIU). Les 4 300 fournisseurs ont rapporté leur expérience de counseling avec 10 patientes après leur participation à la première partie. Quarante pour cent des patientes utilisaient une méthode de contraception orale, et 53 % d'entre elles étaient insatisfaites. Après le counseling, les patientes ont déclaré se sentir le plus à l'aise avec la CIU (55 %). Le plus souvent, les méthodes de contraception à court terme et celles à long terme ont toutes deux été abordées ou suggérées (dans 74 % des cas), suivies par une mention de la contraception réversible à action prolongée seulement (21 %) et des méthodes à court terme seulement (5 %).

      Conclusion

      Ce programme de formation a répondu au besoin d'informer les patientes et a donné aux fournisseurs des outils pour modifier leur comportement et leurs pratiques de prescription de la CIU. D'après ces résultats, on peut conclure qu'un modèle d'évaluation des pratiques est un moyen efficace de modifier des comportements.

      Key Words

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