3 results on '"Speidel, J. Joseph"'
Search Results
2. Copper intrauterine device for emergency contraception: clinical practice among contraceptive providers.
- Author
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Harper CC, Speidel JJ, Drey EA, Trussell J, Blum M, and Darney PD
- Subjects
- Adult, California, Data Collection, Evidence-Based Medicine, Family Practice education, Family Practice statistics & numerical data, Female, Gynecology education, Gynecology statistics & numerical data, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Obstetrics education, Obstetrics statistics & numerical data, Patient Selection, Women's Health Services statistics & numerical data, Clinical Competence, Contraception, Postcoital, Health Knowledge, Attitudes, Practice, Intrauterine Devices, Copper, Practice Patterns, Physicians' statistics & numerical data
- Abstract
Objective: The copper intrauterine device (IUD) is the most effective emergency contraceptive available but is largely ignored in clinical practice. We examined clinicians' recommendations of the copper IUD for emergency contraception in a setting with few cost obstacles., Methods: We conducted a survey among clinicians (n=1,246; response rate 65%) in a California State family planning program, where U.S. Food and Drug Administration-approved contraceptives are available at no cost to low-income women. We used multivariable logistic regression to measure the association of intrauterine contraceptive training and evidence-based knowledge with having recommended the copper IUD for emergency contraception., Results: The large majority of clinicians (85%) never recommended the copper IUD for emergency contraception, and most (93%) required two or more visits for an IUD insertion. Multivariable analyses showed insertion skills were associated with having recommended the copper IUD for emergency contraception, but the most significant factor was evidence-based knowledge of patient selection for IUD use. Clinicians who viewed a wide range of patients as IUD candidates were twice as likely to have recommended the copper IUD for emergency contraception. Although more than 93% of obstetrician-gynecologists were skilled in inserting the copper IUD, they were no more likely to have recommended it for emergency contraception than other physicians or advance practice clinicians., Conclusion: Recommendation of the copper IUD for emergency contraception is rare, despite its high efficacy and long-lasting contraceptive benefits. Recommendation would require clinic flow and scheduling adjustments to allow same-day IUD insertions. Patient-centered and high-quality care for emergency contraception should include a discussion of the most effective method., Level of Evidence: III.
- Published
- 2012
- Full Text
- View/download PDF
3. Challenges in translating evidence to practice: the provision of intrauterine contraception.
- Author
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Harper CC, Blum M, de Bocanegra HT, Darney PD, Speidel JJ, Policar M, and Drey EA
- Subjects
- Abortion, Induced, Age Factors, California, Counseling, Data Collection, Female, Humans, Logistic Models, Male, Middle Aged, Nurse Practitioners, Parity, Physician Assistants, Physicians, Pregnancy, Health Knowledge, Attitudes, Practice, Health Personnel, Intrauterine Devices
- Abstract
Objective: Intrauterine contraception is used by many women worldwide, however, it is rarely used in the United States. Although available at no cost from the state family planning program for low-income women in California, only 1.3% of female patients obtain intrauterine contraceptives annually. This study assessed knowledge and practice patterns of practitioners regarding intrauterine contraception., Methods: We conducted a survey among physicians, nurse practitioners, and physician assistants (n=1,246) serving more than 100 contraceptive patients per year in the California State family planning program. The response rate was 65% (N=816). We used multiple logistic regression to measure the association of knowledge with clinical practice among different provider types., Results: Forty percent of providers did not offer intrauterine contraception to contraceptive patients, and 36% infrequently provided counseling, although 92% thought their patients were receptive to learning about the method. Regression analyses showed younger physicians and those trained in residency were more likely to offer insertions. Fewer than half of clinicians considered nulliparous women (46%) and postabortion women (39%) to be appropriate candidates. Evidence-based views of the types of patients who could be safely provided with intrauterine contraception were associated with more counseling and method provision, as well as with knowledge of bleeding patterns for the levonorgestrel-releasing intrauterine system and copper devices., Conclusion: Prescribing practices reflected the erroneous belief that intrauterine contraceptives are appropriate only for a restricted set of women. The scientific literature shows intrauterine contraceptives can be used safely by many women, including postabortion patients. Results revealed a need for training on updated insertion guidelines and method-specific side effects, including differences between hormonal and nonhormonal devices., Level of Evidence: III.
- Published
- 2008
- Full Text
- View/download PDF
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