Evidence-based selection of candidates for the levonorgestrel intrauterine device (IUD)

Lisa S. Callegari, Blair G. Darney, Emily M. Godfrey, Olivia Sementi, Rebecca Dunsmoor-Su, Sarah W. Prager

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Background: Recent evidence-based guidelines expanded the definition of appropriate candidates for the levonorgestrel-releasing intrauterine system (LNG-IUS). We investigated correlates of evidencebased selection of candidates for the LNG-IUS by physicians who offer insertion. Methods: We conducted a mixed-mode (online and mail) survey of practicing family physicians and obstetrician-gynecologists in Seattle. Results: A total of 269 physicians responded to the survey (44% response rate). Of the 217 respondents who inserted intrauterine devices, half or fewer routinely recommended the LNG-IUS to women who are nulliparous, younger than 20 years old, or have a history of sexually transmitted infections (STIs). In multivariable analyses, training/resident status was positively associated with recommending the LNG-IUS to women <20 years old (adjusted odds ratio [aOR], 3.6; 95% confidence interval [CI], 1.6-8.0) and women with history of STI (aOR, 3.7; 95% CI, 1.6-8.4). Perceived risk of infection or infertility was negatively associated with recommending the LNG-IUS to nulliparous women (aOR, 0.2; 95% CI, 0.1- 0.5) and women with a history of STI (aOR, 0.3; 95% CI, 0.1- 0.8). Conclusions: Many family physicians and obstetrician-gynecologists who insert the LNG-IUS are overly restrictive in selecting candidates, although those who train residents are more likely to follow evidence-based guidelines. Interventions that address negative bias and perceptions of risks, in addition to improving knowledge, are needed to promote wider use of the LNG-IUS.

Original languageEnglish (US)
Pages (from-to)26-33
Number of pages8
JournalJournal of the American Board of Family Medicine
Volume27
Issue number1
DOIs
StatePublished - Jan 2014

Keywords

  • Contraception
  • Evidence-based Medicine
  • Graduate Education
  • Intrauterine Devices

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice

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