番茄社区

AUSTIN, Texas -- Barriers to ob/gyn residents' experience in placing long-acting reversible contraception (LARC) tended to vary both by region and year of residency, researchers said here.

Residents cited financial barriers, religious affiliation, institutional policy, and perception of patient demand as barriers, though those tended to vary by region of the country, reported Megan Evans, MD, of Tufts Medical Center in Boston, and colleagues.

Performing an intra-uterine and implantable contraceptive placement and managing complications of contraceptive methods and pregnancy termination are two milestones for ob/gyn residents. Moreover, data shows that 12% of U.S. women use either the IUD or the implant, she said in a presentation at the American College of Obstetricians and Gynecologists (ACOG) annual meeting.

Her group conducted an electronic survey that was distributed to all residents taking the annual ob/gyn resident-in-training examination in January 2016. Included were five questions about LARC education in residency:

• Number of IUDs inserted in training
• Number of implants inserted in training
• Experience with immediate postpartum LARC
• Personal/partner contraception use
• Barriers preventing learning about LARC

Overall, 4,284 responses were included out of 4,322 eligible U.S. residents, for a response rate of 99%. Of these, over 80% identified as female, about two-thirds attended university-based programs, over half were married, and around 60% were white.

About two-thirds of residents said they had only placed 1-10 IUDs as PGY1, but by PGY4, almost 40% placed 25-50. When examining by U.S. census region, a little under 40% of PGY4 residents in the West region had placed over 51 IUDs.

But there were still 10% of PGY4 residents who had done only 1-10 IUD insertions and 8% who had done no implant insertions.

Lack of patient interest was cited as a barrier by about a quarter of residents in all regions. Financial barriers, such as being cost prohibitive for the patient or for the hospital or clinic not being able to stock the device, were cited by 40% of residents in the South. Institutional policy and religious affiliation were cited by about a quarter of residents apiece from the Midwest.

"Some residency programs have very strong affiliations with religious organizations that prohibit them from placing these devices in the hospital or clinical setting," Evans told 番茄社区.

She further noted that the question on personal and partner contraception use was addressed in a recently published analysis that found IUDs were the most commonly used contraception method, and that residents who had an IUD themselves were more likely to have performed IUD insertion.

Evans said future directions for the research will include state polices and their impact on LARC insertion in training, as well as evaluating solutions to barriers for LARC training.