Implementation of a training protocol on intrauterine device insertion for resident physicians
DOI:
https://doi.org/10.33448/rsd-v10i5.14794Keywords:
Contraception; Family planning; Intrauterine devices; Inservice training; Family health strategy.Abstract
Objective: To implement a training protocol on intrauterine device (IUD) insertion for resident physicians to improve women’s access to this method. Methods: The staff identified poor access to family planning, in Vila Lobato health center, specially to IUD, there were only 15 IUD insertions in 2015. This implementation research evaluated and identified the barriers of access to IUD use. Then, stakeholders and staff defined the access flow of patients to the health unit and, eventually, the training provided to resident physicians in gynecology and obstetrics (GO) and family medicine (FM). This is a retrospective cohort of the IUD insertions performed by residents between 2016 and 2018. Results : 252 copper IUDs were inserted from 2016 to 2018 and there was a progressive increase in the number of insertions (45 in 2016, 80 in 2017, and 126 in 2018). Thirty-four (16.4%) inadequate insertions and 15 (8.6%) expulsions were observed. There was no case of uterine perforation. Conclusion: The implementation of the protocol on IUD insertion for residents in the primary care setting increased the local number of IUD insertion and might be a strategy to improve the access to the contraceptive method.
References
Aoun, J., Dines, V. A., Stovall, D. W., Mete, M., Nelson, C. B., & Gomez-Lobo, V. (2014). Effects of age, parity, and device type on complications and discontinuation of intrauterine devices. Obstetrics and Gynecology, 123(3), 585–592. https://doi.org/10.1097/AOG.0000000000000144
Buhling, K. J., Hauck, B., Dermout, S., Ardaens, K., & Marions, L. (2014). Understanding the barriers and myths limiting the use of intrauterine contraception in nulliparous women: Results of a survey of European/Canadian healthcare providers. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 183, 146–154. https://doi.org/10.1016/j.ejogrb.2014.10.020
Buhling, K. J., Zite, N. B., Lotke, P., Black, K., & INTRA Writing Group. (2014). Worldwide use of intrauterine contraception: A review. Contraception, 89(3), 162–173. https://doi.org/10.1016/j.contraception.2013.11.011
David H P, Nhan TT, Taghreed A.Alliance for Health Policy and Systems Research, World Health Organization. Implementation Research in Health—A Practical GUide. 2013. Available: Https://www.who.int/alliance-hpsr/resources/implementationresearchguide/en/. (n.d.).
Dermish, A., Turok, D. K., Jacobson, J., Murphy, P. A., Saltzman, H. M., & Sanders, J. N. (2016). Evaluation of an intervention designed to improve the management of difficult IUD insertions by advanced practice clinicians. Contraception, 93(6), 533–538. https://doi.org/10.1016/j.contraception.2016.01.011
Dibaba, Y., Fantahun, M., & Hindin, M. J. (2013). The effects of pregnancy intention on the use of antenatal care services: Systematic review and meta-analysis. Reproductive Health, 10, 50. https://doi.org/10.1186/1742-4755-10-50
Garcia-Rodriguez, J. A., & Donnon, T. (2016). Using Comprehensive Video-Module Instruction as an Alternative Approach for Teaching IUD Insertion. Family Medicine, 48(1), 15–20.
Geary, M., Prifti, C., & Bachorik, A. (2017). Residency Training in Long-Acting Reversible Contraceptive Methods. JAMA Internal Medicine, 177(7), 1061–1062. https://doi.org/10.1001/jamainternmed.2017.2101
IBGE, 2019. Ribeiraão Preto-SP. https://www.ibge.gov.br/cidades-e-estados/sp/ribeirao-preto.html, Acesso em 24/02/2020. (n.d.).
Jatlaoui, T. C., Riley, H. E. M., & Curtis, K. M. (2017). The safety of intrauterine devices among young women: A systematic review. Contraception, 95(1), 17–39. https://doi.org/10.1016/j.contraception.2016.10.006
Kantorová, V., Wheldon, M. C., Ueffing, P., & Dasgupta, A. N. Z. (2020). Estimating progress towards meeting women’s contraceptive needs in 185 countries: A Bayesian hierarchical modelling study. PLOS Medicine, 17(2), e1003026. https://doi.org/10.1371/journal.pmed.1003026
Kemeny, F., Digiusto, E., & Bateson, D. (2016). Insertion of intrauterine contraceptive devices by registered nurses in Australia. The Australian & New Zealand Journal of Obstetrics & Gynaecology, 56(1), 92–96. https://doi.org/10.1111/ajo.12427
Khan, M. N., Harris, M. L., Shifti, D. M., Laar, A. S., & Loxton, D. (2019). Effects of unintended pregnancy on maternal healthcare services utilization in low- and lower-middle-income countries: Systematic review and meta-analysis. International Journal of Public Health, 64(5), 743–754. https://doi.org/10.1007/s00038-019-01238-9
Laporte, M., Becerra, A., Castro, L., Veiga, N., Espejo-Arce, X., & Bahamondes, L. (2020). Evaluation of clinical performance when intrauterine devices are inserted by different categories of healthcare professional. International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics. https://doi.org/10.1002/ijgo.13396
Luchowski, A. T., Anderson, B. L., Power, M. L., Raglan, G. B., Espey, E., & Schulkin, J. (2014). Obstetrician-gynecologists and contraception: Long-acting reversible contraception practices and education. Contraception, 89(6), 578–583. https://doi.org/10.1016/j.contraception.2014.02.004
Martínez, F., Parra, I., Andeyro, M., Cristobal, I., & Quílez, J. C. (2019). Barriers to the use of intrauterine devices among healthcare professionals: Evidence against misconceptions. Progresos de Obstetricia y Ginecologia, 62(1), 63–71. Embase. https://doi.org/10.20960/j.pog.00171
Modesto, W., Bahamondes, M. V., & Bahamondes, L. (2014). A randomized clinical trial of the effect of intensive versus non-intensive counselling on discontinuation rates due to bleeding disturbances of three long-acting reversible contraceptives. Human Reproduction (Oxford, England), 29(7), 1393–1399. https://doi.org/10.1093/humrep/deu089
Nippita, S., Haviland, M. J., Voit, S., Peralta, J. P., Hacker, M. R., & Paul, M. E. (2015). Comfort and Competency With Intrauterine Contraception Insertion: A Randomized Controlled Trial [226]. Obstetrics & Gynecology, 125, 73S-74S. https://doi.org/10.1097/01.AOG.0000463151.05205.32
Ortiz, M. E., & Croxatto, H. B. (2007). Copper-T intrauterine device and levonorgestrel intrauterine system: Biological bases of their mechanism of action. Contraception, 75(6 Suppl), S16-30. https://doi.org/10.1016/j.contraception.2007.01.020
Ouyang, M., Peng, K., Botfield, J. R., & McGeechan, K. (2019). Intrauterine contraceptive device training and outcomes for healthcare providers in developed countries: A systematic review. PloS One, 14(7), e0219746. https://doi.org/10.1371/journal.pone.0219746
Peipert, J. F., Zhao, Q., Allsworth, J. E., Petrosky, E., Madden, T., Eisenberg, D., & Secura, G. (2011). Continuation and satisfaction of reversible contraception. Obstetrics and Gynecology, 117(5), 1105–1113. https://doi.org/10.1097/AOG.0b013e31821188ad
Romero, D., Maldonado, L., Fuentes, L., & Prine, L. (2015). Association of reproductive health training on intention to provide services after residency: The family physician resident survey. Family Medicine, 47(1), 22–30.
Stewart, M., Digiusto, E., Bateson, D., South, R., & Black, K. I. (2016). Outcomes of intrauterine device insertion training for doctors working in primary care. Australian Family Physician, 45(11), 837–841.
Thompson, K. M. J., Rocca, C. H., Kohn, J. E., Goodman, S., Stern, L., Blum, M., Speidel, J. J., Darney, P. D., & Harper, C. C. (2016). Public Funding for Contraception, Provider Training, and Use of Highly Effective Contraceptives: A Cluster Randomized Trial. American Journal of Public Health, 106(3), 541–546. https://doi.org/10.2105/AJPH.2015.303001
Trussell, J. (2011). Contraceptive failure in the United States. Contraception, 83(5), 397–404. https://doi.org/10.1016/j.contraception.2011.01.021
Trussell, J., Henry, N., Hassan, F., Prezioso, A., Law, A., & Filonenko, A. (2013). Burden of unintended pregnancy in the United States: Potential savings with increased use of long-acting reversible contraception. Contraception, 87(2), 154–161. https://doi.org/10.1016/j.contraception.2012.07.016
WHO: Family planning/contraception methods. 2020. Available in: Https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Sérgio Henrique Pires Okano; Bruna Maria Bonatti da Silva Felipe; Giordana Campos Braga
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
