Intrauterine contraception: evaluation of clinician practice patterns in Kaiser Permanente Northern California

BACKGROUND: Despite the medical evidence, few women of reproductive age in the United States use intrauterine contraception (IUC) in comparison with women worldwide. To reduce cost as a barrier, Kaiser Permanente removed the cost to the patient for IUC throughout California in 2002. The goal of this study was to evaluate whether providing evidence-based information about IUC would result in changes in the knowledge, attitudes and practice patterns of clinicians and in greater IUC utilization as compared with removing cost alone. STUDY DESIGN: A comprehensive education intervention was conducted in half of Kaiser Permanente Northern California ob-gyn departments. To make comparisons between the intervention and comparison sites, we surveyed clinicians in both groups before and after the intervention about their IUC knowledge, attitudes as well as practice patterns and collected utilization data for 27 months. RESULTS: Statistically significant changes in attitudes and practice patterns were reported by the intervention group as compared with the usual care comparison group. By the end of the study, change in IUC utilization was significantly greater in the intervention group (utilization rate=9.57/1000) as compared with the comparison group (utilization rate=7.35/1000) (p=.02). CONCLUSION: A multifaceted approach to providing evidence-based clinician and patient education resulted in statistically significant reported changes in attitudes and practice patterns and in greater IUC utilization as compared with usual practice.

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