MN 561 Contraceptive counseling Discussion

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MN 561 Contraceptive counseling Discussion

MN 561 Contraceptive counseling Discussion



Contraceptive counseling provides education, dispels
misinformation, facilitates selection of a method that will be successful for
the individual, and encourages patient involvement in healthcare decisions and
life goals. Discussing contraception brings the nurse practitioner and patient
together to create a tailored plan that meets the individual’s reproductive
needs over a lifetime.

Discuss any clinical encounters that you may have had
relating to contraception. How did you counsel patients on their choices and
possible risks? Describe how you would explain the differences to your patients
in the long acting reversal contraceptive devices.

DQ2 Topic 2: Sexuality

Sexuality affects individuals and society across a broad
spectrum of activities through health, but also through factors at multiple
levels, such as gender relations, reproduction, and economics. Physiologic,
behavioral, and affective measurement of sexuality and sexual behavior is
complicated by cultural values and norms but is essential to individual health
(including happiness) as well as public health. Cultural or structural norms
that stigmatize aspects of sexuality, such as sexual orientation, have adverse
effects on individuals across their lifespan, with homophobia being a prominent
example of such.

Discuss how one’s age, race, lifestyle, and demographics
have an impact on your choice to complete a sexual history when working in the
primary care setting with women across a lifespan.

This study of over 700 women in western Pennsylvania found that women who received contraceptive counseling from a primary care provider were significantly more likely than those who did not to subsequently report use of hormonal contraception the last time they had intercourse. These findings provide further support that contraceptive counseling by clinicians improves women’s contraceptive use  and provide evidence that PCPs can play an important role in promoting contraception use. Efforts to expand provision of contraceptive counseling in primary care settings may help reduce unintended pregnancies .

Strengths of this study include its large sample size, the use of EMR data to determine prior evidence of contraception, and the inclusion of clinics that serve both privately and publicly insured women in both academic and community-based primary care settings. While the survey response rate was relatively low, women who completed surveys were similar to those who did not.

When interpreting these results, there are important limitations to consider. As this was a secondary analysis of data collected to evaluate clinical decision support, we were unable to determine whether participants’ last intercourse occurred before or after the index clinic visit. However, prior studies indicate that the majority of women aged 18–50 have sex at least monthly ,. Since surveys were completed up to 30 days after women visited their primary care clinic, for most women the last episode of intercourse likely followed receipt of counseling. Our results are subject to recall bias because women were asked to provide details of counseling that occurred a week or more prior to the survey. There is the possibility that women who chose to use a contraceptive method were more likely to recall receiving counseling. There is also the chance women’s need for contraceptive counseling may have been misclassified.

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Some women we considered “in need of counseling” may have already been using adequate contraception prior to their survey visit. Others may have been inconsistently using the contraception documented in their EMR, as 15% of women we considered in less need of contraceptive counseling reported use of no contraception at last intercourse. By comparing the survey and EMR data when classifying women, we aimed to reduce misclassification bias. Although we controlled for several important variables that influence contraceptive use, other key covariates, such as a history of reproductive coercion, which has been negatively associated with contraceptive use , was not assessed in this survey. Finally, there was no way to account for whether the counseling was initiated by the patient or by the physician; patients seeking contraceptive counseling who initiated such discussions with their physician would be expected to be more likely to use contraception following their visit.

Future studies are needed to assess how frequency of contraceptive counseling, length of time devoted to counseling, and number of contraceptive methods discussed affect women’s subsequent contraceptive use. In addition, studies are needed that focus on the relationship between contraceptive counseling and contraceptive use among populations at high risk for unintended pregnancy. For example, studies that focus on minority and less-educated populations are needed as these women are at high risk of unintended pregnancy  but were less likely to complete this survey. Consideration should also be given to compensating clinicians for time spent providing contraceptive counseling, as many PCPs’ ability to provide contraceptive counseling is limited by time . In a previous study, 46% of private providers and at least 21% of public providers reported that providing insurance reimbursement for time spent counseling would be a very important way to increase their provision of contraceptive counseling .

In conclusion, we found that receipt of contraceptive counseling from a primary care provider was highly associated with reported use of hormonal contraception at last intercourse. Policy-makers, including the USPSTF, should be encouraged to support provision of contraceptive counseling in primary care settings.

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