Providing Long-Acting Reversible Contraception in an Academic Family Medicine Center

Providing long-acting reversible contraception (LARC), which includes the intrauterine device (IUD) and the implant, falls within the scope of family medicine. The study objective was to describe 12-month rates of LARC continuation, LARC elective removal, and IUD expulsion in an academic family medicine center in New Jersey.

We conducted a retrospective electronic chart review of 219 LARC insertions that occurred from June 2009--May 2012. Life table analyses were used to determine 12-month rates of LARC continuation, elective removal, and IUD expulsion. To explore differences in outcomes based upon training level (faculty versus trainees), we conducted Cox proportional hazard models.

Of 219 LARC insertions, faculty performed 100 (45.7%), and trainees (residents and students) performed 119 (54.3%). The 12-month continuation rate for all devices was 78%. The elective removal rate at 12 months was 17%; trainee-placed devices were more likely to be electively removed than faculty-placed devices (HR 2.43, 95% CI=1.05--5.62). The IUD expulsion rate at 12 months was 7.0%; expulsion rates did not differ by level of training.

These data provide support for the fact that family physicians in an academic setting can provide LARC with continuation, elective removal, and IUD expulsion rates similar to those observed in outpatient specialist clinics without resident training. Potential causes for the higher removal rate associated with trainee-inserted devices should be further explored.