Contraception in the ED: Understanding Education and Opportunities for Clinicians to Advise Patients

The United States faces a high rate of unwanted pregnancies. Despite this, many people continue to face barriers to accessing contraception. The emergency department (ED) can help bridge these gaps, but emergency clinicians must first feel comfortable offering contraceptive services. In this study, we sought to determine emergency clinician comfort in prescribing contraceptives and educating patients on their use. We also gauged clinician interest in receiving education specifically geared toward contraceptive care.

We conducted an online survey of ED residents, attendings, and advanced practice clinicians at Thomas Jefferson Univerity Hospital and affiliates in both the urban and suburban setting. Questions focused on current practices and interest in an educational session on contraceptive care in the ED.

We received 106 responses representing clinicians from 12 hospitals (estimated response rate 20%). While 61% of respondents reported that they offered contraceptive services less than once a month, 64% reported they were comfortable educating patients on the topic and 51% were comfortable providing prescriptions. Of those comfortable prescribing, 84% stated they would be more comfortable after an educational session, while 58% of those currently not comfortable prescribing believed that education would help (P < .01). Perceived benefit of education was also dependent on age, with clinicians < 35 years of age more likely to perceive a benefit (P < .01), and job title, with residents more likely to perceive a benefit (P = .04).

Our data suggest that many emergency clinicians are open to offering contraceptive services, but lack of education may serve as a barrier. Although limited by self-selection bias, this study demonstrates a robust interest in overcoming this barrier within our sample group. Future work will aim to implement clinician education and assess for translation to clinical practice with the goal of increasing access to contraceptive services.