Emergency departments as contraceptive safety nets: A mixed-methods clinician survey

Prior research has demonstrated that adolescent and adult patients are interested in receiving contraceptive care in the ED. We sought to determine knowledge, attitudes, and behaviors of ED clinicians towards contraceptive care and perceived barriers and challenges to providing contraception.

This was cross-sectional online survey of ED physicians and advanced practice providers across 5 Oregon EDs affiliated with a single health system, encompassing academic adult and pediatric, community, and critical access sites. The survey was developed collaboratively by ED and women's health experts and piloted for face validity. Analysis included calculation of counts, means, and percentages, and deductive content analysis of free-text comments.

Fifty people (26% of the practice population) responded to the questionnaire: 72% indicated that prescribing contraception was important and 78% felt it was feasible within their current practice; 24% reported being currently engaged in management of contraception in the ED. Only 73% of surveyed clinicians stated they currently offer emergency contraception; over 90% stated they currently provide or are willing to refill or initiate hormonal contraception. Those practicing at the academic sites were more likely to state that they initiate prescription hormonal therapy (28% vs 9%, p < 0.001) or would be willing to do so in the future (72% vs 45%, p < 0.001) and that they were willing to offer injectable hormonal contraception (89% vs 36%, p < 0.001). Most commonly identified barriers were concerns about adequate follow up, time to provide care, and training needs (e.g., medical indications for and contraindications to contraception).

Contraception provision was seen as important and feasible by many ED practitioners. Training and systems supports that could help EDs function as a contraceptive safety net for some patients were identified.