Instructions:
* Read the article on page 236.
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Registration Deadline: April 1, 2019.
Disclosure Statement:
The authors and planners have disclosed that they have no financial relationships related to this article.
Provider Accreditation:
This activity is approved for 1.50 contact hour(s) of continuing education (which includes 0.0 hours of pharmacology) by the American Association of Nurse Practitioners. Activity ID 18033125. This activity was planned in accordance with AANP CE Standards and Policies.
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Payment:
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DOI: 10.1097/JXX.0000000000000054
Purpose: To provide an overview of barriers to utilization of long acting reversible contraception (LARC) and interventions to address them.
Learning Objectives/Outcomes: After completing this continuing education activity, you should be able to:
1. Distinguish the benefits of LARC as a contraceptive method.
2. List three categories of issues affecting LARC utilization and summarize research findings demonstrating each.
3. Identify the implications for education and practice.
1. The most common form of reversible contraception used in the United States is the
a. intrauterine device (IUD).
b. oral contraceptive pill.
c. contraceptive patch.
2. Two of the most effective choices for contraception available, with failure rates at <1%, are the hormonal implant and the
a. IUD.
b. oral contraceptive pill.
c. depot medroxyprogesterone acetate injection (DMPA).
3. What contraceptive method did Luchowski et al. (2014) find to be safe, cost effective, with minimal adherence issues, and the highest satisfaction and continuation among reversible methods?
a. LARC
b. oral contraceptives
c. DMPA
4. According to the Centers for Disease Control and Prevention, approximately what percentage of women in the United States use LARC?
a. 8%
b. 12%
c. 24%
5. Pace et al. (2016) found that two significant barriers exist to LARC provision: primary care clinics' reduced readiness for implementation of LARC services and
a. patient misconceptions.
b. the high cost of LARC services.
c. insufficient primary care provider training.
6. What did Luchowski et al. (2014) strongly correlate with increased hormonal implant insertion and knowledge of LARC?
a. residency training that included LARC
b. recent continuing education on LARC
c. geographic and socioeconomic demographics
7. The 2014 survey of 114 healthcare providers by Philliber et al. found that clinicians with the most years practicing were more likely to
a. be trained in LARC insertion.
b. be comfortable with LARC insertion procedures.
c. identify suitable candidates for LARC.
8. In the study by Kavanaugh et al. (2013), providers identified two common barriers to the provision of LARC in young adults: limited training and competence and
a. lack of provider infrastructure.
b. personal concerns about IUD use in the population.
c. privacy concerns with parental consent.
9. The Collier et al. (2014) study demonstrated that contraceptive implant use among low-income women was affected by
a. lack of federal funding.
b. patient resistance.
c. overly restrictive practice patterns.
10. In the 2015 Harper et al. study, compared with the control group, the clinics that received evidence-based training for LARC had
a. similar rates of counseling for LARC.
b. more women selecting short acting contraception.
c. a lower pregnancy rate.
11. The American Academy of Pediatrics endorses LARC methods
a. for adolescents with previous pregnancies only.
b. for the highest risk adolescents only.
c. as a first-line contraceptive choice for adolescents.
12. A survey of members of the Society of Adolescent Health and Medicine found the strongest predictor of LARC provision to be
a. type of insurance.
b. exposure to LARC training.
c. urban setting.
13. Bodurtha Smith et al. (2017) found that LARC was more likely to be provided to younger adolescents by providers who
a. were female.
b. were in training or newly practicing.
c. held advanced degrees.
14. Kelly et al. (2017) surveyed advanced practice registered nurses (APRNs) and found the biggest predictor of LARC placement was the
a. opportunity to receive LARC in one visit.
b. age of the patient.
c. APRN's academic training in LARC.
15. The authors conclude that, in order to increase LARC utilization, the makers of LARC devices share a responsibility to support
a. cost containment measures.
b. utilization and outcome research.
c. meaningful training and education.
16. The authors recommend that the reproductive health curriculum for NP programs should include didactic, guided training, and a minimum number of
a. mentor relationships.
b. hands on simulation-based insertion experiences.
c. clinical shadowing hours.
17. The authors suggest that provider level barriers to LARC would be best reduced by providing training in LARC methods to clinicians
a. prior to exiting the academic setting.
b. if they specialize in women's health.
c. when they start seeing adolescent patients.
18. Clinical LARC experts have projected that if barriers were removed,
a. more LARC methods would be developed.
b. younger patients would be more receptive to LARC.
c. the utilization of LARC would at least double.