Document Type

Doctoral Project

Publication Date



In an urban, publicly funded women’s health and family planning clinic, 56% of pregnancies were reported to be unintended. The clinic director decided to address this problem by focusing on providers’ contraceptive prescribing habits; especially contraceptive prescribing for women aged 15-25. The purpose of the evidence-based practice improvement (EBPI) project was to increase provider disclosure about longer-acting reversible contraception (intrauterine and implantable methods known as “LARC” methods). The goal of the EBPI project was to increase the percentage of contraceptive prescriptions that are LARC methods for women aged 15-25 years. The clinical question guiding the EBPI project was “Among healthcare providers in a public health clinic, how does utilization of an evidence-based toolkit for providers, staff, and patients about long acting reversible contraception (LARC), compared to no intervention, affect the percentage of LARC prescriptions among all contraceptive prescriptions written for women ages 15-25 over three months?” The intervention was a toolkit utilizing components created and utilized by The Contraceptive Choice Project that had demonstrated increased LARC prescribing and utilization in a similar Mid-western city. The toolkit addressed specific prescribing barriers that were identified through an internal survey and a literature search. The Evidence-Based Practice Improvement (EBPI) framework guided the EBPI project. This framework included rapid cycling in which the intervention was regularly evaluated and adjusted with the goal of eventually realizing an intervention that would sustain the goal of increasing LARC prescribing for women ages 15-25. The anticipated outcome was an increase in the percent of long-acting reversible contraceptives out of all contraceptives prescribed. Because the patient population was small overall, the EBPI project team decided to collect data on women of all ages, but to separately calculate the EBPI project outcomes for women ages 15-25. The outcome was an increase (from 6% to 20%) in LARC prescribing for patients’ ages 15-25, but a decrease in LARC prescribing for patients older than age 26 (from 23% to 12.5%). Changes in providers’ opinions were also measured with before and after surveys. Findings from these surveys included an increase in consistency of language to describe LARC methods, and recognition of the availability of LARC methods at the site. Concerns about difficult method insertions and the side effect of unpredictable bleeding persisted.

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