Improving APRN Utilization of Long Acting Reversible Contraceptives in a Family Planning Clinic

Abstract

Current contraceptive clinical practice guidelines (CPGs) recommend the use of long acting reversible contraceptives (LARCs), the most effective contraceptives, to prevent unplanned pregnancy in women seeking contraceptive services. Despite this recommendation, healthcare providers worldwide prescribe moderately effective contraceptive methods more often than the most effective ones. Healthcare provider nonadherence to contraceptive CPGs have been attributed to provider, system, and patient level barriers. Nonadherence to evidence-based contraceptive CPGs contributes to poor long-term patient outcomes (i.e. unintended pregnancy and related sequala). An evidence-based practice change project was implemented at a family planning clinic in a local health department setting to increase Advanced Practice Registered Nurses’ (APRN’s) utilization of LARCs. A multicomponent intervention, consisting of one academic detailing session, implementation of four structured documentation templates, and a clinician reminder system, was implemented to improve the intermediate outcome of increasing APRNs utilization of LARCs in women at risk for unintended pregnancy. The multicomponent intervention caused changes in clinical structure and processes, which resulted in a 42% increase in APRNs utilization of LARCs 12 weeks post-intervention. Interventions designed not only to address identified provider level barriers, but system, and/or patient level barriers may increase APRNs’ integration of evidence-based CPGs recommendations into clinical practice.