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Do gaps remain at your facility when it comes to providers’ knowledge about emergency contraception (EC)? If so, now is the time to take advantage of a newly updated teaching curriculum and supporting materials from the Washington, DC-based Association of Reproductive Health Professionals (ARHP).
ARHP’s continuing medical education-accredited "Train the Trainer" emergency contraception program for health care providers started its new phase in August 2001, says Wayne Shields, ARHP president. The program was launched in 1999 with a grant from the David and Lucile Packard Foundation in Los Altos, CA, with updates supported through the Reproductive Health and Rights Program of the Open Society Institute, a New York City-based private operating and grant-making foundation, and Women’s Capital Corp. of Bellevue, WA, manufacturers of Plan B, the levonorgestrel-only emergency contraceptive pill (ECP). Both the teaching curriculum and the supporting materials have been revised to include new advances and recent data. They are available free of charge on ARHP’s web site, www.arhp.org.
The original "Train the Trainer" program featured a formal training session for a clinical faculty representing 44 states. Faculty members presented educational sessions in their home regions, says Shields. To date, more than 10,000 health care providers in the United States and overseas have participated in some form of training based on the ARHP-sponsored curriculum, he states.
ACOG revises EC recommendations
The Washington, DC-based American College of Obstetricians and Gynecologists also has revised its recommendations to physicians regarding the safety and efficacy of prescription EC. It issued a practice bulletin in February 2001, which includes charts on how to combine common prescription oral contraceptives in dosages that provide EC, and information on the two available designated ECPs, Preven (Gynétics, Belle Mead, NJ) and Plan B.
Look for a final report from an EC summit convened in December 2000 by ARHP, which will feature innovative approaches to reach health care providers with messages about emergency contraception. At press time, the report was scheduled for release in September 2001, according to Shields.
Also, check with ARHP about the limited number of "Train the Trainer" sessions scheduled for this fall and again in 2002. For more information about the program, providers may contact ARHP at (202) 466-3825.
Gaps in learning
Why is it so important to offer provider education when it comes to EC? Analysis of a survey of health care providers from 13 San Diego County Kaiser Permanente medical offices shows that while providers who participated in an EC education project showed changes in perceptions, knowledge, and behavior about the method, gaps remained in their knowledge regarding medications, side effects, and mode of action.1
The Kaiser Permanente program was designed to introduce EC as a new service option in the health maintenance organization. (Contraceptive Technology Update reviewed the pilot project in its May 1997 issue, p. 56.) Health care providers completed self-administered questionnaires before and one year after full implementation of the project. More than 60% of the providers who completed both questionnaires were physicians and midlevel professionals who worked in departments such as obstetrics and gynecology, primary care, and emergency medicine.
The frequency of prescription for emergency contraceptive pills (ECPs) increased significantly from baseline to follow-up, according to the survey results. Findings reflected an almost 20% increase in the percentage who prescribed EC at least once a year. While many providers increased their knowledge about the safety and effectiveness of the method, just 13% were aware of all the oral contraceptives recommended for EC, and only 27% could correctly identify the common side effects of ECPs, according to the survey results.
Provider education is critical
Provider education is an important part in the continued success of EC, says Marie Harvey, DrPH, professor and director of research of the Center for the Study of Women in Society at the University of Oregon in Eugene. Harvey served as co-author for the recently published analysis.
"I do feel very strongly that educating providers and having providers knowledgeable of this method, prescribing it for women when they need it and when they don’t need it to have as a backup, is essential until it can go over the counter or [be offered through pharmacist collaborative practice]," Harvey notes. "But as long as the method has to be prescribed by a provider, if providers aren’t aware of this method and/or aren’t willing to prescribe it to their patients, then it certainly isn’t going to make the impact we all hope that it will on preventing unintended pregnancies."
1. Beckman LJ, Harvey SM, Sherman CA, et al. Changes in providers’ views and practices about emergency contraception with education. Obstet Gynecol 2001; 97:942-946.