Article Figures & Data
Figures
- Figure 1.
Knowledge, attitude, and practice survey questions. Mirena is the trade name for releasing levonorgestrel intrauterine system releasing 20 μg/day. IUD, intrauterine device; PID, pelvic inflammatory disease; STI, sexually transmitted infection. FDA, US Food and Drug Administration.
Tables
- Table 1. Sample Characteristics of Physicians Who Insert the Levonorgestrel Intrauterine System (LNG-IUS) (n = 217)
Demographic and practice characteristics Female gender 157 (72.4) Specialty Family physician 132 (60.8) Obstetrician-gynecologist 85 (39.2) Practice setting Academic 43 (19.8) Private practice 122 (56.2) Public health 47 (21.7) Trains residents or fellows 141 (65.0) ≥10 years since residency 134 (61.8) ≥10 LNG-IUSs inserted/year 96 (44.2) Knowledge General, answered correctly LNG-IUS failure rate 177 (81.6) LNG-IUS FDA-approved duration of use 198 (91.2) Perfect score on 2 general knowledge items 163 (75.1) Complications, answered correctly Infertility after removal 206 (94.9) Increased risk for PID ≥20 days after insertion 198 (91.2) Increased risk for PID <20 days after insertion 125 (57.6) Increased risk of STI 195 (89.9) Increased risk of ectopic pregnancy 123 (56.7) Complications score, mean number answered correctly out of 5 (SD)* 3.9 (0.93) Attitudes Factors that negatively influence decision to recommend LNG-IUS, answered yes Increased risk of PID/STIs/infertility 48 (22.1) Cramping/pain side effect 25 (11.5) Irregular bleeding side effect 69 (31.8) Medical liability 4 (1.8) Cost 47 (21.7) Practice Routinely recommend LNG-IUS for the following patients, answered yes Nulliparous women 121 (55.8) Women with a history of STIs/PID 82 (37.8) Women with a history of ectopic pregnancy 81 (37.3) Women <20 years old 80 (36.9) Data are n (%).
↵* Complications score is calculated from number of correct answers on the 5 questions listed.
PID, pelvic inflammatory disease; SD, standard deviation; STI, sexually transmitted infection; FDA, US Food and Drug Administration.
- Table 2. Factors Associated With Physicians Routinely Recommending the 20-μg/day Levonorgestrel Intrauterine System (LNG-IUS) to 4 Patient Types: Multivariable Logistic Regression Models
Patient Types* Nulliparous Women Adolescents (age <20) Women With a History of STIs or PID Women With a History of Ectopic Pregnancy Physician demographics and practice characteristics Family physician† 1.59 (0.68–3.57) 1.45 (0.66–2.78) 1.72 (0.77–3.85) 0.53 (0.24–1.16) Academic practice setting‡ 1.32 (0.51–3.46) 0.99 (0.43–2.30) 0.97 (0.40–2.33) 0.75 (0.31–1.85) Greater than 10 years since residency 0.44 (0.21–0.93)§ 0.73 (0.37–1.45) 0.76 (0.37–1.53) 0.93 (0.45–1.91) Female sex 2.14 (0.97–4.74) 0.92 (0.43–1.96) 0.90 (0.40–2.01) 1.24 (0.56–2.79) Trains residents/fellows 1.95 (0.88–4.30) 3.56 (1.58–8.04)§ 3.71 (1.64–8.43)§ 3.05 (1.32–7.01)§ More than 10 LNG-IUS inserted per year 1.50 (0.67–1.53) 1.50 (0.70–3.20) 2.28 (1.04–5.01)§ 1.11 (0.51–2.42) Knowledge about LNG-IUS Perfect score on 2 item general knowledge 2.39 (1.09–5.25)§ 1.62 (0.73–3.60) 1.57 (0.69–3.56) 1.15 (0.51–2.61) Complications score‖ (continuous out of 5) 1.02 (0.68–1.53) 1.11 (0.76–1.63) 0.96 (0.64–1.43) 1.84 (1.18–2.88)§ Perceived factors that negatively influence recommending LNG-IUS, answered yes Cost 0.76 (0.33–1.74) 0.44 (0.19–1.02) 1.39 (0.60–3.21) 0.92 (0.39–2.16) Irregular bleeding 0.40 (0.18–0.88)§ 1.42 (0.66–3.04) 0.56 (0.25–1.24) 1.30 (0.59–2.87) Cramping/pain 1.04 (0.33–3.29) 0.56 (0.18–1.69) 0.33 (0.09–1.20) 0.30 (0.08–1.11) Risk of infertility/STIs/PID 0.19 (0.08–0.45)§ 0.85 (0.36–2.00) 0.30 (0.11–0.77)§ 0.38 (0.15–0.98)§ Data are adjusted odds ratios (95% confidence intervals).
↵* Logistic regression models adjust for all variables in the table (n = 186 for all models).
↵† Reference is obstetrician-gynecologist.
↵‡ Reference is nonacademic practice settings.
↵§ P < .05.
↵‖ The complications score is calculated from number of correct answers on 5 questions regarding infertility, PID, STI, and ectopic pregnancy risks of LNG-IUS use.
PID, pelvic inflammatory disease; STI, sexually transmitted infection.
