Even though long-acting reversible contraceptives (known as LARCs) such as IUDs have been proven to be the most effective reversible means of pregnancy prevention, LARCs are still by no means the most widely used form of birth control.
However, despite increasing patient and physician education, there remain obstacles in achieving the widespread adoption of LARCs. One such factor which may influence education and adoption of LARCs, it has emerged, are simulators which may be able to advance the use and understanding of these devices.
There is also increasing evidence connecting simulator training for physicians to a rise in LARC usage and a decrease in unwanted pregnancies, to corroborate this relationship. Indeed, it seems apparent that this nexus between simulators, training and modes of contraception holds vast potential to change both patient and physician approach to contraceptive education.
The University of Oklahoma’s Fall/Winter 2017 publication on OU Medicine featured an article entitle “College Uses Simulation to Train Physicians on Use of LARCS.” Dr. Bratzler, D.O., MPH, an associate dean at Oklahoma’s College of Public Health, is identified in the accompanying photograph, and shown using VirtaMed’s GynoS™ to demonstrate the placement of an intrauterine device (IUD).
Though the photograph was arresting, the article offered a fascinating glimpse into this technology. In both Oklahoma City and Tulsa, the Oklahoma Health Care Authority (OHCA) and private donors have collaborated with a team of physicians at OU campuses. This group are aiming to implement an initiative which would train community health care providers on the use of LARCs, primarily IUDs. Over 12 sessions in both Oklahoma City and OU’s Tulsa campus, attendees undertook training which taught them how to insert five current market-leading IUDs using both low- and high-fidelity pelvic simulators.
This collaborative endeavor is based on the shared hope of doctors, donors, and state officials that in physician and practitioner education on LARC usage, as well as increasing the number of practitioners trained in their placement, the uncommonly high rate of teen pregnancy in Oklahoma will decrease.
The Link Between Pregnancy Rates and LARCs
The National Bureau of Economic Research (NBER) and the Centers for Disease Control and Prevention (CDC), among others, conducted research to prove that LARCs provide the most effective means of preventing unwanted pregnancy. The study demonstrates that teen birth rates went down almost by 5% when LARCs are more readily available to patients.
Clarification ensues, in the publication of the report as of June 2015, that “over three- quarters of teen births are unintended at conception and that over a third of unplanned births are to women using contraception.”
Despite the correlation between increased ARC usage and a reduction in unwanted pregnancies and births, there are multiple challenges which come with affording patients ready access to LARCs. The higher per-unit cost of LARCs as opposed to the free structure for other modes of contraception like birth control pills, the ring and the patch, can affect whether or not a clinic keeps the devices stocked. In part, this may be due to patients being less inclined to choose the option which necessitates a higher upfront payment.
In addition, given the fact that fewer practitioners are properly trained in the use and implementation of LARCs, patients are often asked to schedule a follow-up appointment for the IUD or implant insertion. This waiting and scheduling of an appointment has resulted in many patients opting out of IUD use altogether. Contraception Magazine undertook a 2012 study which demonstrated that the two-appointment protocol for IUD insertion resulted in only 54.4% of follow-through – that is, patients who had the IUD inserted.
This demonstrates the critical need for simulation training. If more healthcare providers were sufficiently trained and could provide a same-day insertion service a significant hurdle to widespread adoption of IUDS could be eliminated. A further opportunity is offered here to reverse misinformation and misconceptions about IUDS, which permits the trained health care providers to educate the patients population about IUDs.
Other States, Other Rates
The Oklahoma initiative is not without precedent, nor is it the only state of its kind attempting to redress unwanted teen pregnancies and births with simulation training. Cosmopolitan and Vox both wrote separately in 2016 about how simulator training is integral to the same-day IUD-insertion protocol, and the potential impact this might have in contraceptive methods and women’s’ health.
Upstream USA is a not-for-profit organization which offers simulator training on IUD insertion to providers around the country. They have reported increased LARC usage as a result of their efforts. The percentage of women choosing and receiving IUDs is increasing: from Texas, where the teen pregnancy rate declines slower than the national average, to Delaware, which has the nationally highest rate of unwanted births (ages 15 to 44).
This increase in IUD adoption is a positive step for reducing unwanted pregnancies and births, particularly in light of the fact that, according to the American College of Obstetricians and Gynecologists, LARCs like IUDs are 20 times more effective than other methods of birth control.
Back in Oklahoma
Whether in Oklahoma or anywhere around the world, attempting to find solutions to unwanted teen pregnancies and births offers multiple challenges. Oklahoma, a state with one of the highest national rates of unintended pregnancies, and which offers no public school sexual education, thus seems an ideal place to stage widespread training and dynamic thinking around LARC use.
Though it is still too early to know the effect these initiatives will have, and indeed whether funding will continue for a second phase, it is hopeful that these measures will be a success. Lin Goldston, MHA, is the Operation and Administration director for the Clinical Skills Education and Testing Center, the site of much of the Oklahoma City training. Dr. Goldston commented to OA Medicine: “Empowering physicians to use LARCs has the potential to decrease that statistic.” Indeed, the use of VirtaMed’s GynoS™ as a progressive means by which to advance national progress in this matter appears to be an empowering step, for both patients and physicians alike.
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