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BACKGROUND Unintended pregnancy remains a serious public health challenge in the USA. We assessed the effects of an intervention to increase patients' access to long-acting reversible contraceptives (LARCs) on pregnancy rates. METHODS We did a cluster randomised trial in 40 reproductive health clinics across the USA in 2011-13. 20 clinics were randomly(More)
BACKGROUND Of the 1.3 million abortions performed annually in the United States, approximately half are repeat procedures. Immediate postabortal intrauterine device (IUD) insertion is a safe, effective, practical and underutilized intervention that we hypothesize will significantly decrease repeat unintended pregnancy and abortion. STUDY DESIGN All women(More)
BACKGROUND We hypothesize that barriers to IUD insertion are central to low utilization in the USA. This study evaluates methods to minimize barriers, including post-abortal insertion, staff training and simplified screening. STUDY DESIGN We obtained data on IUD utilization during three study periods: a control period (Period 1), a period after initiating(More)
BACKGROUND Almost one-half of women having an abortion in the United States have had a previous procedure, which highlights a failure to provide adequate preventive care. Provision of intrauterine devices and implants, which have high upfront costs, can be uniquely challenging in the abortion care setting. OBJECTIVE We conducted a study of a clinic-wide(More)
Medicine is in constant change, with new evidence continually replacing how we consider health and illness. In health care we are deluged with articles about change — how to accomplish it, how to measure it, how to sustain it. Patients have become more robust advocates. With the proliferation of new medications and data, both patients and clinicians must(More)
BACKGROUND Three family medicine residency programs in California integrated abortion training into routine gynecology rotations in academic years 2003-2004 and 2004-2005. METHODS Forty-six (88%) of 52 eligible residents participated in the abortion training sessions. Of these 46 residents, 39 (85%) chose to perform abortion procedures, and seven(More)
BACKGROUND AND OBJECTIVES Family physicians and obstetrician-gynecologists provide much of contraceptive care in the United States and have a shared goal in preventing unintended pregnancy among patients. We assessed their competency to offer women contraceptives of the highest efficacy levels. METHODS We conducted a national probability survey of family(More)
OBJECTIVES To apply principles of shared decision-making to EPF management counseling. To present a patient treatment priority checklist developed from review of available literature on patient priorities for EPF management. METHODS Review of evidence for patient preferences; personal, emotional, physical and clinical factors that may influence patient(More)
OBJECTIVES We determined whether public funding for contraception was associated with long-acting reversible contraceptive (LARC) use when providers received training on these methods. METHODS We evaluated the impact of a clinic training intervention and public funding on LARC use in a cluster randomized trial at 40 randomly assigned clinics across the(More)
BACKGROUND With 1.1 million US women having first-trimester abortions annually, clinicians have an opportunity to diagnose molar pregnancy early. Early moles, however, may lack "classic" diagnostic hallmarks. STUDY DESIGN This study aimed to assess the accuracy of the diagnosis of hydatidiform mole in women seeking abortion services at a large Planned(More)