Norplant prescribing in family practice

Abstract

Background: This study describes the Norplant prescribing experience, training, and attitudes of South Carolina family practice and general practice (FP/GP) physicians.

Methods: A survey was mailed to all FP/GP physicians licensed in South Carolina, with two follow-up mailings to nonrespondents.

Results: Responses were received from 520 physicians, representing 43% of all licensed FP/GP physicians and 73% of all board-certified FP physicians. Norplant had been inserted by 39% of the respondents, and fewer than 10% reported encountering complications during the insertion process. Norplant removal was reported by 135 physicians, averaging 4.4 removals per year. Complications during removal were reported by 52% of physicians, with the most common problem being difficulty finding the capsules. Some degree of training in Norplant insertion was reported by 82% of physicians; 69% reported having had some training, formal or informal, in removal; but only 57% reported having received formal training either during residency or at a workshop. Training reduced insertion time but did not affect removal time or the number of complications encountered. Formal training was more likely to prepare physicians to successfully manage procedural complications.

Conclusions: FP/GP physicians are important providers of Norplant. Improved training is needed to ensure that insertion is performed properly and to disseminate effective removal techniques.

PIP: A descriptive study of Norplant prescribing experiences, training, and attitudes among South Carolina physicians revealed a need for improved training opportunities. A questionnaire mailed to all 1201 family and general practice physicians licensed in South Carolina was returned by 540 (43%) physicians. 200 (39%) of these respondents had prescribed Norplant for women seeking contraception. Female physicians, younger physicians, and those who listed their specialty as family rather than general practice were significantly more likely than their counterparts to prescribe this method. The mean number of Norplant insertions per month was 1.9; only 7 physicians performed 10 or more insertions per month. Only 13 physicians reported any insertion-related complications (primarily bruising). Norplant removal was reported by 135 (24%) physicians, with an average of 4.4 removals annually. Complications during removal, primarily difficulties locating the capsules, were reported by 52% of physicians. 82% of physicians had received some form of training in Norplant insertion, including observing another physician, and 69% had been trained in capsule removal; formal training (residency or workshop) in insertion and removal was reported by only 57% and 53%, respectively. Training both reduced insertion time and prepared physicians to manage procedural complications.