Public and private providers' involvement in improving their patients' contraceptive use.

BACKGROUND This study measured differences in the provision of care between public and private providers of contraceptive services, what problems using contraception these providers perceived their patients to have and providers' views on how to improve their patients' method use. STUDY DESIGN A nationally representative mixed-mode survey (mail, Internet and fax) of private family practice and obstetrician/gynecologist physicians who provided contraceptive care in 2005 was conducted. A parallel survey was administered to public contraceptive care providers in community health centers, hospitals, Planned Parenthood clinics and other sites during the same period. Descriptive and multivariate analyses were conducted across both surveys. RESULTS A total of 1256 questionnaires were completed for a response rate of 62%. A majority of providers surveyed believed that over 10% of their contraceptive clients experienced ambivalence about avoiding pregnancy, underestimated the risk of pregnancy and failed to use contraception for one or more months when at risk for unintended pregnancy. Implementation of protocols to promote contraceptive use ranged widely among provider types: a full 78% of Panned Parenthood clinics offered quick-start pill initiation, as did 47% of public health departments. However, 38% of obstetrician-gynecologists, 27% of "other public" clinics and only 13% of family physicians did so. Both public and private providers reported that one of the most important things they could do to improve patients' contraceptive method use was to provide more and better counseling. At least 46% of private providers and at least 21% of public providers reported that changing insurance reimbursement to allow more time for counseling was very important. CONCLUSIONS Strategies to improve contraceptive use for all persons in need in the United States have the potential to be more effective if the challenges contraceptive providers face and the differences between public and private providers are taken into account.