| Description |
Intrauterine devices (IUDs) are highly effective, long-term, and reversible contraception options that are cost-effective and have excellent continuation rates. These devices also provide emergency contraception and gynecologic treatment benefits. Data indicates that fear of procedural pain is a barrier to patient selection of an IUD. There is no standardized protocol for intrauterine device placement pain management due to a lack of consensus in the available evidence. However, current data recommends identifying known risk factors for increased perceived pain and offering eligible patients targeted interventions. Injected lidocaine demonstrates benefits and feasibility for targeted pain management for IUD placement in these cases. Local Problem: Contraception use in Utah is increasing, with IUDs being the most selected method among individuals at risk for pregnancy. Yet, over one-third of this population uses no method or a method classified as least effective as a primary contraceptive method. These factors indicate a population that could benefit from interventions aimed at increasing IUD access, such as addressing the barrier of fear of pain with placement. Methods: The Iowa Model provides the framework for this needs assessment to determine the gaps with intrauterine device placement. A retrospective chart review was conducted to assess missed frequency counts. A mixed-methods descriptive survey assessed participants' current practices, knowledge, and perspectives. A SWOT analysis was conducted to gather organization- specific information. An executive summary was presented to the organization's leaders, including updated resources and plans for recommended next steps. Interventions: An evidence-based clinical workflow resource was developed based on the SWOT analysis and needs assessment pre-survey data. These tools focused on assessing factors that can result in increased perceived pain and offering injected lidocaine as a targeted intervention. The resources were presented to participants, followed by a mixed-methods post- survey to collect feedback and assess feasibility, usability, and acceptability. Quantitative data was summarized using descriptive statistics, and qualitative data was summarized and categorized. Results: Provider and MA participants reported weekly involvement with IUD placement procedures in outpatient clinics. Most participants reported never receiving training for IUD placement pain management. Providers conveyed wide variations in current practices, but approximately half noted components of risk factor assessment and providing pre-placement pharmaceutical interventions. After the intervention, participant knowledge, skill preparation, and belief in the importance of project aspects improved. Specific decreases did occur in post- intervention perspectives. Certain unexpected results may have related to an improved grasp of the topic, resulting in a perceived satisfactory understanding. The proposed resources' overall feasibility, usability, and acceptability were demonstrated, with an emphasis that additional training is desired. Conclusion: This needs assessment provided the project location practice with pertinent information to address barriers to IUD use through individualized pain management interventions. Participants indicated receptiveness to risk factor assessment, targeted injected lidocaine use, future training, and proposed resources, suggesting appropriateness for escalating the topic for further consideration. By identifying current facilitators, anticipating potential needs, and providing tailored resources, the organization is poised to consider the next steps in implementing evidence-based care that better supports health equity through access to family planning and gynecological treatment options. |
