Overview and Aims:

LARCs (long-acting reversible contraceptives) are long-term contraceptives suitable for all women, not dependent on use, with high contraceptive efficacy, satisfaction, and continuity by users. In Portugal, LARCs are free of charge in Primary Health Care and their placement is part of the family physicians' skills. The present study aimed to characterize contraceptive practices and LARCs prescribing and placement in the Northern Regional Health Administration of Portugal.

Study Design:

Cross-sectional study.

Population:

Specialists and trainees family physicians from Northern Portuguese Primary Health Care

Methods:

We used a non-random, “snowball” sample, disseminated via social networks and supported by health care institutions and professional organizations.

Results:

We obtained a sample of 167 participants, corresponding to 5.9% of the Northern Portuguese Primary Care family physicians, which represents 26.2% of the health units and 23 of the 24 Groups of Primary Care Centres of this region. Estroprogestative pills lead the contraceptive recommendation (84,4%; 95%CI: 78,5% - 89,8%), followed by LARCs (21,6%; 95%CI: 15,6% - 28,1%). The subcutaneous implant was the most recommended (74,9%; 95%CI: 68,3% - 80,8%) and placed LARC (70,7%; 95%CI: 62,9% - 77,8%). Most family physicians do not place Intrauterine contraceptives (59,9%; 95%CI: 52,1% - 67,1%), opting to refer to a gynecologist. The subcutaneous implant tends to be recommended for nulliparous (p < 0,001) and Intrauterine contraception for multiparous women (p < 0,001).

Conclusions:

There is a paradigm shift in contraception in Northern Portuguese Primary Health Care, with the increased use of LARCs. In this region, subcutaneous Implant represents the most commonly used LARC, opposing the global tendency where Intrauterine contraception is the LARC of choice. Intrauterine LARCs appear to be more dependent on external barriers than family physicians competence. Apart from decreasing hospital referrals, improving LARC placement conditions could optimize the use of Intrauterine contraception and users’ sexual health.

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