• Minji Michelle Kang, Timothy C Guetterman, Julie K Prussack, Allison Ursu, and Justine P Wu.
• University of Michigan, Michigan Medicine, Department of Family Medicine, Ann Arbor, MI.
• Fam Med. 2019 Jul 1; 51 (7): 559566559-566.

Background And ObjectivesWomen with medical conditions are at higher risk of pregnancy-related morbidity and mortality than women without medical conditions. Thus, women who do not desire pregnancy should be offered contraceptive counseling and methods. The objective of this qualitative study was to identify potential best practices to guide primary care physicians (PCPs) in providing contraception and contraceptive counseling for women with medical conditions.MethodsWe conducted semistructured qualitative interviews of 10 PCPs who routinely provide contraception including long-acting reversible contraception (LARC). To inform the data collection and analysis, we adapted constructs from the Theoretical Domains Framework. We coded transcripts and identified themes until saturation of our theoretical constructs was achieved.ResultsPhysician time constraints, lack of patient knowledge, and competing demands related to medical condition management were identified as barriers to contraceptive care. The study participants reported multiple strategies to mitigate these barriers. They emphasized providing reproductive health education in the context of an individual's chronic conditions and medications, educating about LARC methods, and using the US Medical Eligibility Criteria (US MEC) as a point-of-care clinical tool to guide contraceptive selection.ConclusionsThe study participants (PCPs experienced in contraceptive care), described multifaceted approaches to providing contraception for women with medical conditions, including tailored contraceptive education and use of the US MEC for clinical guidance. Future research is needed to assess if such strategies can improve patient outcomes and be adopted by PCPs who have less experience with contraceptive care.

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