BACKGROUND: Many health care providers believe that women who initiate long-acting reversible contraceptives (LARC) discontinue the method because of side effects too soon for the method to be economical. The purpose of this quality improvement project was to implement and evaluate an evidence-based telephone triage nursing
guideline for management of side effects of LARC with an ultimate goal of reducing the number of early discontinuations.
METHODS: A telephone triage
guideline was adapted from the Contraceptive Choice Project\'s Clinician Call Back System, supplemented with evidence-based resources, and approved by clinicians at 2 community women\'s health and midwifery offices. Baseline retrospective data were collected on all women over the age of 18 who had LARC inserted at the 2 sites in the year prior to
guideline implementation and in the 3 months after implementation. Rates of LARC removal at or before 3 months postinsertion, before and after
guideline implementation, were evaluated.
RESULTS: Approximately 1 in 5 women called for help managing LARC side effects. Of the callers, 3 of 32 (9.4%) women receiving standard care discontinued their LARC prior to 3 months, whereas 0 of 24 women who were triaged using the guideline discontinued their LARC prior to 3 months (P = .12). Cramping, bleeding, and malposition or expulsion were the most common concerns and reasons for discontinuation.
CONCLUSIONS: Fewer women than anticipated called to report side effects, and even fewer chose to discontinue their LARC early. There were fewer discontinuations with
guideline use, but this was not a statistically significant difference. Most women did not discontinue their LARC early for any reason, including side effects.