MÉTODOS REVERSÍVEIS DE CONTRACEÇÃO DE LONGA DURAÇÃO NOS CUIDADOS DE SAÚDE PRIMÁRIOS

Abstract

Abstract Background and purpose: LARCs (long-acting reversible contraceptive) 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. This study aimed to characterise contraceptive practices and the prescribing/placement of LARCs in Northern Primary Health Care, Portugal. Methods: Cross-sectional observational study. A "snowball" sample of specialists and trainees Family Physicians was used through an online questionnaire, via Google Forms®, with multiple choice questions and Likert Scales. Results: Oral estroprogestatives lead the contraceptive recommendation in Portuguese Primary Health Care (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%), choosing to refer users 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 of Portuguese Primary Health Care, with an increase in the use of LARCs. There is a divergence in the preference of LARCs in Portugal, as intrauterine contraception is the most used LARC worldwide. The use of intrauterine LARCs seems to be more dependent on external barriers than on Family Physicians competence. Improving the LARC placement conditions could optimize the use of intrauterine contraception and users' sexual health as well as decrease hospital referrals. Keywords: Contraceptive Devices; Contraceptive Agents; Long-Acting Reversible Contraception; Primary Health Care