Long-Acting Reversible Contraception in Primary Care: A Cross-Sectional Study on the Perspectives of Portuguese Family Physicians

Abstract

Long-acting reversible contraceptives (LARC) are recommended as first-line methods due to high efficacy and safety. Family Medicine (FM) physicians are ideally positioned to provide counseling and LARC-related services; however, their implementation in primary care is hindered by multiple constraints. The aim of this nationwide cross-sectional study was to characterize family planning practices among FM physicians in Portugal, to identify the main obstacles to LARC provision, and to propose strategies to enhance clinical autonomy. In this manner, an anonymous online questionnaire was distributed among FM physicians (specialists and residents), currently working within the Portuguese National Health Service. A total of 220 responses were collected over six weeks. While nearly all physicians (99.5%) routinely conducted family planning consultations, only 31.8% of respondents reported feeling fully prepared to perform LARC insertions autonomously. Among those who rarely insert LARC (18.7%), the main barriers identified were related to organizational constraints (38.0%) and gaps in practical training (37.0%). The majority (98.2%) expressed interest in further training, particularly in practical insertion/removal techniques. In conclusion, this study highlighted a significant gap in confidence among Portuguese FM physicians regarding LARC provision. Strengthening simulation-based training and promoting structured mentorship with gynecology specialists may help overcome these barriers.