Title: Association of 12-month contraceptive supply policy and months of oral contraception
prescribed by Obstetrics and Gynecology resident physicians: An exploratory cross-sectional
study
Version: 3 Date: 06 Apr 2022
Reviewer's report:
I think the authors did a really nice job responding to the comments provided by the reviewers
and also providing additional analysis and data as requested.  On rereading this manuscript,
I realized that the authors could provide clarity in their outcome being a prescription that
would dispense a 12mos supply of contraception vs. a prescription written for a 12mos supply.
Technically a prescription dispensing 3mos with 4 refills would be a year supply--BUT I think
the authors were trying to examine whether residents would write a prescription to dispense
12mos of contraception.
Therefore, I suggest the following edits (all caps=edits):
Background:
1. Line 75: "prescribers need to write A PRESCRIPTION TO DISPENSE A 12-month supply
of  contraception"
2. Do these state policies only apply to oral contraception or all forms of contraception?  Given
the Rx to complete on the survey was for oral contraception, you may want to clarify that in the
background when discussing state policies
Methods:
1. Line 87: "Our primary outcome was the  NUMBER OF months of  DISPENSED of ORAL
CONTRACEPTION PRESCRIBED."
2.  Given the date that South Carolina law was changed, were those respondents excluded from
analysis?
3. Why was the survey opened only for that short period of time?  Were authors waiting for a
certain number of survey responses and then it was closed?
Results:
1. Line 112:  "When asked to write a prescription for a 12-month supply of contraception,
respondents on average wrote a prescription TO DISPENSE  2.40 (Standard Deviation,
SD=1.85) months of OCs. The mean months of  CONTRACEPTION DISPENSED  by
RESPONDENTS IN states with and without a policy were 2.81 (Standard Deviation, SD 2.07)
and 2.02 (SD 1.54), respectively (p<0.05). Both groups routinely prescribed a median of 4 refills.
2. I would move the following sentence to the methods section:
"To correctly have prescribed 12-months of contraception, respondents would have had to
prescribe 12-months of OCs with 1 refill."  Also consider adding something about how they
would have done that.  From the added Figure 1, I assume that means either saying "365 duration"
or Dispense Quantity: 365" 1 refill"
3. Is there a p-value associated with this comparison that can be added? "Similarly, in states
with a 12-month contraceptive policy in place, 3.8% of resident physicians reported regularly
prescribing a 12-month supply, while only 1.4% of physicians in states without a policy reported
regularly prescribing a 12-month supply. "
4. Figure 2--can authors add a symbol (maybe *) to show when the comparison between states
with and without the policy were significantly different via fisher exact test?  I assume it was
significant in a few of the comparisons just visually looking at the graph.
Discussion:
1. Line 129: "Resident physicians in states with the policy were slightly more likely to
prescribe a  DISPENSING of 12mos supply; HOWEVER THAT WASN'T STATISTICALLY
SIGNIFICANT WHEN COMPARED TO STATES WITHOUT THE POLICY."
2. Line 136--provider-level trainings could be beyond just OB/GYN's, it may be helpful to widen
the net to family medicine, internal medicine, pediatrics, advanced practice providers,  etc.
3. Line 145-Consider discussing the role pharmacists could play in requesting changes in
prescriptions written for states with the policy to dispense more.
4. The authors mention other issues to explore such as institutional policies and implicit bias--
can they add references to those being possible etiology to different prescribing patterns
5. Line 168:  "The results of this exploratory study suggest that OB/GYN providers are
largely UNAWARE of 12mos contraceptive DISPENSING policies...SPECIFIC provider
training  ON THIS TOPIC  COULD BE HELPFUL TO INCREASE KNOWLEDGE
IN THIS POPULATION  WITH THE GOAL TO IMPROVE policy implementation.
ADDITIONAL RESEARCH SHOULD EXAMINE ADDITIOAL BARRIERS TO POLICY
IMPLEMENTATION."