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Goldin Evans M, Gee RE, Phillippi S, Sothern M, Theall KP, Wightkin J. Multilevel Barriers to Long-Acting Reversible Contraceptive Uptake: A Narrative Review. Health Promot Pract 2023:15248399231211531. [PMID: 37978809 DOI: 10.1177/15248399231211531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Unintended pregnancies, which occur in almost half (45%) of all pregnancies in the United States, are associated with adverse health and social outcomes for the infant and the mother. The risk of unintended pregnancies is significantly reduced when women use long-acting reversible contraceptives (LARCs), namely intrauterine devices and implants. Although LARCs are highly acceptable to women at risk of unintended pregnancies, barriers to accessing LARCs hinder its uptake. These barriers are greater among racial and socioeconomic lines and persist within and across the intrapersonal, interpersonal, institutional, and policy levels. A synthesis of these barriers is unavailable in the current literature but would be beneficial to health care providers of reproductive-aged women, clinical managers, and policymakers seeking to provide equitable reproductive health care services. The aim of this narrative review was to aggregate these complex and overlapping barriers into a concise document that examines: (a) patient, provider, clinic, and policy factors associated with LARC access among populations at risk of unintended pregnancy and (b) the clinical implications of mitigating these barriers to provide equitable reproductive health care services. This review outlines numerous barriers to LARC uptake across multiple levels and demonstrates that LARC uptake is possible when the woman is informed of her contraceptive choices and when financial and clinical barriers are minimized. Equitable reproductive health care services entail unbiased counseling, a full range of contraceptive options, and patient autonomy in contraceptive choice.
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Affiliation(s)
- Melissa Goldin Evans
- Mary Amelia Center for Women's Health Equity Research, Tulane University, New Orleans, LA, USA
| | | | - Stephen Phillippi
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Melinda Sothern
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Katherine P Theall
- Mary Amelia Center for Women's Health Equity Research, Tulane University, New Orleans, LA, USA
| | - Joan Wightkin
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Canela MRM, Brito LGO, Silva-Filho AL, Bahamondes L, Juliato CRT. Provision of contraceptives by Brazilian general gynaecologists: a nationwide online survey. EUR J CONTRACEP REPR 2023; 28:251-257. [PMID: 37505798 DOI: 10.1080/13625187.2023.2233649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/16/2023] [Accepted: 06/30/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To assess the provision of contraceptives by Brazilian obstetricians and gynaecologists (Obst/Gyns) during medical consultation and associated factors. METHODS An anonymous online survey was conducted with Obst/Gyns regarding age, gender, training, method counselling about and provision of long-acting reversible contraception (LARC). RESULTS Of 16,000 Obst/Gyns, 610 (3.8%) answered the survey. After multiple regression analysis, female Obst/Gyns (reference) (OR male was 0.53 [95%CI 0.28-0.98], p = 0.044) and Obst/Gyns aged between 20 and 39 were more likely to provide an IUD. For hormonal-IUDs, Obst/Gyns who had had theoretical training in hormonal-IUD insertion (reference no training) (OR = 2.13 [95%CI 1.14-3.99], p = 0.018), those who work in a private facility or public hospital, and those that allowed more time during consultations (reference) (OR short time = 0.33 [95%CI 0.17-0.63], p < 0.001) were more likely to provide them. Obst/Gyns who were hands-on trained were more likely to provide subdermal implant (OR = 2.04 [95%CI 1.45-2.87], p < 0.001). CONCLUSIONS There is a gap between theoretical and practical training received by this cohort of Obst/Gyns regarding LARCs, mainly contraceptive implants and hormonal-IUDs. The identification of barriers to offering contraceptives is essential to providing client-centred contraceptive care.
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Affiliation(s)
- Mariana R M Canela
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Faculty of Medical Sciences, Campinas, Brazil
| | - Luiz G O Brito
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Faculty of Medical Sciences, Campinas, Brazil
| | - Agnaldo Lopes Silva-Filho
- Department of Obstetrics and Gynecology, Federal University of Minas Gerais, (UFMG), Belo Horizonte, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Faculty of Medical Sciences, Campinas, Brazil
| | - Cássia R T Juliato
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Faculty of Medical Sciences, Campinas, Brazil
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Stuart GS, Yates L, Crump J, Allison BA, Navarro AL, Tadikonda A, Neal-Perry G, Arora KS. Single-visit insertion of long-acting reversible contraception in a single health system. Contraception 2023; 123:110009. [PMID: 36931546 DOI: 10.1016/j.contraception.2023.110009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/05/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE To identify patient and practice characteristics associated with single-visit placement of long-acting reversible contraception (LARC) across the University of North Carolina Health system. STUDY DESIGN We conducted a retrospective observational study using existing electronic health records. We abstracted data from charts of individuals ages 15-50 years who received a LARC device between March 15, 2019, and March 14, 2021. Our primary outcome was whether a patient received LARC at one, or after multiple, outpatient visits. We used descriptive statistics to examine patient, clinician, and practice characteristics. We used bivariate analysis and generalized estimating equation to examine relationships between characteristics and single-visit LARC receipt. RESULTS Most of the 4599 individuals received care at obstetrics and gynecology clinics (3411/4599; 74%), and received their LARC device in a single visit (3163/4599; 69%). More intrauterine devices (3151) were placed than implants (1448). The adjusted odds of receiving a LARC in a single visit was highest for those who self-paid (aOR (adjusted odds ratio) 1.83, 1.19-2.82) and those who received an implant (aOR 1.25, 1.07-1.46). Patients seen by advanced practice practitioners (aOR 0.67, 0.56-0.80) or by an internal medicine specialty clinician (aOR 0.13, 0.00-0.35) had lower odds of receiving a single-visit LARC compared to those seen by a specialist obstetrician-gynecologist physician. CONCLUSION Most single-visit LARC placements were performed by clinicians in obstetrician-gynecologist specialty practices. IMPLICATIONS Among individuals seeking long-acting reversible contraceptives from clinics in a single health system in North Carolina, most received a device at a single visit and most single-visit insertions were done by an obstetrician-gynecologist.
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Affiliation(s)
- Gretchen S Stuart
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, United States.
| | - Lindsey Yates
- Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, NC, United States
| | - Johanna Crump
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Bianca A Allison
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Ashley L Navarro
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Ananya Tadikonda
- School of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Genevieve Neal-Perry
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Kavita S Arora
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
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McColl R, Gifford K, McDuffie MJ, Boudreaux M. Same-day long-acting reversible contraceptive utilization after a statewide contraceptive access initiative. Am J Obstet Gynecol 2023; 228:451.e1-451.e8. [PMID: 36565901 PMCID: PMC10065916 DOI: 10.1016/j.ajog.2022.12.304] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/01/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Same-day placement of long-acting reversible contraceptives, occurring when the device is requested and placed within a single visit, reduces barriers to the patient and reduces unintended pregnancies. Despite the safety and efficacy of same-day placement, access to same-day services remains low. OBJECTIVE This study aimed to evaluate the effects of the Delaware Contraceptive Access Now initiative, a statewide initiative in Delaware focused on increasing same-day access to effective contraception on same-day receipt of long-acting reversible contraceptives. STUDY DESIGN We used Medicaid claims and encounter data to identify instances of same-day and multivisit receipts of long-acting reversible contraceptives among Medicaid-enrolled individuals in Delaware and Maryland aged 15-44 years who were covered in a full-benefits or family planning Medicaid aid category during the month of the placement and the 2 previous months. We used a difference-in-differences design that compared changes in the outcome from before to after implementation of the initiative among placements at agencies that participated in the initiative (n=6676) vs 2 alternative comparison groups: placements at Delaware agencies that did not participate (n=688) and placements in Maryland (n=35,847). RESULTS We found that the intervention was associated with a 13.3 percentage point increase (95% confidence interval, 1.9%-24.7%) in receipt of same-day long-acting reversible contraceptives using a nonparticipating Delaware comparison group, a 21.1 percentage point increase (95% confidence interval, 13.7%-28.6%) using a Maryland comparison group, and a 21.0 percentage point increase (95% confidence interval, 14.1%-27.9%) using a pooled comparison group. The effects were larger for implants than intrauterine devices. CONCLUSION The Delaware Contraceptive Access Now initiative substantially increased the number of patients receiving long-acting reversible contraceptives through a single-visit encounter. Our findings suggested that coordinated interventions involving provider and staff training and capital investments that seed device stocking can increase the number of patients receiving same-day long-acting reversible contraceptives.
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Affiliation(s)
- Rebecca McColl
- Biden School of Public Policy and Administration, University of Delaware, Newark, DE.
| | - Katie Gifford
- Biden School of Public Policy and Administration, University of Delaware, Newark, DE
| | - Mary Joan McDuffie
- Biden School of Public Policy and Administration, University of Delaware, Newark, DE
| | - Michel Boudreaux
- University of Maryland School of Public Health, College Park, MD
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Reeves JA, Zapata LB, Curtis KM, Whiteman MK. Intrauterine Device Training, Attitudes, and Practices Among U.S. Health Care Providers: Findings from a Nationwide Survey. Womens Health Issues 2023; 33:45-53. [PMID: 36123229 DOI: 10.1016/j.whi.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 07/18/2022] [Accepted: 08/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Provider training in intrauterine device (IUD) procedures is a key strategy for improving evidence-based IUD care. We examined the influence of IUD training on IUD attitudes and practices among U.S. family planning providers. METHODS In 2019, we conducted a cross-sectional survey of U.S. family planning providers. We performed logistic regression to examine associations between training in routine IUD placement and specific IUD safety attitudes, confidence performing IUD procedures, and specific IUD practices. RESULTS Among 1,063 physicians and advanced practice clinicians, 85.1% reported training in routine IUD placement. Overall, IUD training was associated with accurately stating IUDs are safe for queried groups, including patients immediately postpartum (prevalence ratio [PR] 4.22; 95% confidence interval [CI] 1.29-13.85). Trained providers reported higher confidence in routine IUD placement for parous (PR 7.71; 95% CI 1.31-45.3) and nulliparous (PR 7.12; 95% CI 1.17-43.5) women and in IUD removal (PR 2.06; 95% CI 1.12-3.81). Among providers with IUDs available onsite, IUD training was associated with frequent same-day IUD provision for adults (PR 7.32; 95% CI 2.16-24.79) and adolescents (PR 7.63; 95% CI 2.22-26.24). Trained providers were also less likely to routinely use misoprostol before IUD placement for nulliparous (PR 0.19; 95% CI 0.11-0.33) and parous women (PR 0.07; 95% CI 0.03-0.16). CONCLUSION Training in routine IUD placement was associated with evidence-based IUD safety attitudes, confidence in performing IUD procedures, and clinical practices aligned with Centers for Disease Control and Prevention contraception guidance. Expanding IUD training might increase evidence-based care and patient access to the full range of contraception, including IUDs.
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Affiliation(s)
- Jennifer A Reeves
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Lauren B Zapata
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathryn M Curtis
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maura K Whiteman
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Ventura LM, Beatty KE, Khoury AJ, Smith MG, Ariyo O, Slawson DL, Weber AJ. Contraceptive Access at Federally Qualified Health Centers During the South Carolina Choose Well Initiative: A Qualitative Analysis of Staff Perceptions and Experiences. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 2:608-620. [PMID: 35141709 PMCID: PMC8820399 DOI: 10.1089/whr.2021.0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 11/20/2022]
Abstract
Introduction: Federally qualified health centers (FQHCs) provide essential contraceptive services to low-income individuals; yet, access to all method options, notably intrauterine devices (IUDs) and implants, may be limited at non-Title X FQHCs. The South Carolina (SC) Choose Well initiative is a statewide contraceptive access initiative that was launched in 2017 and extends into 2022. Choose Well established a collaborative network between training and clinical partners and is aimed at facilitating implementation of contraceptive care best practices through capacity-building and training of clinical and administrative staff in partner organizations. The initiative provided funding for workforce expansion and contraceptive methods. We examined perceptions of staff from Choose Well-participating FQHCs regarding contraceptive access during the first 2 years of the initiative, including factors that facilitated or posed access challenges as well as sustaining factors. This study informs the process evaluation of Choose Well while providing data critical for uncovering and scaling up contraceptive access initiatives. Materials and Methods: Interviews were conducted with FQHC staff (n = 34) in 2018 and 2019 to assess Choose Well implementation and were recorded, transcribed, and double-coded via at least 80% interrater reliability or consensus coding. Data were analyzed according to clinical and administrative factors influencing contraceptive access. Results: Increased capacity for contraceptive counseling and provision through training and external funding for IUDs and implants were the most noted clinical factors facilitating access. Streamlining workflow processes was also a facilitator. Buy-in and engagement among staff and leadership emerged as a facilitator at some clinics and as a barrier at others. Policy/structural factors related to costs of devices and insurance coverage were identified as threats to sustainability. Conclusions: The Choose Well initiative contributed to the perception of an increase in contraceptive access at participating FQHCs in SC. Statewide contraceptive access initiatives have the potential to support FQHCs in meeting their clients' contraceptive needs. Organizational buy-in, sustainability of funding, and training are key to realizing the full potential of these initiatives.
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Affiliation(s)
- Liane M Ventura
- Department of Health Services Management and Policy, Center for Applied Research and Evaluation in Women's Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Kate E Beatty
- Department of Health Services Management and Policy, Center for Applied Research and Evaluation in Women's Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Amal J Khoury
- Department of Health Services Management and Policy, Center for Applied Research and Evaluation in Women's Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Michael G Smith
- Department of Health Services Management and Policy, Center for Applied Research and Evaluation in Women's Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Oluwatosin Ariyo
- Department of Health Services Management and Policy, Center for Applied Research and Evaluation in Women's Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Deborah L Slawson
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Amy J Weber
- Department of Health Services Management and Policy, Center for Applied Research and Evaluation in Women's Health, East Tennessee State University, Johnson City, Tennessee, USA
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Matsushita T, Hasegawa T, Noma H, Ota E, Chou VB, Okada Y. Interventions to increase access to long-acting reversible contraceptives. Hippokratia 2021. [DOI: 10.1002/14651858.cd014987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tomomi Matsushita
- Department of Obstetrics and Gynaecology; Showa University School of Medicine; Tokyo Japan
| | - Takeshi Hasegawa
- Showa University Research Administration Center (SURAC); Showa University; Tokyo Japan
| | - Hisashi Noma
- Department of Data Science; The Institute of Statistical Mathematics; Tokyo Japan
| | - Erika Ota
- Global Health Nursing, Graduate School of Nursing Science; St. Luke's International University; Chuo-ku Japan
| | - Victoria B Chou
- Department of International Health; Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland USA
| | - Yoshiyuki Okada
- Department of Obstetrics and Gynecology; Showa University Northern Yokohama Hospital; Kanagawa Japan
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8
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Eeckhaut MCW, Rendall MS, Zvavitch P. Women's Use of Long-Acting Reversible Contraception for Birth Timing and Birth Stopping. Demography 2021; 58:1327-1346. [PMID: 34251428 PMCID: PMC9341462 DOI: 10.1215/00703370-9386084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The use of long-acting reversible contraceptive (LARC) methods-intrauterine devices (IUDs) and implants-has recently expanded rapidly in the United States, and these methods together approach the contraceptive pill in current prevalence. Research on LARCs has analyzed their use to reduce unintended pregnancies but not their use to enable intended pregnancies. Knowledge of both is necessary to understand LARCs' potential impacts on the reproductive life courses of U.S. women. We combine data from two nationally representative surveys to estimate women's likelihood and timing of subsequent reproductive events, including births resulting from an intended pregnancy up to nine years after discontinuing LARC use. We estimate that 62% of women will give birth, and 45% will give birth from an intended pregnancy. Additionally, 18% will have a new LARC inserted, and 13% will transition to sterilization. Most of these reproductive events occur within two years after discontinuing LARC use. Births from an intended pregnancy are especially common when no intervening switch to another contraceptive method occurs. We infer that women's motives for using LARC are varied but include the desire to postpone a birth, to postpone a decision about whether to have a(nother) birth, and to transition definitively to the completion of childbearing.
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Affiliation(s)
- Mieke C W Eeckhaut
- Department of Sociology and Criminal Justice, University of Delaware, Newark, DE, USA
| | - Michael S Rendall
- Department of Sociology and Maryland Population Research Center, University of Maryland, College Park, MD, USA
| | - Polina Zvavitch
- Department of Sociology and Maryland Population Research Center, University of Maryland, College Park, MD, USA
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Serpico JJ, Ricks JM, Smooth WG, Romanos C, Brook DL, Gallo MF. Access to single-visit IUD insertion at obstetrician-gynecology practices in Ohio: An audit study. Contraception 2020; 102:190-194. [DOI: 10.1016/j.contraception.2020.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 11/16/2022]
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Abstract
Long-acting reversible contraceptives are the most effective methods to prevent pregnancy and also offer noncontraceptive benefits such as reducing menstrual blood flow and dysmenorrhea. The safety and efficacy of long-acting reversible contraception are well established for adolescents, but the rate of use remains low for this population. The pediatrician can play a key role in increasing access to long-acting reversible contraception for adolescents by providing accurate patient-centered contraception counseling and by understanding and addressing the barriers to use.
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Affiliation(s)
- Seema Menon
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Rael CT, Lentz C, Carballo-Diéguez A, Giguere R, Dolezal C, Feller D, D'Aquila RT, Hope TJ. Understanding the Acceptability of Subdermal Implants as a Possible New HIV Prevention Method: Multi-Stage Mixed Methods Study. J Med Internet Res 2020; 22:e16904. [PMID: 32348277 PMCID: PMC7418007 DOI: 10.2196/16904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/27/2020] [Accepted: 03/21/2020] [Indexed: 01/02/2023] Open
Abstract
Background A long-acting implant for HIV pre-exposure prophylaxis (PrEP) is in development in the Sustained Long-Action Prevention Against HIV (SLAP-HIV) trial. This could provide an alternative to oral PrEP. Objective Our mixed methods study aimed to understand (1) users’ experiences with a similar subdermal implant for contraception and (2) factors influencing the likelihood that gay and bisexual men (GBM) would use a proposed PrEP implant. Methods Work was completed in 4 stages. In stage 1, we conducted a scientific literature review on existing subdermal implants, focusing on users’ experiences with implant devices. In stage 2, we reviewed videos on YouTube, focusing on the experiences of current or former contraceptive implant users (as these implants are similar to those in development in SLAP-HIV). In stage 3, individuals who indicated use of a subdermal implant for contraception in the last 5 years were recruited via a web-based questionnaire. Eligible participants (n=12 individuals who liked implants a lot and n=12 individuals who disliked implants a lot) completed in-depth phone interviews (IDIs) about their experiences. In stage 4, results from IDIs were used to develop a web-based survey for HIV-negative GBM to rate their likelihood of using a PrEP implant on a scale (1=very unlikely and 5=very likely) based on likely device characteristics and implant concerns identified in the IDIs. Results In the scientific literature review (stage 1), concerns about contraceptive implants that could apply to the PrEP implants in development included potential side effects (eg, headache), anticipated high cost of the device, misconceptions about PrEP implants (eg, specific contraindications), and difficulty accessing PrEP implants. In the stage 2 YouTube review, individuals who had used contraceptive implants reported mild side effects related to their device. In stage 3, implant users reported that devices were comfortable, unintrusive, and presented only minor discomfort (eg, bruising) before or after insertion and removal. They mainly reported removing or disliking the device due to contraceptive-related side effects (eg, prolonged menstruation). Participants in the stage 4 quantitative survey (N=304) were mainly gay (204/238, 85.7%), white (125/238, 52.5%), cisgender men (231/238, 97.1%), and 42.0% (73/174) of them were on oral PrEP. Not having to take a daily pill increased the likelihood of using PrEP implants (mean 4.13). Requiring >1 device to achieve 1 year of protection (mean range 1.79-2.94) mildly discouraged PrEP implant use. Participants did not mind moderate bruising, a small scar, tenderness, or bleeding after insertion or removal, and an implant with a size slightly larger than a matchstick (mean ratings 3.18-3.69). Conclusions PrEP implants are promising among GBM. Implant features and insertion or removal-related concerns do not seem to discourage potential users. To ensure acceptability, PrEP implants should require the fewest possible implants for the greatest protection duration.
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Affiliation(s)
- Christine Tagliaferri Rael
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Alex Carballo-Diéguez
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Daniel Feller
- Department of Biomedical Informatics, Columbia University, New York, NY, United States
| | - Richard T D'Aquila
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Thomas J Hope
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,McCormick School of Engineering and Applied Sciences, Northwestern University, Chicago, IL, United States
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Judge-Golden CP, Wiesenfeld HC, Chen BA, Borrero S. Adherence to Recommended Practices for Provision of Long-Acting Reversible Contraception Among Providers in a Large U.S. Health Care System. J Womens Health (Larchmt) 2020; 29:1586-1595. [PMID: 32667847 DOI: 10.1089/jwh.2019.8169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Background: There is little research examining adherence to practice guidelines for long-acting reversible contraception (LARC). We assessed same-day LARC provision and adherence to other guideline-recommended practices among providers in a large academic health care system. Materials and Methods: We surveyed 363 providers who had billed using LARC-related codes within the prior 12 months. Primary outcomes were, for women requesting an intrauterine device (IUD) or implant, the typical number of visits for method provision and ability to add an insertion procedure to an annual examination. We used chi-square tests and multivariable logistic regression to identify characteristics associated with primary outcomes and described other practices and barriers to same-day LARC. Results: Our response rate was 42% (153/363). A typical single visit for women requesting an IUD or implant was reported by 37% of IUD providers and 51% of implant providers, respectively, and was associated with obstetrician-gynecologist specialty versus family medicine (IUD: 44% vs. 12%, p = 0.001; implant: 57% vs. 26%, p = 0.002) and practicing in the county of the main academic medical center versus any other county (IUD: 48% vs. 20%, p = 0.001; implant: 65% vs. 27%, p < 0.001). High ability to add LARC insertion to an annual examination was reported by 48% of IUD providers and 51% of implant providers, with similar associations of specialty and county. Barriers to same-day LARC included scheduling constraints, insurance and billing concerns, and device stocking. Nearly all respondents provide LARC to nulliparous women and adolescents. Among IUD providers, 73% schedule routine follow-up after insertion. Conclusions: Same-day LARC provision is low among providers in a large academic health care system. Provider-identified barriers suggest interventions to improve LARC access, including incentivizing device stocking and billing and insurance education.
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Affiliation(s)
- Colleen P Judge-Golden
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Harold C Wiesenfeld
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Beatrice A Chen
- Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Sonya Borrero
- Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania, USA
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Samy A, Abdelhakim AM, Latif D, Hamza M, Osman OM, Metwally AA. Benefits of vaginal dinoprostone administration prior to levonorgestrel-releasing intrauterine system insertion in women delivered only by elective cesarean section: a randomized double-blinded clinical trial. Arch Gynecol Obstet 2020; 301:1463-1471. [PMID: 32314015 DOI: 10.1007/s00404-020-05543-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 04/06/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed at investigating the efficacy and safety of dinoprostone 3 mg vaginally prior to levonorgestrel-releasing intrauterine system (LNG-IUS) insertion in women undergoing elective cesarean delivery (CD). METHODS We conducted a prospective, randomized, double-blinded, placebo-controlled trial at family planning clinic of Cairo University hospitals from August 2019 to January 2020. We included 200 women aged ≥ 18 years who previously delivered by elective CD willing to receive LNG-IUS. Women were randomly assigned with a 1:1 allocation ratio to receive 3 mg vaginal dinoprostone or placebo tablets two hours before LNG-IUS insertion. Our main outcomes were patient-reported pain during insertion and 30 min post-procedure, ease of insertion, satisfaction, duration of insertion, and different side effects. RESULTS Patient-perceived pain during LNG-IUS insertion was significantly reduced in dinoprostone compared to placebo (4.1 ± 1.7 vs 6.4 ± 1.3; p < 0.001). Dinoprostone reduced pain scores 30 min post-procedure compared to placebo, but the difference was not statistically significant (3.5 ± 1.1 vs 3.7 ± 1.6; p = 0.25). Satisfaction score was higher in dinoprostone compared to placebo (7.9 ± 1.0 vs 5.9 ± 0.8; p < 0.001). The insertion was significantly easier and shorter in dinoprostone than placebo (3.9 ± 1.1 vs 5.9 ± 1.1; p < 0.001) and (5.6 ± 0.9 vs 7.2 ± 0.8; p < 0.001), respectively. Adverse events were not significantly different between both groups. CONCLUSION Dinoprostone administration 2 h before LNG-IUS insertion in women delivered by elective CD effectively reduced pain during insertion and 30 min post-procedure. Women received dinoprostone had easier and shorter insertion and were more satisfied with tolerable side effects.
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Affiliation(s)
- Ahmed Samy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Dina Latif
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Hamza
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Omneya M Osman
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed A Metwally
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Wilkinson TA, Downs SM, Tucker Edmonds B. Cost Minimization Analysis of Same-Day Long-Acting Reversible Contraception for Adolescents. JAMA Netw Open 2019; 2:e1911063. [PMID: 31509208 PMCID: PMC6739899 DOI: 10.1001/jamanetworkopen.2019.11063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Long-acting reversible contraception (LARC) is considered first-line contraception for adolescents but often requires multiple clinic visits to obtain. OBJECTIVE To analyze Indiana Medicaid's cost savings associated with providing adolescents with same-day access to LARC. DESIGN, SETTING, AND PARTICIPANTS An economic evaluation of cost minimization from the payer's (Medicaid) perspective was performed from August 2017 through August 2018. The cost model examined the anticipated outcome of providing LARC at the first visit compared with requiring a second visit for placement. The costs and probabilities of clinic visits, devices, device insertions and removals, unintended pregnancy, and births, according to previously published sources, were incorporated into the model. The participants were payers (Medicaid). MAIN OUTCOMES AND MEASURES The outcomes were the cost of same-day LARC placement vs LARC placement at a subsequent visit in US dollars, and rates of unintended pregnancy and abortion. One-way sensitivity analysis was done. RESULTS Same-day LARC placement was associated with lower overall costs ($2016 per patient over 1 year) compared with LARC placement at a subsequent visit ($4133 per patient over 1 year). Compared with the return-visit strategy, same-day LARC was associated with an unintended pregnancy rate of 14% vs 48% and an abortion rate of 4% vs 14%. CONCLUSIONS AND RELEVANCE Providing same-day LARC could save costs for Medicaid, largely by preventing unintended pregnancy. Expected cost savings could be used to implement policies that make this strategy feasible in all clinical settings.
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Affiliation(s)
- Tracey A. Wilkinson
- Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis
| | - Stephen M. Downs
- Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis
| | - Brownsyne Tucker Edmonds
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis
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15
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Coleman-Minahan K, Potter JE. Quality of postpartum contraceptive counseling and changes in contraceptive method preferences .. Contraception 2019; 100:492-497. [PMID: 31491380 DOI: 10.1016/j.contraception.2019.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/27/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We examined the association between quality of postpartum contraceptive counseling and changes in contraceptive method preference between delivery and 3-months postpartum. STUDY DESIGN We used data from 1167 postpartum women delivering at eight hospitals in Texas who did not initiate contraception in the hospital. We conducted baseline and 3-month follow-up interviews to ask women about the method they would prefer to use at 6-months postpartum, postpartum contraceptive counseling, reproductive history, and demographic characteristics. We measured quality of postpartum contraceptive counseling with seven items related to satisfaction and information received. High-quality counseling was defined as meeting all seven criteria. We used logistic regression to predict the primary outcome of changes in preferred method by contraceptive counseling and described contraceptive counseling and changes in preferred method by demographic characteristics. RESULTS Receipt of high-quality postpartum contraceptive counseling was reported by 26%. At 3-months postpartum 70% of participants reported the same contraceptive preferences by category of effectiveness that they expressed at the time of delivery. Spanish-speaking, Hispanic foreign-born, and lower socioeconomic status women were less likely to receive high-quality counseling than their counterparts. High-quality counseling was associated with lower odds of preferring a less effective method (OR: 0.31, 95% CI: 0.18-0.52) and changing preference from an IUD or implant (OR: 0.34, 95% CI: 0.17-0.68). CONCLUSIONS High-quality postpartum contraceptive counseling is relatively rare and occurs less often among low SES and immigrant women. High-quality counseling appears to reinforce preferences for effective contraception. IMPLICATIONS Training healthcare providers to provide high-quality contraceptive counseling to all postpartum women may reduce contraceptive disparities related to race/ethnicity and social class.
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Affiliation(s)
- Kate Coleman-Minahan
- University of Colorado College of Nursing, United States; University of Colorado Population Center, University of Colorado Boulder, United States.
| | - Joseph E Potter
- Population Research Center, University of Texas at Austin, United States
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16
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Implementing best practices for the provision of long-acting reversible contraception: a survey of obstetrician-gynecologists. Contraception 2019; 100:123-127. [DOI: 10.1016/j.contraception.2019.03.053] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/18/2022]
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Morgan IA, Zapata LB, Curtis KM, Whiteman MK. Health Care Provider Attitudes about the Safety of "Quick Start" Initiation of Long-Acting Reversible Contraception for Adolescents. J Pediatr Adolesc Gynecol 2019; 32:402-408. [PMID: 30731216 PMCID: PMC6717043 DOI: 10.1016/j.jpag.2019.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/30/2018] [Accepted: 01/27/2019] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE To identify characteristics associated with provider attitudes on the safety of "Quick Start" initiation of long-acting reversible contraception (LARC) for adolescents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We conducted a cross-sectional survey of providers in public-sector health centers and office-based physicians (n = 2056) during 2013-2014. RESULTS Overall, the prevalence of considering "Quick Start" initiation of LARC for adolescents as safe was 70.9% for implants and 64.5% for intrauterine devices (IUDs). Among public-sector providers, those not trained in implant or IUD insertion had lower odds of perceiving the practice safe (adjusted odds ratio [aOR], 0.32; 95% confidence interval [CI], 0.25-0.41 for implants; aOR 0.42; 95% CI, 0.32-0.55 for IUDs), whereas those practicing at health centers that did not receive Title X funding had lower odds of perceiving the practice safe for IUDs (aOR, 0.77; 95% CI, 0.61-0.98). Among office-based physicians, lack of training in LARC insertion was associated with lower odds of perceiving "Quick Start" initiation to be safe for IUDs (aOR, 0.31; 95% CI, 0.12-0.77). Those specializing in adolescent medicine had higher odds of reporting "Quick Start" initiation of LARC as safe (implants: aOR, 2.21; 95% CI, 1.23-3.98; IUDs: aOR, 3.37; 95% CI, 1.39-8.21) compared with obstetrician-gynecologists. CONCLUSION Approximately two-thirds of providers considered "Quick Start" initiation of LARC for adolescents safe; however, there were differences according to provider characteristics (eg, Title X funding, training in LARC insertion, specialty). Targeted LARC insertion training and dissemination of evidence-based family planning guidance and implementation into facility and practice-level policies might increase access to "Quick Start" initiation of LARC for adolescents.
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Affiliation(s)
- Isabel A Morgan
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Lauren B Zapata
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Kathryn M Curtis
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maura K Whiteman
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Onyewuchi UF, Tomaszewski K, Upadhya KK, Gupta PS, Whaley N, Burke AE, Trent ME. Improving LARC Access for Urban Adolescents and Young Adults in the Pediatric Primary Care Setting. Clin Pediatr (Phila) 2019; 58:24-33. [PMID: 30318927 PMCID: PMC6261697 DOI: 10.1177/0009922818805234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this quality improvement study was to assess the feasibility, acceptability, and impact of integrating long-acting reversible contraceptive (LARC) delivery services into an academic pediatric primary care practice. Adolescent medicine providers in Baltimore, Maryland, were trained in LARC placement with gynecology providers integrated to offer onsite LARC placement and procedural support. Referrals, appointments, and contraceptive method choice/receipt were tabulated. Of 212 individuals referred for LARC consultations, 104 attended appointments. LARC placement at the initial referral increased from year 1 (N = 1) to year 2 (N = 42; P < .01). Adolescent medicine providers placed more LARCs in year 2 (N = 34) than year 1 (N = 0; P < .01). Patients aged 18 to 24 years were less likely to have a LARC placed than those aged 13 to 17 years (unadjusted odds ratio = 0.47 [0.26-0.86]). In conclusion, provider training and service integration of LARC services within a pediatric practice is feasible, acceptable, and increases LARC access and placement.
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Affiliation(s)
| | | | | | - Priya S. Gupta
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | | | - Anne E. Burke
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maria E. Trent
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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19
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Coleman-Minahan K, Dillaway CH, Canfield C, Kuhn DM, Strandberg KS, Potter JE. Low-Income Texas Women's Experiences Accessing Their Desired Contraceptive Method at the First Postpartum Visit. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2018; 50:189-198. [PMID: 30506996 PMCID: PMC6314803 DOI: 10.1363/psrh.12083] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 06/09/2023]
Abstract
CONTEXT Early access to contraception may increase postpartum contraceptive use. However, little is known about women's experiences receiving their desired method at the first postpartum visit or how access is associated with use. METHODS In a 2014-2016 prospective cohort study of low-income Texas women, data were collected from 685 individuals who desired a reversible contraceptive and discussed contraception with a provider at their first postpartum visit, usually within six weeks of birth. Women's experiences were captured using open- and closed-ended survey questions. Thematic and multivariate logistic regression analyses were employed to examine contraceptive access and barriers, and method use at three months postpartum. RESULTS Twenty-three percent of women received their desired method at the first postpartum visit; 11% a prescription for their desired pill, patch or ring; 8% a method (or prescription) other than that desired; and 58% no method. Among women who did not receive their desired method, 44% reported clinic-level barriers (e.g., method unavailability or no same-day provision), 26% provider-level barriers (e.g., inaccurate contraceptive counseling) and 23% cost barriers. Women who used private practices were more likely than those who used public clinics to report availability and cost barriers (odds ratios, 6.4 and 2.7, respectively). Forty-one percent of women who did not receive their desired method, compared with 86% of those who did, were using that method at three months postpartum. CONCLUSION Eliminating the various barriers that postpartum women face may improve their access to contraceptives. Further research is needed to improve the understanding of clinic- and provider-level barriers.
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Affiliation(s)
- Kate Coleman-Minahan
- Assistant Professor, College of Nursing, University of Colorado Anschutz Medical Campus, Aurora
| | - Chloe H Dillaway
- Graduate Student at Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Caitlin Canfield
- Evaluation Manager, Evaluation and Research, Louisiana Public Health Institute, New Orleans
| | - Daniela M Kuhn
- Research Associate, Population Research Center, University of Texas at Austin
| | | | - Joseph E Potter
- Professor, Population Research Center, University of Texas at Austin
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20
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Madden T, Barker AR, Huntzberry K, Secura GM, Peipert JF, McBride TD. Medicaid savings from the Contraceptive CHOICE Project: a cost-savings analysis. Am J Obstet Gynecol 2018; 219:595.e1-595.e11. [PMID: 30194049 DOI: 10.1016/j.ajog.2018.08.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/25/2018] [Accepted: 08/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Forty-five percent of births in the United States are unintended, and the costs of unintended pregnancy and birth are substantial. Clinical and policy interventions that increase access to the most effective reversible contraceptive methods (intrauterine devices and contraceptive implants) have potential to generate significant cost savings. Evidence of cost savings for these interventions is needed. OBJECTIVE The purpose of this study was to conduct a cost-savings analysis of the Contraceptive CHOICE Project, which provided counseling and no-cost contraception, to demonstrate the value of investment in enhanced contraceptive care to the Missouri Medicaid program. STUDY DESIGN The Contraceptive CHOICE Project was a prospective cohort study of 9256 reproductive-age women who were enrolled between 2007 and 2011. Study follow-up was completed October 2013. This analysis includes 5061 Contraceptive CHOICE Project participants who were current Missouri Medicaid beneficiaries or were uninsured and reported household incomes <201% of the federal poverty line. We created a simulated comparison group of women who were receiving care through the Missouri Title X program and modeled the contraception and pregnancy outcomes that would have occurred in the absence of the Contraceptive CHOICE Project. Data about contraceptive use for the comparison group (N=5061) were obtained from the Missouri Title X program and adjusted based on age, race, ethnicity, and income. To make an accurate comparison that would account for the difference in the 2 populations, we used our simulation model to estimate total Contraceptive CHOICE Project costs and total comparison group costs. We reported all costs in 2013 dollars to account for inflation. RESULTS Among the Contraceptive CHOICE Project participants who were included, the uptake of intrauterine devices and implants was 76.1% compared with 4.8% among the comparison group. The estimated contraceptive cost for the simulated Contraceptive CHOICE Project group was $4.0 million vs $2.3 million for the comparison group. The estimated numbers of unintended pregnancies and births averted among the simulated Contraceptive CHOICE Project group compared with the comparison group were 927 and 483, respectively, which represented a savings in pregnancy and maternity care of $6.7 million. We estimated that the total cost savings for the state of Missouri attributable to the Contraceptive CHOICE Project was $5.0 million (40.7%) over the project duration. CONCLUSION A program providing counseling and no-cost contraception yields substantial cost savings because of the increased uptake of highly effective contraception and consequent averted unintended pregnancy and birth.
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21
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Olson EM, Kramer RD, Gibson C, Wautlet CK, Schmuhl NB, Ehrenthal DB. Health Care Barriers to Provision of Long-Acting Reversible Contraception in Wisconsin. WMJ : OFFICIAL PUBLICATION OF THE STATE MEDICAL SOCIETY OF WISCONSIN 2018; 117:149-155. [PMID: 30407764 PMCID: PMC6734562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Long-acting reversible contraceptives (LARC), specifically implants and intrauterine devices (IUD), are highly effective, low maintenance forms of birth control. Practice guidelines from the American College of Obstetricians and Gynecologists, American Academy of Family Physicians, and American Academy of Pediatrics recommend that LARC be considered first-line birth control for most women; however, uptake remains low. In this study, we sought to understand practices and barriers to provision of LARC in routine and immediate postpartum settings as they differ between specialties. METHODS We surveyed 3,000 Wisconsin physicians and advanced-practice providers in obstetrics-gynecology/women's health (Ob-gyn), family medicine, pediatrics, and midwifery to assess practices and barriers (56.5% response rate). This analysis is comprised of contraceptive care providers (n=992); statistical significance was tested using chi-square and 2-sample proportions tests. RESULTS More providers working Ob-gyn (94.3%) and midwifery (78.7%) were skilled providers of LARC methods than those in family medicine (42.5%) and pediatrics (6.6%) (P < .0001). Lack of insertion skill was the most-cited barrier to routine provision among family medicine (31.1%) and pediatric (72.1%) providers. Among prenatal/delivery providers, over 50% across all specialties reported lack of device availability on-site as a barrier to immediate postpartum LARC provision; organizational practices also were commonly reported barriers. CONCLUSIONS Gaps in routine and immediate postpartum LARC practice were strongly related to specialty, and providers' experience heightened barriers to immediate postpartum compared to routine insertion. Skills training targeting family medicine and pediatric providers would enable broader access to LARC. Organizational barriers to immediate postpartum LARC provision impact many providers.
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Affiliation(s)
- Emily M Olson
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Renee D Kramer
- Department of Population Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Crystal Gibson
- Wisconsin Department of Health Services, Madison, Wisconsin
| | - Cynthia K Wautlet
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Nicholas B Schmuhl
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Deborah B Ehrenthal
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin,
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Moniz MH, Kirch MA, Solway E, Goold SD, Ayanian JZ, Kieffer EC, Clark SJ, Tipirneni R, Kullgren JT, Chang T. Association of Access to Family Planning Services With Medicaid Expansion Among Female Enrollees in Michigan. JAMA Netw Open 2018; 1:e181627. [PMID: 30646135 PMCID: PMC6324283 DOI: 10.1001/jamanetworkopen.2018.1627] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE To date, 32 states and the District of Columbia have expanded Medicaid programs under the Patient Protection and Affordable Care Act. It is vital to understand whether expanded health insurance coverage of low-income individuals improves access to family planning services as a first step toward improving reproductive health outcomes. OBJECTIVE To evaluate the association of Medicaid expansion coverage with access to birth control and family planning services among women of reproductive age enrolled in the Michigan expansion plan. DESIGN, SETTING, AND PARTICIPANTS In a survey study, from January 13 through December 15, 2016, telephone surveys of a stratified sample of enrollees in Michigan's Section 1115 Medicaid Expansion waiver program, the Healthy Michigan Plan (HMP), were conducted. Interviewers completed surveys for 4090 sampled enrollees, of whom 1166 were women aged 19 to 44 years. Surveys were conducted with a computer-assisted telephone interviewing system in English, Arabic, and Spanish. The sample was weighted to 113 565 women. Dates of data analysis were from January 27 through September 18, 2017. MAIN OUTCOMES AND MEASURES Self-reported change in access to birth control and family planning services through HMP (better, worse, about the same, or don't know/doesn't apply), compared with before enrollment. RESULTS Among the 1166 survey respondents aged 19 to 44 years (mean [SD] age, 31.0 [0.3] years) and the weighted sample of 113 565, 74.7% (95% CI, 72.2%-76.9%) lived in very-low-income households (<100% federal poverty level), 64.0% (95% CI, 60.5%-67.3%) reported at least 1 chronic medical condition, 23.5% (95% CI, 20.6%-26.6%) reported fair or poor health, and 17.7% (95% CI, 15.7%-19.9%) lived in rural settings. Overall, 35.5% (95% CI, 32.2%-39.0%) reported increased access to family planning services. After adjusting, those most likely to report increased access were women without health insurance coverage in the year preceding HMP enrollment (adjusted odds ratio [aOR], 2.02; 95% CI, 1.41-2.89) compared with women with health insurance for the full 12 months preceding enrollment; younger women (aOR for 19-24 years, 2.80 [95% CI, 1.75-4.50]; aOR for 25-34 years, 2.35 [95% CI, 1.60-3.45]) compared with women aged 35 to 44 years; and women with a recent visit to a primary care clinician (aOR 1.69; 95% CI, 1.03-2.76) compared with women without a primary care visit in the preceding 12 months. CONCLUSIONS AND RELEVANCE One in 3 women of reproductive age reported better ability to access birth control and family planning services through HMP compared with before enrollment. This finding suggests that Medicaid expansion is associated with improved access to family planning services, which may enable low-income women to maintain optimal reproductive health.
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Affiliation(s)
- Michelle H. Moniz
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Matthias A. Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Susan D. Goold
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- School of Public Health, University of Michigan, Ann Arbor
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor
| | - John Z. Ayanian
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- School of Public Health, University of Michigan, Ann Arbor
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Edith C. Kieffer
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- School of Social Work, University of Michigan, Ann Arbor
| | - Sarah J. Clark
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Pediatrics, University of Michigan, Ann Arbor
| | - Renuka Tipirneni
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Jeffrey T. Kullgren
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor
- Veterans Affairs Ann Arbor Center for Clinical Management Research, University of Michigan, Ann Arbor
| | - Tammy Chang
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Family Medicine, University of Michigan, Ann Arbor
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23
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Gorman CD, Dennis J, Heathcote JA. Telephone counselling for subdermal implants and intrauterine contraceptives. BMJ SEXUAL & REPRODUCTIVE HEALTH 2018; 44:136-138. [PMID: 29150521 DOI: 10.1136/bmjsrh-2017-101883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/28/2017] [Accepted: 10/25/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Caitlin D Gorman
- Medicine and Health, School of Medicine, The University of Manchester Medical School, Manchester, UK
| | - Joanne Dennis
- East Cheshire Community Sexual Health Clinic, East Cheshire NHS Trust, Macclesfield, UK
| | - Jennifer A Heathcote
- East Cheshire Community Sexual Health Clinic, East Cheshire NHS Trust, Macclesfield, UK
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Millar A, Vogel RI, Bedell S, Ayers Looby M, Hubbs JL, Harlow BL, Ghebre R. Patterns of postpartum contraceptive use among Somali immigrant women living in Minnesota. Contracept Reprod Med 2017; 2:14. [PMID: 29201419 PMCID: PMC5683445 DOI: 10.1186/s40834-017-0041-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 02/16/2017] [Indexed: 11/16/2022] Open
Abstract
Background The postpartum period is a crucial time to provide family planning counseling and can decrease incidence of adverse reproductive outcomes. The purpose of this study was to characterize patterns of postpartum contraception and to investigate long acting reversible contraceptive (LARC) use among Somali women living in a metropolitan area of Minnesota in an effort to provide better family planning and reproductive health counseling in this growing immigrant population. Methods A retrospective chart review was conducted of Somali women who delivered between January 1, 2011 and December 31, 2014. Information was collected regarding family planning counseling provided and contraceptive methods chosen at the postpartum clinic visit. Results Of the 747 Somali women who delivered during this time period, 56.4% had no postpartum follow up visit. At the postpartum visit, 88.3% of women received family planning counseling and 80.8% chose a contraceptive method with the remainder declining. The intrauterine device (IUD) was the most popular contraceptive method, chosen by 39.7% of women. Other than parity, no statistically significant differences were observed between women who chose LARC versus other contraceptive methods. Of the women that chose a LARC, 39.4% had it placed at the time of their postpartum visit; immediate placement was statistically significantly more likely with more recent delivery, lower BMI and obstetrician as the provider type. Conclusions The IUD was the most popular method of postpartum contraception. There was a trend toward increase in LARC use with increasing parity. Same-day LARC placement was uncommon, but should be encouraged in this population given high loss to follow up rate.
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Affiliation(s)
- Amy Millar
- University of Minnesota Department of Obstetrics, Gynecology and Women's Health, 420 Delaware St SE, MMC 395, Minneapolis, MN 55455 USA
| | - Rachel Isaksson Vogel
- University of Minnesota Department of Obstetrics, Gynecology and Women's Health, 420 Delaware St SE, MMC 395, Minneapolis, MN 55455 USA
| | - Sabrina Bedell
- University of Minnesota Department of Obstetrics, Gynecology and Women's Health, 420 Delaware St SE, MMC 395, Minneapolis, MN 55455 USA
| | - Maureen Ayers Looby
- University of Minnesota Department of Obstetrics, Gynecology and Women's Health, 420 Delaware St SE, MMC 395, Minneapolis, MN 55455 USA
| | - Jessica L Hubbs
- University of Minnesota Department of Obstetrics, Gynecology and Women's Health, 420 Delaware St SE, MMC 395, Minneapolis, MN 55455 USA
| | | | - Rahel Ghebre
- University of Minnesota Department of Obstetrics, Gynecology and Women's Health, 420 Delaware St SE, MMC 395, Minneapolis, MN 55455 USA.,Human Resources for Health Program Rwanda and Yale School of Medicine, New Haven, CT USA
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Coleman-Minahan K, Aiken ARA, Potter JE. Prevalence and Predictors of Prenatal and Postpartum Contraceptive Counseling in Two Texas Cities. Womens Health Issues 2017; 27:707-714. [PMID: 28662935 PMCID: PMC5694359 DOI: 10.1016/j.whi.2017.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 05/07/2017] [Accepted: 05/15/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We investigated the prevalence of and sociodemographic associations with receiving prenatal and postpartum contraceptive counseling, including counseling on intrauterine devices (IUDs) and implants. METHODS We used data from a prospective cohort study of 803 postpartum women in El Paso and Austin, Texas. We examined the prevalence of prenatal and postpartum counseling, provider discouragement of IUDs and implants, and associated sociodemographic characteristics using χ2 tests and logistic regression. RESULTS One-half of participants had received any prenatal contraceptive counseling, and 13% and 37% received counseling on both IUDs and implants prenatally and postpartum, respectively. Women with more children were more likely to receive any contraceptive counseling prenatally (odds ratio [OR], 1.99; p < .01). Privately insured women (OR, 0.53; p < .05) had a lower odds of receiving prenatal counseling on IUDs and implants than publicly insured women. Higher education (OR, 2.16; p < .05) and attending a private practice (OR, 2.16; p < .05) were associated with receiving any postpartum counseling. Older age (OR, 0.61; p < .05) was negatively associated with receiving postpartum counseling about IUDs and implants and a family income of $10,000 to $19,000 (OR, 2.21; p < .01) was positively associated. Approximately 20% of women receiving prenatal counseling and 10% receiving postpartum counseling on IUDs and implants were discouraged from using them. The most common reason providers restricted use of these methods was inaccurate medical advice. CONCLUSIONS Prenatal and postpartum counseling, particularly about IUDs and implants, was infrequent and varied by sociodemographics. Providers should implement evidence-based prenatal and postpartum contraceptive counseling to ensure women can make informed choices and access their preferred method of postpartum contraception.
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Affiliation(s)
- Kate Coleman-Minahan
- College of Nursing, University of Colorado Denver, Aurora, Colorado; Population Research Center, University of Texas at Austin, Austin, Texas.
| | - Abigail R A Aiken
- Population Research Center, University of Texas at Austin, Austin, Texas; LBJ School of Public Affairs, University of Texas at Austin, Austin, Texas
| | - Joseph E Potter
- Population Research Center, University of Texas at Austin, Austin, Texas
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Contraception After Delivery Among Publicly Insured Women in Texas: Use Compared With Preference. Obstet Gynecol 2017; 130:393-402. [PMID: 28697112 DOI: 10.1097/aog.0000000000002136] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess women's preferences for contraception after delivery and to compare use with preferences. METHODS In a prospective cohort study of women aged 18-44 years who wanted to delay childbearing for at least 2 years, we interviewed 1,700 participants from eight hospitals in Texas immediately postpartum and at 3 and 6 months after delivery. At 3 months, we assessed contraceptive preferences by asking what method women would like to be using at 6 months. We modeled preference for highly effective contraception and use given preference according to childbearing intentions using mixed-effects logistic regression testing for variability across hospitals and differences between those with and without immediate postpartum long-acting reversible contraception (LARC) provision. RESULTS Approximately 80% completed both the 3- and 6-month interviews (1,367/1,700). Overall, preferences exceeded use for both-LARC: 40.8% (n=547) compared with 21.9% (n=293) and sterilization: 36.1% (n=484) compared with 17.5% (n=235). In the mixed-effects logistic regression models, several demographic variables were associated with a preference for LARC among women who wanted more children, but there was no significant variability across hospitals. For women who wanted more children and had a LARC preference, use of LARC was higher in the hospital that offered immediate postpartum provision (P<.035) as it was for U.S.-born women (odds ratio [OR] 2.08, 95% CI 1.17-3.69) and women with public prenatal care providers (OR 2.04, 95% CI 1.13-3.69). In the models for those who wanted no more children, there was no significant variability in preferences for long-acting or permanent methods across hospitals. However, use given preference varied across hospitals (P<.001) and was lower for black women (OR 0.26, 95% CI 0.12-0.55) and higher for U.S.-born women (OR 2.32, 95% CI 1.36-3.96), those 30 years of age and older (OR 1.82, 95% CI 1.07-3.09), and those with public prenatal care providers (OR 2.04, 95% CI 1.18-3.51). CONCLUSION Limited use of long-acting and permanent contraceptive methods after delivery is associated with indicators of health care provider and system-level barriers. Expansion of immediate postpartum LARC provision as well as contraceptive coverage for undocumented women could reduce the gap between preference and use.
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Kottke M, Hailstorks T. Improvements in Contraception for Adolescents. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0214-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rowlands S, Ingham R. Long-acting reversible contraception: conflicting perspectives of advocates and potential users. BJOG 2017; 124:1474-1476. [DOI: 10.1111/1471-0528.14699] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 11/26/2022]
Affiliation(s)
- S Rowlands
- Centre of Postgraduate Medical Research and Education; Bournemouth University; Bournemouth UK
| | - R Ingham
- Centre for Sexual Health Research; University of Southampton; Southampton UK
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Affiliation(s)
- Kathryn M Curtis
- From the Centers for Disease Control and Prevention, Atlanta (K.M.C.); and the Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis (J.F.P.)
| | - Jeffrey F Peipert
- From the Centers for Disease Control and Prevention, Atlanta (K.M.C.); and the Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis (J.F.P.)
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Turok DK, Eisenberg DL, Teal SB, Keder LM, Creinin MD. A prospective assessment of pelvic infection risk following same-day sexually transmitted infection testing and levonorgestrel intrauterine system placement. Am J Obstet Gynecol 2016; 215:599.e1-599.e6. [PMID: 27180886 DOI: 10.1016/j.ajog.2016.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/20/2016] [Accepted: 05/05/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Misperceptions persist that intrauterine device placement is related to pelvic infections and Chlamydia and gonorrhea testing results are needed prior to placement. OBJECTIVE We sought to evaluate the relationship of Chlamydia and gonorrhea screening to pelvic infection for up to 2 years following placement of the levonorgestrel 52-mg intrauterine system. STUDY DESIGN A total of 1751 nulliparous and multiparous females 16 to 45 years old enrolled in a multicenter trial designed to evaluate the efficacy and safety of a new levonorgestrel intrauterine system for up to 7 years. Participants had Chlamydia screening at study entry and yearly if they were age ≤25 years. Women also had baseline gonorrhea screening if testing had not been performed since starting their current sexual relationship. Those who changed sexual partners during the trial had repeated Chlamydia and gonorrhea testing. Intrauterine system insertion could occur on the same day as screening. Participants did not receive prophylactic antibiotics for intrauterine system placement. Investigators performed pelvic examinations after 12 and 24 months and when clinically indicated during visits at 3, 6, and 18 months after placement and unscheduled visits. Pelvic infection included any clinical diagnosis of pelvic inflammatory disease or endometritis. RESULTS Most participants (n = 1364, 79.6%) did not have sexually transmitted infection test results available prior to intrauterine system placement. In all, 29 (1.7%) participants had positive baseline testing for a sexually transmitted infection (Chlamydia, n = 25; gonorrhea, n = 3; both, n = 1); 6 of these participants had known results (all with Chlamydia infection) prior to intrauterine system placement and received treatment before enrollment. The 23 participants whose results were not known at the time of intrauterine system placement received treatment without intrauterine system removal and none developed pelvic infection. The incidence of positive Chlamydia testing was similar among those with and without known test results at the time of intrauterine system placement (1.9% vs 1.5%, respectively, P = .6). Nine (0.5%) participants had a diagnosis of pelvic infection over 2 years after placement, all of whom had negative Chlamydia screening on the day of or within 1 month after intrauterine system placement. Infections were diagnosed in 3 participants within 7 days, 1 at 39 days, and 5 at ≥6 months. Seven participants received outpatient antibiotic treatment and 2 (diagnoses between 6-12 months after placement) received inpatient treatment. Two (0.1%) participants had intrauterine system removal related to infection (at 6 days and at 7 months after placement), both of whom only required outpatient treatment. CONCLUSION Conducting Chlamydia and gonorrhea testing on the same day as intrauterine system placement is associated with a low risk of pelvic infection (0.2%). Over the first 2 years of intrauterine system use, infections are infrequent and not temporally related to intrauterine system placement. Pelvic infection can be successfully treated in most women with outpatient antibiotics and typically does not require intrauterine system removal. Women without clinical evidence of active infection can have intrauterine system placement and sexually transmitted infection screening, if indicated, on the same day.
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Affiliation(s)
- David K Turok
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - David L Eisenberg
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO
| | - Stephanie B Teal
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, CO
| | - Lisa M Keder
- Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH
| | - Mitchell D Creinin
- Department of Obstetrics and Gynecology, University of California-Davis, Sacramento, CA.
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Lotke PS. Increasing Use of Long-Acting Reversible Contraception to Decrease Unplanned Pregnancy. Obstet Gynecol Clin North Am 2016; 42:557-67. [PMID: 26598299 DOI: 10.1016/j.ogc.2015.07.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Unintended pregnancy remains high in the United States, accounting for one-half of pregnancies. Both contraceptive nonuse and imperfect use contribute to unplanned pregnancies. Long-acting reversible contraception (LARC) have greater efficacy than shorter acting methods. Data from large studies show that unplanned pregnancy rates are lower among women using LARC. However, overall use of LARC is low; of the reproductive age women using contraception, less than 10% are LARC users. Barriers include lack of knowledge and high up-front cost, and prevent more widespread use. Overcoming these barriers and increasing the number of women using LARC will decrease unplanned pregnancies and abortions.
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Affiliation(s)
- Pamela S Lotke
- Division of Family Planning and Preventive Care, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, 110 Irving Street, Northwest, Washington, DC 20010, USA.
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Jacobson L, Garbers S, Helmy H, Roobol H, Kohn JE, Kavanaugh ML. IUD services among primary care practices in New York City. Contraception 2016; 93:257-62. [DOI: 10.1016/j.contraception.2015.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/28/2015] [Accepted: 11/01/2015] [Indexed: 11/28/2022]
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Foster DG, Barar R, Gould H, Gomez I, Nguyen D, Biggs MA. Projections and opinions from 100 experts in long-acting reversible contraception. Contraception 2015; 92:543-52. [PMID: 26515195 DOI: 10.1016/j.contraception.2015.10.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 10/13/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This survey of published researchers of long-acting reversible contraceptives (LARCs) examines their opinions about important barriers to LARC use in the United States (US), projections for LARC use in the absence of barriers and attitudes toward incentives for clinicians to provide and women to use LARC methods. STUDY DESIGN We identified 182 authors of 59 peer-reviewed papers on LARC use published since 2013. A total of 104 completed an internet survey. We used descriptive and multivariate analyses to assess LARC use barriers and respondent characteristics associated with LARC projections and opinions. RESULTS The most commonly identified barrier was the cost of the device (63%), followed by women's knowledge of safety, method acceptability and expectations about use. A shortage of trained providers was a commonly cited barrier, primarily of primary care providers (49%). Median and modal projections of LARC use in the absence of these barriers were 25-29% of contracepting women. There was limited support for provider incentives and almost no support for incentives for women to use LARC methods, primarily out of concern about coercion. CONCLUSIONS Clinical and social science LARC experts project at least a doubling of the current US rate of LARC use if barriers to method provision and adoption are removed. While LARC experts recognize the promise of LARC methods to better meet women's contraceptive needs, they anticipate that the majority of US women will not choose LARC methods. Reducing unintended pregnancy rates will depend on knowledge, availability and use of a wider range of methods of contraception to meet women's individual needs. IMPLICATIONS Efforts to increase LARC use need to meet the dual goals of increasing access to LARC methods and protecting women's reproductive autonomy. To accomplish this, we need reasonable expectations for use, provider training, low-cost devices and noncoercive counseling, rather than incentives for provision or use.
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Affiliation(s)
- Diana Greene Foster
- University of California, San Francisco, Advancing New Standards in Reproductive Health, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA.
| | - Rana Barar
- University of California, San Francisco, Advancing New Standards in Reproductive Health, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA
| | - Heather Gould
- University of California, San Francisco, Advancing New Standards in Reproductive Health, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA
| | - Ivette Gomez
- University of California, San Francisco, Advancing New Standards in Reproductive Health, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA
| | - Deborah Nguyen
- University of California, San Francisco, Advancing New Standards in Reproductive Health, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA
| | - M Antonia Biggs
- University of California, San Francisco, Advancing New Standards in Reproductive Health, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA
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California Family Planning Health Care Providers' Challenges to Same-Day Long-Acting Reversible Contraception Provision. Obstet Gynecol 2015; 126:338-345. [DOI: 10.1097/aog.0000000000000969] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Stern LF, Simons HR, Kohn JE, Debevec EJ, Morfesis JM, Patel AA. Differences in contraceptive use between family planning providers and the U.S. population: results of a nationwide survey. Contraception 2015; 91:464-9. [PMID: 25722074 DOI: 10.1016/j.contraception.2015.02.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/06/2015] [Accepted: 02/16/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To describe contraceptive use among U.S. female family planning providers and to compare their contraceptive choices to the general population. STUDY DESIGN We surveyed a convenience sample of female family planning providers ages 25-44 years, including physicians and advanced practice clinicians, via an internet-based survey from April to May 2013. Family planning providers were compared to female respondents ages 25-44 years from the 2011-2013 National Survey of Family Growth. RESULTS A total of 488 responses were eligible for analysis; 331 respondents (67.8%) were using a contraceptive method. Providers' contraceptive use differed markedly from that of the general population, with providers significantly more likely to use intrauterine contraception, an implant, and the vaginal ring. Providers were significantly less likely to use female sterilization and condoms. There were no significant differences between providers and the general population in use of partner vasectomy or the pill. Long-acting reversible contraception (LARC) use was significantly higher among providers than in the general population (41.7% vs. 12.1%, p<.001). These results were consistent when stratifying by variables including self-identified race/ethnicity and educational level. CONCLUSIONS The contraceptive choices of this sample of female family planning providers differed significantly from the general population. These findings have implications for clinical practice, patient education, and health policy. IMPLICATIONS Family planning providers report higher use of LARC than the general population. This may reflect differences in preferences and access. Providers might consider sharing these findings with patients, while maintaining patient choice and autonomy.
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Affiliation(s)
- Lisa F Stern
- Planned Parenthood Federation of America, New York, NY, USA.
| | | | - Julia E Kohn
- Planned Parenthood Federation of America, New York, NY, USA
| | - Elie J Debevec
- Planned Parenthood Federation of America, New York, NY, USA
| | | | - Ashlesha A Patel
- Division of Family Planning, Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
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Did increasing use of highly effective contraception contribute to declining abortions in Iowa? Contraception 2015; 91:167-73. [DOI: 10.1016/j.contraception.2014.10.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 10/16/2014] [Accepted: 10/26/2014] [Indexed: 11/21/2022]
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Thompson K, Belden P. Counseling for emergency contraception: time for a tiered approach. Contraception 2014; 90:559-61. [PMID: 25444255 DOI: 10.1016/j.contraception.2014.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 09/05/2014] [Accepted: 09/09/2014] [Indexed: 12/30/2022]
Affiliation(s)
- Kirsten Thompson
- Bixby Center for Global Reproductive Health, University of California, San Francisco, 3333 California Street, Suite 335, Box 0744, San Francisco, CA 94143.
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Papic M, Wang N, Parisi SM, Baldauf E, Updike G, Schwarz EB. Same-day intrauterine device placement is rarely complicated by pelvic infection. Womens Health Issues 2014; 25:22-7. [PMID: 25445666 DOI: 10.1016/j.whi.2014.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 09/02/2014] [Accepted: 09/23/2014] [Indexed: 11/15/2022]
Abstract
PURPOSE To compare rates of pelvic inflammatory disease (PID) among women who did and did not receive an intrauterine device (IUD) the day they sought emergency contraception (EC) or pregnancy testing. METHODS Women, 15 to 45 years of age, who sought EC or pregnancy testing from an urban family planning clinic completed surveys at the time of their clinic visit (August 22, 2011, to May 30, 2013) and 3 months after their clinic visit. The surveys assessed contraceptive use and symptoms, testing, and treatment for sexually transmitted infections (STI) and PID. We reviewed the medical records of participants who reported IUD placement within 3 months of enrollment and abstracted de-identified electronic medical record (EMR) data on all women who sought EC or pregnancy testing from the study clinic during the study period. FINDINGS During the study period, 1,060 women visited the study clinic; 272 completed both enrollment and follow-up surveys. Among survey completers with same-day IUD placement, PID in the 3 months after enrollment was not more common (1/28 [3.6%]; 95% CI, 0%-10.4%) than among women who did not have a same-day IUD placed (11/225 [4.9%]; 95% CI, 2.7%-8.6%; p = .71). Chart review and EMR data similarly showed that rates of PID within 3 months of seeking EC or pregnancy testing were low whether women opted for same-day or delayed IUD placement. CONCLUSIONS Same-day IUD placement was not associated with higher rates of PID. Concern for asymptomatic STI should not delay IUD placement, and efforts to increase the uptake of this highly effective reversible contraception should not be limited to populations at low risk of STI.
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Affiliation(s)
- Melissa Papic
- Department of Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nan Wang
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sara M Parisi
- Department of Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erin Baldauf
- Department of Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Glenn Updike
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
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Hubacher D, Spector H, Monteith C, Chen PL, Hart C. Rationale and enrollment results for a partially randomized patient preference trial to compare continuation rates of short-acting and long-acting reversible contraception. Contraception 2014; 91:185-92. [PMID: 25500324 DOI: 10.1016/j.contraception.2014.11.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/16/2014] [Accepted: 11/08/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Most published contraceptive continuation rates have scientific limitations and cannot be compared; this is particularly true for dissimilar contraceptives. This study uses a new approach to determine if high continuation rates of long-acting reversible contraception (LARC) and protection from unintended pregnancy are observable in a population not self-selecting to use LARC. STUDY DESIGN We are conducting a partially randomized patient preference trial (PRPPT) to compare continuation rates of short-acting reversible contraception (SARC) and LARC. Only women seeking SARC were invited to participate. Participants chose to be in the preference cohort (self-selected method use) or opted to be randomized to SARC or LARC; only those in the randomized cohort received free product. We compared participant characteristics, reasons for not trying LARC previously and the contraceptive choices that were made. RESULTS We enrolled 917 eligible women; 57% chose to be in the preference cohort and 43% opted for the randomized trial. The preference and randomized cohorts were similar on most factors. However, the randomized cohort was more likely than the preference cohort to be uninsured (48% versus 36%, respectively) and to cite cost as a reason for not trying LARC previously (50% versus 10%) (p<.01 for both comparisons). In the preference cohort, fear of pain/injury/side effects/health risks were the predominant reasons (cited by over 25%) for not trying LARC previously (p<.01 in comparison to randomized cohort). CONCLUSIONS Enrollment was successful and the process created different cohorts to compare contraceptive continuation rates and unintended pregnancy in this ongoing trial. The choices participants made were associated with numerous factors; lack of insurance was associated with participation in the randomized trial. IMPLICATIONS This PRPPT will provide new estimates of contraceptive continuation rates, such that any benefits of LARC will be more easily attributable to the technology and not the user. Combined with measuring level of satisfaction with LARC, the results will help project the potential role and benefits of expanding voluntary use of LARC.
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Affiliation(s)
- David Hubacher
- FHI 360, 359 Blackwell Street, Suite 200, Durham, NC 27701, USA.
| | - Hannah Spector
- Planned Parenthood of Central North Carolina, PO Box 3258, Chapel Hill, NC 27515, USA
| | - Charles Monteith
- Planned Parenthood of Central North Carolina, PO Box 3258, Chapel Hill, NC 27515, USA
| | - Pai-Lien Chen
- FHI 360, 359 Blackwell Street, Suite 200, Durham, NC 27701, USA
| | - Catherine Hart
- FHI 360, 359 Blackwell Street, Suite 200, Durham, NC 27701, USA
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Obstetrician–Gynecologists and contraception: long-acting reversible contraception practices and education. Contraception 2014; 89:578-83. [DOI: 10.1016/j.contraception.2014.02.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 02/04/2014] [Accepted: 02/10/2014] [Indexed: 11/23/2022]
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Wilson S, Tennant C, Sammel MD, Schreiber C. Immediate postpartum etonogestrel implant: a contraception option with long-term continuation. Contraception 2014; 90:259-64. [PMID: 24993485 DOI: 10.1016/j.contraception.2014.05.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 05/01/2014] [Accepted: 05/04/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine 3-year continuation rates of the etonogestrel contraceptive implant when inserted immediately postpartum and to identify factors associated with discontinuation. STUDY DESIGN A retrospective cohort of 262 women who had the contraceptive implant inserted immediately postpartum between January 2008 and March 2009 was collected from electronic medical records. Continuation rates at 1, 2 and 3 years were estimated. Adverse effects leading to removal of the implant were recorded. Multivariable Cox proportional hazard models were performed to determine factors associated with early discontinuation. RESULTS Large subsets of the study patients were adolescent (28.2%) and multigravid (71.8%) and presented for fewer than six prenatal visits (38.5%). Follow-up rates were over 70% at each of the 3 years. Adolescents and women with fewer than six prenatal visits had the highest continuation rates at 1 year, 94.5% and 94.1%, respectively. The cumulative implant continuation rate after 3 years was 66.3%. Multivariable analysis indicated that having six or more prenatal care visits was the only independent predictor of early discontinuation, with a hazard ratio of 3.1 (p=0.04) and 1.8 (p=<0.01) at 1 and 3 years, respectively. The most commonly reported reasons for early removal were abnormal bleeding (41.2%) and weight gain (19.1%). CONCLUSION The contraceptive implant has high continuation over its 3-year lifespan when inserted immediately postpartum. Continuation rates were highest among populations most vulnerable to rapid repeat and unintended pregnancies. IMPLICATIONS The etonogestrel implant, when placed immediately postpartum for contraception, can have high continuation rates of use for up to 3 years duration.
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Affiliation(s)
| | | | - Mary D Sammel
- Department of Biostatistics and Epidemiology & Center for Clinical Epidemiology and Biostatistics (CCEB), Perelman School of Medicine, University of Pennsylvania
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Factors Influencing the Provision of Long-Acting Reversible Contraception in California. Obstet Gynecol 2014; 123:593-602. [DOI: 10.1097/aog.0000000000000137] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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