Same-day long-acting reversible contraceptive utilization after a statewide contraceptive access initiative - 30/03/23
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.
Le texte complet de cet article est disponible en PDF.Key words : contraception, implant, intrauterine device, long-acting reversible contraception
Plan
| The authors report no conflict of interest. |
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| This work was supported by infrastructural support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, population research infrastructure grant P2C-HD041041, and a research grant from a private philanthropic foundation. We thank the Hilltop Institute and the Delaware Division of Medicaid and Medical Assistance for their generous assistance with the data featured in this study. The funders had no role in the study design or collection, analysis, or interpretation of data. |
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| Cite this article as: McColl R, Gifford K, McDuffie MJ, et al. Same-day long-acting reversible contraceptive utilization after a statewide contraceptive access initiative. Am J Obstet Gynecol 2023;228:451.e1-8. |
Vol 228 - N° 4
P. 451.e1-451.e8 - avril 2023 Retour au numéro
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