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Policy change is not enough: engaging provider champions on immediate postpartum contraception.

Abstract：

:Rates of short-interval pregnancies that result in unintended pregnancies remain high in the United States and contribute to adverse reproductive health outcomes. Long-acting reversible contraception methods have annual failure rates of <1%, compared with 9% for oral contraceptive pills, and are an effective strategy to reduce unintended pregnancies. To increase access to long-acting reversible contraception in the immediate postpartum period, several State Medicaid programs, which include those in Iowa and Louisiana, recently established reimbursement policies to remove the barriers to reimbursement of immediate postpartum long-acting reversible contraception insertion. We used a mixed-methods approach to analyze 2013-2015 linked Medicaid and vital records data from both Iowa and Louisiana and to describe trends in immediate postpartum long-acting reversible contraception provision 1 year before and after the Medicaid reimbursement policy change. We also used data from key informant interviews with state program staff to understand how provider champions affected policy uptake. We found that the monthly average for the number of insertions in Iowa increased from 4.6 per month before the policy to 6.6 per month after the policy; in Louisiana, the average number of insertions increased from 2.6 per month before the policy to 45.2 per month. In both states, the majority of insertions occurred at 1 academic/teaching hospital. In Louisiana, the additional increase may be due to the engagement of a provider champion who worked at both the state and facility level. Recruiting, training, engaging, and supporting provider champions, as facilitators, with influence at state and facility levels, is an important component of a multipart strategy for increasing successful implementation of state-level Medicaid payment reform policies that allow reimbursement for immediate postpartum long-acting reversible contraception insertions.

journal_name

Am J Obstet Gynecol

journal_title

American journal of obstetrics and gynecology

authors

Okoroh EM,Kane DJ,Gee RE,Kieltyka L,Frederiksen BN,Baca KM,Rankin KM,Goodman DA,Kroelinger CD,Barfield WD

doi

10.1016/j.ajog.2018.03.007

subject

Has Abstract

pub_date

2018-06-01 00:00:00

pages

590.e1-590.e7

issue

eissn

0002-9378

issn

1097-6868

pii

S0002-9378(18)30213-8

journal_volume

218

pub_type

杂志文章

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Policy change is not enough: engaging provider champions on immediate postpartum contraception.