Details:

Alternative Title:
Am J Obstet Gynecol
Personal Author:
Okoroh, Ekwutosi M. ; Kane, Debra J. ; Gee, Rebekah E. ; Kieltyka, Lyn ; Frederiksen, Brittni N. ; ... More +
Okoroh, Ekwutosi M. ; Kane, Debra J. ; Gee, Rebekah E. ; Kieltyka, Lyn ; Frederiksen, Brittni N. ; Baca, Katharyn M. ; Rankin, Kristin M. ; Goodman, David A. ; Kroelinger, Charlan D. ; Barfield, Wanda D. ; Less -
Description:
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.
Subject:
[+]
Article
Champion
Insertions
Inter-pregnancy Intervals
Long Acting Reversible Contraception
Medicaid
Policy
Postpartum
Pregnancy Spacing
Provider Champions
Providers
Reimbursement Policy
State
Uptake

Source:
Am J Obstet Gynecol. 218(6):590.e1-590.e7. ;
Pubmed ID:
29530670
Pubmed Central ID:
PMC5970075
Document Type:
Journal Article ;
Funding:
CC999999/Intramural CDC HHS/United States ;
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:ce462f90656a4ce90c8eef87b1a3cbb63bb7cf44671483d7dcda96064f625dec
File Type:

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