Analysis of Postpartum Uptake of Long-Acting Reversible Contraceptives Before and After Implementation of Medicaid Reimbursement Policy

Smith, Madeline; McCool-Myers, Megan; Kottke, Melissa

doi:10.1007/s10995-021-03180-w

Cited by 7 publications

(9 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For the full report, our electronic searches yielded 25 973 citations (Figure). We screened 589 full-text articles, of which 28 studies, reported in 29 articles, were eligible for the current systematic review.…”

Section: Resultsmentioning

confidence: 99%

“…25 Thirteen studies evaluated the impact of policy changes that made insurance coverage more comprehensive. These included 9 studies of Medicaid expansion in various states 24,33,36,37,[39][40][41][42]44,52 ; 1 study that evaluated the impact of a law requiring hospitals to provide the option of long-acting reversible contraception (LARC) placement after delivery in Ohio 32 ; 1 that evaluated the impact of unbundling (ie, separate reimbursement for immediate postpartum LARC) in Wisconsin 29 ; 1 that evaluated the transition from…”

Section: Comparisons Addressed In Included Evidencementioning

confidence: 99%

See 1 more Smart Citation

Health Insurance Coverage and Postpartum Outcomes in the US

Saldanha,

Adam,

Kanaan

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceApproximately half of postpartum individuals in the US do not receive any routine postpartum health care. Currently, federal Medicaid coverage for pregnant individuals lapses after the last day of the month in which the 60th postpartum day occurs, which limits longer-term postpartum care.ObjectiveTo assess whether health insurance coverage extension or improvements in access to health care are associated with postpartum health care utilization and maternal outcomes within 1 year post partum.Evidence ReviewMedline, Embase, CENTRAL, CINAHL, and ClinicalTrials.gov were searched for US-based studies from inception to November 16, 2022. The reference lists of relevant systematic reviews were scanned for potentially eligible studies. Risk of bias was assessed using questions from the Cochrane Risk of Bias tool and the Risk of Bias in Nonrandomized Studies of Interventions tool. Strength of evidence (SoE) was assessed using the Agency for Healthcare Research and Quality Methods Guide.FindingsA total of 25 973 citations were screened and 28 mostly moderate-risk-of-bias nonrandomized studies were included (3 423 781 participants) that addressed insurance type (4 studies), policy changes that made insurance more comprehensive (13 studies), policy changes that made insurance less comprehensive (2 studies), and Medicaid expansion (9 studies). Findings with moderate SoE suggested that more comprehensive association was likely associated with greater attendance at postpartum visits. Findings with low SoE indicated a possible association between more comprehensive insurance and fewer preventable readmissions and emergency department visits.Conclusions and RelevanceThe findings of this systematic review suggest that evidence evaluating insurance coverage and postpartum visit attendance and unplanned care utilization is, at best, of moderate SoE. Future research should evaluate clinical outcomes associated with more comprehensive insurance coverage.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Comparisons Addressed In Included Evidencementioning

confidence: 99%

Health Insurance Coverage and Postpartum Outcomes in the US

Saldanha,

Adam,

Kanaan

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

show abstract

“…To evaluate changes in postpartum LARC use after DelCAN, our analytical design offers three innovations relative to studies assessing similar outcomes after a payment policy change (Liberty et al, 2020 ; Smith et al, 2021 ; Steenland et al, 2021 ). First, we use survey-based, state-representative measurement that assesses LARC use among all postpartum women, not just LARC insertion rates among those enrolled in Medicaid.…”

Section: Methodsmentioning

confidence: 99%

Association of the Delaware Contraceptive Access Now Initiative with Postpartum LARC Use

Caudillo

Hurtado-Acuna

Rendall

et al. 2022

Matern Child Health J

View full text Add to dashboard Cite

Objectives Although multi-component policy interventions can be important tools to increase access to contraception, we know little about how they may change contraceptive use among postpartum women. We estimate the association of the Delaware Contraceptive Access Now (DelCAN) initiative with use of postpartum Long-Acting Reversible Contraception (LARC). DelCAN included Medicaid payment reform for immediate postpartum LARC use, provider training and technical assistance in LARC provision, and a public awareness campaign. Methods We used a difference-in-differences design and data from the 2012 to 2017 pregnancy risk assessment monitoring system to compare changes in postpartum LARC use in Delaware versus 15 comparison states, and differences in such changes by women’s Medicaid enrollment. Results Relative to the comparison states, postpartum LARC use in Delaware increased by 5.26 percentage points (95% CI 2.90–7.61, P < 0.001) during the 2015–2017 DelCAN implementation period. This increase was the largest among Medicaid-covered women, and grew over the first three implementation years. By the third year of the DelCAN initiative (2017), the relative increase in postpartum LARC use for Medicaid women exceeded that for non-Medicaid women by 7.24 percentage points (95% CI 0.12–14.37, P = 0.046). Conclusions for Practice The DelCAN initiative was associated with increased LARC use among postpartum women in Delaware. During the first 3 years of the initiative, LARC use increased progressively and to a greater extent among Medicaid-enrolled women. Comprehensive initiatives that combine Medicaid payment reforms, provider training, free contraceptive services, and public awareness efforts may reduce unmet demand for highly effective contraceptives in the postpartum months.

show abstract

“…In seven studies, while the timing was not reported in terms of hours or days, it was inferred by the timing description that insertion was within 48 hours (eg, 'immediately after childbirth', 'immediate post-pregnancy IUD placement'). In one study the IUD insertion time was potentially beyond 48 hours, 27 as the authors reported: 'Inpatient postpartum refers to insertions of IUDs and implants occurring during the same hospitalisation as a delivery up to 7 days after delivery.' Table 1 displays the definitions used in each of the 133 studies.…”

Section: Population Characteristicsmentioning

confidence: 99%

Utilisation, effectiveness, and safety of immediate postpartum intrauterine device insertion: a systematic literature review

Bolling

Wahdan

Warnock

et al. 2022

BMJ Sex Reprod Health

View full text Add to dashboard Cite

BackgroundIntrauterine devices (IUDs) are highly effective contraception. IUDs inserted directly following delivery provide immediate birth control and may decrease unintended pregnancies, including short-interval pregnancies, thereby mitigating health risks and associated economic burden.MethodsThis systematic literature review included published global data on the utilisation, effectiveness, and safety of postpartum intrauterine devices (PPIUDs) of any type. English language articles indexed in MEDLINE, Embase, and Cochrane from January 2010–October 2021 were included.Results133 articles met the inclusion criteria (46% interventional studies; 54% observational; n=87 from lower-income countries; n=46 from higher-income countries). PPIUD use was low in higher-income countries (6/10 000 US deliveries in 2013–2016) and varied widely in lower-income countries (2%-46%). Across both higher- and lower-income countries, in most studies (79%), >80% of women with PPIUDs had an IUD in place by 3 months; at 6 and 12 months, 76% and 54% of included studies reported that >80% of women had an IUD in place; reason for discontinuation was infrequently reported. Pregnancies were rare (96 pregnancies across 12 191 women from 37 studies reporting data) and were generally unrelated to device failure, but rather occurred in women no longer using a PPIUD. Expulsions occurred mainly in the early outpatient period and ranged widely (within 3 months: 0–41%). Abnormal bleeding, infections, or perforations were rare.ConclusionsPPIUDs are safe and effective. Long-term follow-up data are limited. Future research elucidating reasons underlying lack of PPIUD use is warranted.

show abstract

Analysis of Postpartum Uptake of Long-Acting Reversible Contraceptives Before and After Implementation of Medicaid Reimbursement Policy

Cited by 7 publications

References 19 publications

Health Insurance Coverage and Postpartum Outcomes in the US

Health Insurance Coverage and Postpartum Outcomes in the US

Association of the Delaware Contraceptive Access Now Initiative with Postpartum LARC Use

Utilisation, effectiveness, and safety of immediate postpartum intrauterine device insertion: a systematic literature review

Contact Info

Product

Resources

About