Cost Sharing and Utilization of Postpartum Intrauterine Devices and Contraceptive Implants Among Commercially Insured Women

Moniz, Michelle H.; Soliman, Ann; Kolenic, Giselle; Tilea, Anca; Fendrick, A. Mark; Bell, Sarah; Dalton, Vanessa K.

doi:10.1016/j.whi.2019.07.006

Cited by 11 publications

(7 citation statements)

References 36 publications

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“…Immediate postpartum contraception involves the insertion of a long-acting reversible contraceptive (LARC; e.g., intrauterine device or contraceptive implant) during hospitalization for childbirth. Although national guidelines recommend universal access to this service, it is provided almost exclusively at a small number of “early adopter” academic medical centers [ 14 , 17 ], and immediate postpartum LARC utilization remains rare [ 17 , 18 ]. Implementation is complex, requiring coordination across settings (e.g., outpatient and inpatient) and often siloed stakeholder groups (e.g., providers, pharmacy, and billing) [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Champions in context: which attributes matter for change efforts in healthcare?

et al. 2020

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Background: Research to date has focused on strategies and resources used by effective champions of healthcare change efforts, rather than personal characteristics that contribute to their success. We sought to identify and describe champion attributes influencing outcomes of healthcare change efforts. To examine attributes of champions, we used postpartum contraceptive care as a case study, because recommended services are largely unavailable, and implementation requires significant effort. Methods: We conducted a comparative case study of the implementation of inpatient postpartum contraceptive care at 11 U.S. maternity hospitals in 2017-18. We conducted site visits that included semi-structured key informant interviews informed by the Consolidated Framework for Implementation Research (CFIR). Phase one analysis (qualitative content analysis using a priori CFIR codes and cross-case synthesis) showed that implementation leaders ("champions") strongly influenced outcomes across sites. To understand champion effects, phase two inductive analysis included (1) identifying and elaborating key attributes of champions; (2) rating the presence or absence of each attribute in champions; and 3) cross-case synthesis to identify patterns among attributes, context, and implementation outcomes. Results: We completed semi-structured interviews with 78 clinicians, nurses, residents, pharmacy and revenue cycle staff, and hospital administrators. All identified champions were obstetrician-gynecologists. Six key attributes of champions emerged: influence, ownership, physical presence at the point of change, persuasiveness, grit, and participative leadership style. These attributes promoted success by enabling champions to overcome institutional siloing, build and leverage professional networks, create tension for change, cultivate a positive learning climate, optimize compatibility with existing workflow, and engage key stakeholders. Not all champion attributes were required for success, and having all attributes did not guarantee success. Conclusions: Effective champions appear to leverage six key attributes to facilitate healthcare change efforts. Prospective evaluations of the interactions among champion attributes, context, and outcomes may further elucidate how champions exert their effects.

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Section: Introductionmentioning

confidence: 99%

Champions in context: which attributes matter for change efforts in healthcare?

et al. 2020

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Section: Resultsmentioning

confidence: 99%

“…A study utilising US claims data suggested that in-hospital PPIUD insertion has increased over time (0.10/10 000 deliveries from 2001 to 2002, 28 0.55/10 000 deliveries from 2007 to 2008, 28 and 6/10 000 from 2013 to 2016). 29 Evidence from two non-randomised interventional studies in Scotland between 2015-2019 suggested higher utilisation of PPIUD following caesarean (12.9% 30 ) versus vaginal (4.7% 31 ) delivery. In contrast, in a prospective observational study conducted between 2006-2008 in Guatemala, none of the women who had a caesarean delivery opted for a PPIUD compared with 0.16% of women with a vaginal delivery (table 2).…”

Section: Ppiud Utilisation Higher-income Countriesmentioning

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

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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.

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“…Clinical practice change requires rigorous planning, skilled champions, and evaluation with course corrections as needed. Patient preferences should guide change effort s in contraceptive care delivery [58][59][60][61][62][63][64][65][66][67] .…”

Section: Event 6 Panel 2: Access To Iuds: Real Life Challenges To Bri...mentioning

confidence: 99%

Recap of the sixth international symposium on intrauterine devices and systems for women's health

et al. 2022

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Cost Sharing and Utilization of Postpartum Intrauterine Devices and Contraceptive Implants Among Commercially Insured Women

Cited by 11 publications

References 36 publications

Champions in context: which attributes matter for change efforts in healthcare?

Champions in context: which attributes matter for change efforts in healthcare?

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

Recap of the sixth international symposium on intrauterine devices and systems for women's health

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