Improving access and training for LARC: evaluation of the Ryan LARC program

Simonson, Kristin; Gerard, Naqash; Pomerantz, Tali; Mullersman, K.

doi:10.1016/j.contraception.2014.05.108

Cited by 4 publications

(2 citation statements)

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“…Transabdominal ultrasound to guide or confirm IUD placement was used at the discretion of the provider. IUDs were provided through philanthropic funding 13 or, after April 2015, through a combination of philanthropic and research funding. Medical assistance did not cover immediate postpartum LARC during the study period.…”

Section: Methodsmentioning

confidence: 99%

Six-month expulsion of postplacental copper intrauterine devices placed after vaginal delivery

Gurney

Sonalkar

McAllister

et al. 2018

American Journal of Obstetrics and Gynecology

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This prospective assessment of postplacental TCu380A intrauterine device placement, with ultrasound to confirm device position, finds a complete intrauterine device expulsion proportion of 8.0% at 6 months. The association of increasing parity with expulsion is consistent with prior research. The clinical significance of covariates associated with partial expulsion (provider specialty and gestational weight gain) is unclear. Due to the observational study design, any associations cannot imply causality. The proportion of partially expelled and malpositioned intrauterine devices was high, and the area under the receiver operating characteristics curve of 0.5 indicates that a string check is a poor test for assessing device position. Women considering a postplacental intrauterine device should be counseled about the risk of position abnormalities, as well as the possibility of nonvisible strings, which may complicate clinical follow-up. The clinical significance of intrauterine device position abnormalities is unknown; future research should evaluate the influence of malposition and partial expulsion on contraceptive effectiveness and side effects.

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Section: Methodsmentioning

confidence: 99%

Six-month expulsion of postplacental copper intrauterine devices placed after vaginal delivery

Gurney

Sonalkar

McAllister

et al. 2018

American Journal of Obstetrics and Gynecology

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“…On the other hand, hospital academic affiliation facilitates patient access to IPP LARC (Castleberry, Stark, L., Schulkin, J., & Grossman, 2019; Holden et al, 2018;Okoroh et al, 2018). Many academic obstetrics and gynecology departments received funding for IPP LARC services through external training programs (Hill, Slusky, & Ginther, 2019;Simonson, Gerard, Pomerantz, Mullersman, & Landy, 2014). Experiences of two early adopting states suggested that IPP LARC provision occurred nearly exclusively at academic hospitals, due at least in part to significant efforts from faculty "champions" to implement it (Okoroh et al, 2018).…”

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confidence: 99%

Provision of Immediate Postpartum Long-Acting Reversible Contraceptives Before and After Wisconsin Medicaid's Payment Change

Kramer

Gangnon

Burns

2021

Women's Health Issues

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Objectives: We aimed to estimate the association between Medicaid unbundling of payment for long-acting reversible contraceptives (LARC) from the global delivery fee and immediate postpartum (IPP) LARC provision, in a state outside a select group of early-adopters. We also examine the potential moderating roles of hospital academic affiliation and Catholic status on the association between unbundling and IPP LARC provision. Methods: We used a pre-post design to examine the association between unbundling and IPP LARC provision. We observed Medicaid-covered childbirth deliveries in Wisconsin hospitals between January 2016 and December 2017 (n ¼ 45,200) in the State Inpatient Database from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project. We conducted multivariate regressions using generalized linear mixed models. Results: From 2016 to 2017, IPP LARC provision increased from 0.28% to 0.44% of deliveries (p ¼ .003). In our adjusted model, IPP LARC provision was 1.55 times more likely in the post-period versus the pre-period (95% confidence interval, 1.12-2.13). Both before and after unbundling, IPP LARC provision was significantly more common in academic versus nonacademic settings and was exceedingly rare in Catholic institutions. Conclusions: In contrast with many early adopting states, in this later adopting state, Wisconsin Medicaid's unbundling of LARC from the global fee did not meaningfully change the rates of IPP LARC provision. These results indicate that delivery hospital characteristics are strong correlates of access to IPP LARC and suggest the need for interventionsdperhaps outside of the inpatient settingdto ensure that patients can access desired contraceptive methods promptly postpartum.

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Impact of Integrated Family Planning Training

Schreiber¹,

Darney

2021

Advancing Women's Health Through Medical Education

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Improving access and training for LARC: evaluation of the Ryan LARC program

Cited by 4 publications

References 0 publications

Six-month expulsion of postplacental copper intrauterine devices placed after vaginal delivery

Six-month expulsion of postplacental copper intrauterine devices placed after vaginal delivery

Provision of Immediate Postpartum Long-Acting Reversible Contraceptives Before and After Wisconsin Medicaid's Payment Change

Impact of Integrated Family Planning Training

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