Postpartum Contraceptive Use Among US Medicaid Recipients

Rodríguez, María I.; Meath, Thomas H. A.; Watson, Kelsey; Daly, Ashley; Tracy, Kyle; McConnell, K. John

doi:10.1001/jamanetworkopen.2021.45175

Cited by 19 publications

(9 citation statements)

References 3 publications

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“…With the T-MSIS data, we excluded 7 states from the analysis due to documented data quality issues . However, other published literature using T-MSIS data has followed similar data quality checks, and this study nonetheless provided analysis from 43 states and Washington, DC. We also note that there are documented limitations to the AMA Masterfile.…”

Section: Discussionmentioning

confidence: 99%

Training in Residency and Provision of Reproductive Health Services Among Family Medicine Physicians

Strasser,

Schenk,

Luo

et al. 2023

JAMA Netw Open

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ImportanceContraception and abortion services are essential health care, and family medicine (FM) physicians are an important part of the workforce providing this care. Residency could inform the reproductive health services FM physicians provide.ObjectiveTo determine which residency training factors are associated with FM physicians’ provision of reproductive health services to Medicaid beneficiaries.Design, Setting, and ParticipantsThis cross-sectional, population-based observational study of inpatient and outpatient FM physicians who completed residency between 2008 and 2018 and treated at least 1 Medicaid beneficiary in 2019 was conducted from November 2022 to March 2023. The study used 2019 American Medical Association Masterfile and Historical Residency file, as well as the 2019 Transformed Medicaid Statistical Information System claims.ExposuresResidency training in community-based or reproductive health-focused programs.Main Outcomes and MeasuresThe outcomes were providing the following to at least 1 Medicaid beneficiary in 2019: prescription contraception (pill, patch, and/or ring), intrauterine device (IUD) and/or contraceptive implant, and dilation and curettage (D&amp;C). Odds of providing each outcome were measured using correlated random-effects regression models adjusted for physician, residency program, and county characteristics.ResultsIn the sample of 21 904 FM physician graduates from 410 FM residency programs, 12 307 were female (56.3%). More than half prescribed contraception to Medicaid beneficiaries (13 373 physicians [61.1%]), with lower proportions providing IUD or implant (4059 physicians [18.5%]) and D&amp;C (152 physicians [.7%]). FM physicians who graduated from a Reproductive Health Education in Family Medicine program, which fully integrates family planning into residency training, had significantly greater odds of providing prescription contraception (odds ratio [OR], 1.23; 95% CI, 1.07-1.42), IUD or implant (OR, 1.79; 95% CI, 1.28-2.48), and D&amp;C (OR, 3.61; 95% CI, 2.02-6.44). Physicians who completed residency at a Teaching Health Center, which emphasizes community-based care, had higher odds of providing an IUD or implant (OR, 1.51; 95% CI, 1.19-1.91).Conclusions and RelevanceIn this cross-sectional study of FM physicians providing Medicaid service, characteristics of residency training including community-based care and integration of family planning training are associated with greater odds of providing reproductive health services. With growing reproductive health policy restrictions, providing adequate training in reproductive health is critical to maintaining access to care, especially for underserved populations.

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Section: Discussionmentioning

confidence: 99%

Training in Residency and Provision of Reproductive Health Services Among Family Medicine Physicians

Strasser,

Schenk,

Luo

et al. 2023

JAMA Netw Open

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“…Disparities exist for vulnerable populations due to barriers such as lack of insurance coverage and scarcity of practitioners offering contraception care . Medicaid, which insures more than 87 million individuals, mostly populations with disabilities and low income, is one of the largest payers of contraception care . While it is known that the income, insurance coverage, and socioeconomic status of an individual are associated with contraceptive use, little is known about the factors associated with physicians choosing to provide contraception care, especially to Medicaid beneficiaries.…”

Section: Introductionmentioning

confidence: 99%

Association of Primary Care Physicians’ Individual- and Community-Level Characteristics With Contraceptive Service Provision to Medicaid Beneficiaries

et al. 2023

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ImportanceLittle is known about primary care physicians who provide contraceptive services to Medicaid beneficiaries. Evaluating this workforce may help explain barriers to accessing these services since contraceptive care access is critical for Medicaid beneficiaries’ health.ObjectiveTo describe the primary care physician workforce that provides contraceptive services to Medicaid beneficiaries and explore the factors associated with their Medicaid contraceptive service provision.Design, Setting, and ParticipantsThis cross-sectional study, conducted from August 1 to October 10, 2022, used data from the Transformed Medicaid Statistical Information System from 2016 for primary care physicians from 4 specialties (family medicine, internal medicine, obstetrics and gynecology [OBGYN], and pediatrics).Main Outcomes and MeasuresThe main outcomes were providing intrauterine devices (IUDs) or contraceptive implants to at least 1 Medicaid beneficiary, prescribing hormonal birth control methods (including a pill, patch, or ring) to at least 1 Medicaid beneficiary, the total number of Medicaid beneficiaries provided IUDs or implants, and the total number Medicaid beneficiaries prescribed hormonal birth control methods in 2016. Physician- and community-level factors associated with contraceptive care provision were assessed using multivariate regression methods.ResultsIn the sample of 251 017 physicians (54% male; mean [SD] age, 49.17 [12.58] years), 28% were international medical graduates (IMGs) and 70% practiced in a state that had expanded Medicaid in 2016. Of the total physicians, 48% prescribed hormonal birth control methods while 10% provided IUDs or implants. For OBGYN physicians, compared with physicians younger than 35 years, being aged 35 to 44 years (odds ratio [OR], 3.51; 95% CI, 2.93-4.21), 45 to 54 years (OR, 3.01; 95% CI, 2.43-3.72), or 55 to 64 years (OR, 2.27; 95% CI, 1.82-2.83) was associated with higher odds of providing IUDs and implants. However, among family medicine physicians, age groups associated with lower odds of providing IUDs or implants were 45 to 54 years (OR, 0.66; 95% CI, 0.55-0.80), 55 to 64 years (OR, 0.51; 95% CI, 0.39-0.65), and 65 years or older (OR, 0.29; 95% CI, 0.19-0.44). Except for those specializing in OBGYN, being an IMG was associated with lower odds of providing hormonal contraceptive service (family medicine IMGs: OR, 0.80 [95% CI, 0.73-0.88]; internal medicine IMGs: OR, 0.85 [95% CI, 0.77-0.93]; and pediatric IMGs: OR, 0.85 [95% CI, 0.78-0.93]). Practicing in a state that expanded Medicaid by 2016 was associated with higher odds of prescribing hormonal contraception for family medicine (OR 1.50; 95% CI, 1.06-2.12) and internal medicine (OR, 1.71; 95% CI, 1.18-2.48) physicians but not for physicians from other specialties.Conclusions and RelevanceIn this cross-sectional study of primary care physicians, physician- and community-level factors, such as specialty, age, and the Medicaid expansion status of their state, were significantly associated with how they provided contraceptive services to Medicaid beneficiaries. However, the existence of associations varied across clinical specialties. Ensuring access to contraception among Medicaid beneficiaries may therefore require policy and program approaches tailored for different physician types.

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“… [3] , [4] At six weeks postpartum, all contraceptive options are deemed safe, including combined oral, vaginal, and transdermal contraceptives, oral or injectable progesterone, progesterone and copper IUDs, and contraceptive implants. Access to the benefits of postpartum contraception differs based on insurance status and ethnicity; only one-third of Medicaid-insured patients use a form of contraception at 60 days postpartum [5] and Hispanic patients are significantly less likely to receive their chosen contraceptive method, despite being more likely to have a postpartum contraception plan. [6] .…”

Section: Introductionmentioning

confidence: 99%

An assessment of postpartum contraception rates with evolving care during the COVID-19 pandemic

Lagon

Mauney

Onwuzurike

et al. 2023

Sexual & Reproductive Healthcare

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Postpartum Contraceptive Use Among US Medicaid Recipients

Abstract: This cohort study uses national Medicaid claims data to assess US state variation in effective contraceptive use 60 days post partum.

Cited by 19 publications

References 3 publications

Training in Residency and Provision of Reproductive Health Services Among Family Medicine Physicians

Training in Residency and Provision of Reproductive Health Services Among Family Medicine Physicians

Association of Primary Care Physicians’ Individual- and Community-Level Characteristics With Contraceptive Service Provision to Medicaid Beneficiaries

An assessment of postpartum contraception rates with evolving care during the COVID-19 pandemic

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