Racial Differences in Contraception Encounters and Dispensing Among Female Medicaid Beneficiaries With Systemic Lupus Erythematosus

Williams, Jessica N.; Xu, Chang; Costenbader, Karen H.; Bermas, Bonnie L.; Pace, Lydia E.; Feldman, Candace H.

doi:10.1002/acr.24346

Cited by 9 publications

(3 citation statements)

References 35 publications

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“…Thus, contraception is important to prevent pregnancy in women with lupus who are at increased risk for health complications or medication teratogenicity with unintended pregnancy. Compared with White women with SLE, Black women had 11% lower odds of any contraception dispensing and 29% lower odds of "highly effective contraception use" (use of long-acting reversible contraception methods, intrauterine devices and implants, or sterilization) (88). Quality of care affects SLE-related damage accrual rates and disease activity, particularly among Black and Hispanic patients and those publicly insured (89)(90)(91)(92).…”

Section: Resultsmentioning

confidence: 99%

Disparities in Lupus and the Role of Social Determinants of Health: Current State of Knowledge and Directions for Future Research

Buie

McMillan

Kirby

et al. 2023

ACR Open Rheumatology

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Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. The complex relationships between race and ethnicity and social determinants of health (SDOH) in influencing SLE and its course are increasingly appreciated. Multiple SDOH have been strongly associated with lupus incidence and outcomes and contribute to health disparities in lupus. Measures of socioeconomic status, including economic instability, poverty, unemployment, and food insecurity, as well as features of the neighborhood and built environment, including lack of safe and affordable housing, crime, stress, racial segregation, and discrimination, are associated with race and ethnicity in the US and are risk factors for poor outcomes in lupus. In this scientific statement, we aimed to summarize current evidence on the role of SDOH in relation to racial and ethnic disparities in SLE and SLE outcomes, primarily as experienced in the U.S. Lupus Foundation of America's Health Disparities Advisory Panel, comprising 10 health disparity experts, including academic researchers and patients, who met 12 times over the course of 18 months in assembling and reviewing the data for this study. Sources included articles published from 2011 to 2023 in PubMed, Centers for Disease Control and Prevention data, and bibliographies and recommendations. Search terms included lupus, race, ethnicity, and SDOH domains. Data were extracted and synthesized into this scientific statement. Poorer neighborhoods correlate with increased damage, reduced care, and stress‐induced lupus flares. Large disparities in health care affordability, accessibility, and acceptability exist in the US, varying by region, insurance status, and racial and minority groups. Preliminary interventions targeted social support, depression, and shared‐decision‐making, but more research and intervention implementation and evaluation are needed. Disparities in lupus across racial and ethnic groups in the US are driven by SDOH, some of which are more easily remediable than others. A multidimensional and multidisciplinary approach involving various stakeholder groups is needed to address these complex challenges, address these diminish disparities, and improve outcomes.

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Section: Resultsmentioning

confidence: 99%

Disparities in Lupus and the Role of Social Determinants of Health: Current State of Knowledge and Directions for Future Research

Buie

McMillan

Kirby

et al. 2023

ACR Open Rheumatology

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“…However, women with RD of reproductive age often are not prescribed effective contraception, even when treated with teratogenic medications. [22][23][24] While rheumatologists do feel responsible for contraceptive counselling, 20 they may be uncomfortable with this area and may not provide adequate counselling. 12,18,20,23,25 Young women with RD often turn to OB/GYNs for information and support.…”

Section: Contraception and Pregnancy Terminationmentioning

confidence: 99%

Challenges in Family Planning and Pregnancy for Women with Rheumatic Diseases

Siegel¹,

Sammaritano²

2023

Rheumatology

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Systemic rheumatic diseases (RDs) often affect women in their reproductive years and may complicate family planning and pregnancy. For women with RD who are not pursuing pregnancy, especially those at the highest risk of maternal morbidity or on teratogenic medications, effective contraception is important. For women with active systemic lupus erythematosus (SLE) and/or antiphospholipid antibodies, oestrogen-containing contraceptive methods are generally not recommended. Emergency contraception and induced abortion are safe for women with RD and should be discussed when clinically appropriate. Women with RD commonly have questions and concerns about the impact of their disease on fertility and conception. RD-associated factors may contribute to difficulties in conceiving and decreased family size. Assisted reproductive technology (ART) is often a safe option for women with RD. However, precautions and specific treatment modifications may be needed, particularly in women with SLE and/or antiphospholipid antibody positivity. SLE and antiphospholipid syndrome (APS) are the RDs associated with the greatest risk of maternal and foetal pregnancy complications. Regardless of the specific RD, having an active disease is a significant risk factor for poor pregnancy outcomes. With appropriate preconception planning and multidisciplinary management during and after pregnancy, most women with RD can have successful pregnancies.

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“…Pregnancy planning can help all people optimize preconception health, and particularly for individuals with chronic disease, help to prevent disease exacerbation, pregnancy complications, and fetal exposure to teratogenic medications with resulting developmental impacts [ 1 ]. However, female individuals with several chronic diseases, including sickle cell disease, epilepsy, and systemic rheumatic diseases, have been shown to receive contraceptive counseling and use contraception at lower rates than the general population [ 2 – 4 ]. Medical specialist and primary care providers who have robust longitudinal relationships with these high-risk patients enjoy an opportunity to improve maternal and infant health outcomes by asking patients about their conception plans and integrating appropriate, timely referrals to contraceptive or preconception services into their routine practice [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Screening to understand pregnancy preferences and offer referrals and treatment (SUPPORT): Results of a pilot quality improvement initiative

Janiak,

Rexrode,

Santacroce

et al. 2024

PLoS ONE

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Objective To assess the feasibility of integrating a pregnancy intention assessment screening algorithm into the electronic medical record (EMR) at a multispecialty clinic focused on the health of women and people assigned female at birth (AFAB). Study design This pilot quality improvement project implemented a series of clinician reminders, new data fields in the patient record, and templated clinical notes to prompt care providers across specialties to ask AFAB reproductive age individuals about their desire for future pregnancies. Investigators created a novel screening question based on prior literature and expert input. Prospective observational study of one year of during-intervention EMR data on screening uptake and documentation, contraceptive use, and referrals to obstetrics and gynecology (OBGYN) for preconception care, contraceptive care, and related services. Results SUPPORT launched in February 2020 and was paused for 6 months due to the COVID-19 pandemic. During the intervention period through July 2021, 18% of patients for whom the automated screening reminder was activated had a documented pregnancy intention. Patients were screened in OBGYN, internal medicine, and eight subspecialty medical clinics. Among those screened, individuals who reported they did not desire pregnancy in the next year were more likely to use contraception (aOR 1.8, 95% CI 1.1, 3.1). Individuals that did desire pregnancy in the next year were more likely to be subsequently referred to OBGYN (aOR 2.7, 95% CI 1.2, 6.0). Conclusions Despite the competing demands of the COVID-19 pandemic, the SUPPORT intervention was utilized at higher rates than prior similar interventions and across multiple disease specialties. Implications Results from the SUPPORT pilot suggest that pregnancy intention screening of reproductive age AFAB individuals with an EMR-based screening prompt is feasible at scale.

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Racial Differences in Contraception Encounters and Dispensing Among Female Medicaid Beneficiaries With Systemic Lupus Erythematosus

Cited by 9 publications

References 35 publications

Disparities in Lupus and the Role of Social Determinants of Health: Current State of Knowledge and Directions for Future Research

Disparities in Lupus and the Role of Social Determinants of Health: Current State of Knowledge and Directions for Future Research

Challenges in Family Planning and Pregnancy for Women with Rheumatic Diseases

Screening to understand pregnancy preferences and offer referrals and treatment (SUPPORT): Results of a pilot quality improvement initiative

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