The Experts below are selected from a list of 2619 Experts worldwide ranked by ideXlab platform
David A. Klein - One of the best experts on this subject based on the ideXlab platform.
-
Long-Acting Reversible Contraception in adolescents: a systematic review and meta-analysis.
American Journal of Obstetrics and Gynecology, 2016Co-Authors: Justin T. Diedrich, David A. Klein, Jeffrey F PeipertAbstract:Background Among adolescent pregnancies, 75% are unintended. Greater use of highly-effective Contraception can reduce unintended pregnancy. Although multiple studies discuss adolescent contraceptive use, there is no consensus regarding the use of Long-Acting Reversible Contraception as a first-line Contraception option. Objective We performed a systematic review of the medical literature to assess the continuation of Long-Acting Reversible contraceptives among adolescents. Study Design Ovid-MEDLINE, Cochrane databases, and Embase databases were searched using key words relevant to the provision of Long-Acting Contraception to adolescents. Articles published from January 2002 through August 2016 were selected for inclusion based on specific key word searches and detailed review of bibliographies. For inclusion, articles must have provided data on method continuation, effectiveness, or satisfaction of at least 1 Long-Acting Reversible contraceptive method in participants Results This review included 12 studies, including 6 retrospective cohort studies, 5 prospective observational studies, and 1 randomized controlled trial. The 12 studies included 4886 women age Conclusion Adolescents and young women have high 12-month continuation of Long-Acting Reversible contraceptive methods. Intrauterine devices and implants should be offered to all adolescents as first-line contraceptive options.
-
Initiation and continuation of Long-Acting Reversible Contraception in the United States military healthcare system
American Journal of Obstetrics and Gynecology, 2016Co-Authors: Daniel P. Chiles, Timothy A. Roberts, David A. KleinAbstract:Background Long-Acting Reversible Contraception is more effective for pregnancy prevention than shorter-acting contraceptive methods and has the potential to reduce healthcare disparities and costs. However, Long-Acting Reversible Contraception is underused in the United States. One population of interest is beneficiaries of the United States military healthcare system who have access to universal healthcare, including no-cost, no-copay Contraception with unlimited method switching, and comprise a large, actual use cohort. Efforts to increase Long-Acting Reversible Contraception initiation and continuation in this population may improve health outcomes and mitigate the profound consequences of unintended or mistimed pregnancy on readiness and cost to the military. Objective We aimed to determine Long-Acting Reversible Contraception initiation and continuation rates among the diverse population with universal healthcare who are enrolled in the US military healthcare system. Study Design This study is a retrospective cohort of >1.7 million women, aged 14–40 years, who were enrolled in the US military healthcare system, TRICARE Prime, between October 2009 and September 2014. Individuals were assessed for Long-Acting Reversible Contraception initiation and continuation with the use of medical billing records. Method continuation and factors that were associated with early method discontinuation were evaluated with the Kaplan-Meier estimator and Cox proportional hazard models. Results During the study dates, 188,533 women initiated Long-Acting Reversible Contraception. Of these, 74.6% women selected intrauterine contraceptives. Method initiation rates remained relatively stable (41.7–50.1/1000 women/year) for intrauterine methods, although the rate for subdermal implants increased from 6.1–23.0/1000 women/year. In analysis of women who selected intrauterine contraceptives, 61.2% continued their method at 36 months, and 48.8% continued at 60 months. Among women who selected the implant, 32.0% continued their method at 36 months; however, 45.8% continued until 33 months (ie, 3 months before the currently recommended expiration date). Compared with intrauterine contraceptive users, implant users were more likely to discontinue their method during the 36 months after insertion (hazard ratio, 1.59; 95% confidence interval, 1.56–1.62; P Conclusion In the US military healthcare system, TRICARE Prime, the initiation of Long-Acting Reversible Contraception is low but increasing, and continuation rates are high. This evidence supports Long-Acting Reversible Contraception as first-line recommendations for women of all ages who seek Contraception.
-
Initiation and continuation of Long-Acting Reversible Contraception in the United States military healthcare system.
American journal of obstetrics and gynecology, 2016Co-Authors: Daniel P. Chiles, Timothy A. Roberts, David A. KleinAbstract:Long-Acting Reversible Contraception is more effective for pregnancy prevention than shorter-acting contraceptive methods and has the potential to reduce healthcare disparities and costs. However, Long-Acting Reversible Contraception is underused in the United States. One population of interest is beneficiaries of the United States military healthcare system who have access to universal healthcare, including no-cost, no-copay Contraception with unlimited method switching, and comprise a large, actual use cohort. Efforts to increase Long-Acting Reversible Contraception initiation and continuation in this population may improve health outcomes and mitigate the profound consequences of unintended or mistimed pregnancy on readiness and cost to the military. We aimed to determine Long-Acting Reversible Contraception initiation and continuation rates among the diverse population with universal healthcare who are enrolled in the US military healthcare system. This study is a retrospective cohort of >1.7 million women, aged 14-40 years, who were enrolled in the US military healthcare system, TRICARE Prime, between October 2009 and September 2014. Individuals were assessed for Long-Acting Reversible Contraception initiation and continuation with the use of medical billing records. Method continuation and factors that were associated with early method discontinuation were evaluated with the Kaplan-Meier estimator and Cox proportional hazard models. During the study dates, 188,533 women initiated Long-Acting Reversible Contraception. Of these, 74.6% women selected intrauterine contraceptives. Method initiation rates remained relatively stable (41.7-50.1/1000 women/year) for intrauterine methods, although the rate for subdermal implants increased from 6.1-23.0/1000 women/year. In analysis of women who selected intrauterine contraceptives, 61.2% continued their method at 36 months, and 48.8% continued at 60 months. Among women who selected the implant, 32.0% continued their method at 36 months; however, 45.8% continued until 33 months (ie, 3 months before the currently recommended expiration date). Compared with intrauterine contraceptive users, implant users were more likely to discontinue their method during the 36 months after insertion (hazard ratio, 1.59; 95% confidence interval, 1.56-1.62; P < .001). Adolescents aged 14-19 years were the least likely age group to discontinue the implant before 36 months; women aged 35-40 years were the least likely to discontinue an intrauterine contraceptive before 60 months. In multivariable analysis that controlled for demographic factors and contraceptive type, early contraceptive method discontinuation was most likely among women aged 20-24 years, implant users, and women with method initiation in military clinics. In the US military healthcare system, TRICARE Prime, the initiation of Long-Acting Reversible Contraception is low but increasing, and continuation rates are high. This evidence supports Long-Acting Reversible Contraception as first-line recommendations for women of all ages who seek Contraception. Published by Elsevier Inc.
Nikki B. Zite - One of the best experts on this subject based on the ideXlab platform.
-
Obstetrics-gynecology resident Long-Acting Reversible Contraception training: the role of resident and program characteristics.
American Journal of Obstetrics and Gynecology, 2020Co-Authors: Jill M. Maples, Eve Espey, Megan L. Evans, Janis L. Breeze, Tony Ogburn, Nikki B. ZiteAbstract:Background Obstetrics–gynecology residents should graduate with competence in comprehensive contraceptive care, including Long-Acting Reversible Contraception. Lack of hands-on training and deficits in provider education are barriers to Long-Acting Reversible Contraception access. Identifying the number of Long-Acting Reversible Contraception insertions performed by obstetrics–gynecology residents could provide insight into the depth and breadth of Long-Acting Reversible Contraception training available to obstetrics–gynecology residents in Accreditation Council for Graduate Medical Education–accredited residency programs. Objective Our study investigates Long-Acting Reversible Contraception–specific training in obstetrics–gynecology residency programs across the United States, including the self-reported number of Long-Acting Reversible Contraception insertions per resident and the impact of resident demographic characteristics and residency program characteristics on training. Study Design Obstetrics–gynecology residents completed a voluntary electronic survey during the 2016 Council on Resident Education in Obstetrics and Gynecology examination. The survey included resident demographic characteristics and residency program characteristics as well as resident education and training in Long-Acting Reversible Contraception (number of intrauterine devices and implants inserted, training in immediate postpartum intrauterine device placement). A binary “Long-Acting Reversible Contraception insertion experience” variable dichotomized respondents as having a low level of Long-Acting Reversible Contraception insertions (0 implants and/or 10 or fewer intrauterine devices ) or a high level of Long-Acting Reversible Contraception insertions (1 or more implants and/or 11 or more intrauterine devices). χ2 tests were used to compare the presence of Long-Acting Reversible Contraception insertion experience by postgraduate year, resident demographic characteristics, and residency program characteristics. Adjusted logistic regression was performed to ascertain the independent effects of gender, race/ethnicity (non-Hispanic white vs other), residency program type (university vs community), and residency program geographic region on the likelihood of “low” overall Long-Acting Reversible Contraception insertion experience. Results In total, 5055 obstetrics–gynecology residents completed the survey (85%); analysis included only residents in United States obstetrics–gynecology programs (N=4322). Of the total analytic sample, 1777 (41.2%) had low Long-Acting Reversible Contraception insertion experience. As expected, the number of intrauterine device insertions, implant insertions, and overall Long-Acting Reversible Contraception experience increased as residents progressed through training. Long-Acting Reversible Contraception insertion experience varied by residency program geographic region: 169 (27.1%) residents in programs in the West had low Long-Acting Reversible Contraception insertion experience compared with 498 (39.0%) in the South, 473 (45.3%) in the Midwest, and 615 (46.0%) in the Northeast. Only 152 (14.9%) of all postgraduate year 4 residents had low Long-Acting Reversible Contraception insertion experience. Among postgraduate year 4 residents, low Long-Acting Reversible Contraception insertion experience was significantly associated racial/ethnic minority status and community-based residency program type (compared with university-based). Postgraduate year 4 residents in programs located in the Northeast and Midwest had 4.25 (95% confidence interval, 2.04–8.85) and 2.75 (95% confidence interval, 1.27–5.97) times the odds of low Long-Acting Reversible Contraception experience compared with those in residency programs in the West, even after adjusting for other respondent characteristics and other residency program characteristics. Conclusion Obstetrics–gynecology residents experience a range of Long-Acting Reversible Contraception training and insertions, which differed according to resident race/ethnicity and residency program characteristics (program type and geographic region). Residency programs with low Long-Acting Reversible Contraception training experience should consider opportunities to improve competence in this fundamental obstetrics–gynecology skill.
-
Statewide quality improvement initiative to implement immediate postpartum Long-Acting Reversible Contraception.
American Journal of Obstetrics and Gynecology, 2020Co-Authors: Megan M Lacy, Theresa A Scott, Brenda Barker, Suzanne Mcmurtry Baird, Nikki B. ZiteAbstract:Background Women face barriers to obtaining Contraception and postpartum care. In a review of Tennessee birth data from 2014, 56% of pregnancies were unintended, 22.7% were short-interval pregnancies, and 57.9% of women who were not intending to get pregnant were not using Contraception. Offering Long-Acting Reversible contraceptive methods in the immediate postpartum period allows women who desire these effective methods of Contraception to obtain unobstructed access and lower unintended and short-interval pregnancy rates. Objective We report the experience of Tennessee’s perinatal quality collaborative that aimed to address unintended and short-interval pregnancy by increasing access to immediate postpartum Long-Acting Reversible Contraception through woman-centered counseling and ensuring reimbursement for devices. This followed a policy change in November 2017 that allowed women who were insured under Tennessee Medicaid programs (TennCare) to achieve access to immediate postpartum Long-Acting Reversible Contraception. Study Design From March 2018 to March 2019, 6 hospital sites participated in this statewide quality improvement project that was based on the Institute of Health Improvement Breakout Collaborative model. An evidence-based toolkit was created to provide guidance to the sites. During the year of implementation, monthly huddles occurred, and each facility took a differing amount of time to implement immediate postpartum Long-Acting Reversible Contraception. Various statewide and hospital-specific barriers occurred and were overcome throughout the year. Results In total, 2012 Long-Acting Reversible Contraception devices were provided to eligible and desiring women. All but 1 institution was able to offer immediate postpartum Long-Acting Reversible Contraception by March 2019. Reimbursement was the biggest statewide barrier because rates were low initially but improved through intensive intervention by dedicated team members at each site and the state level. Even with dedicated team members, false assurances were given repeatedly by billing and claims staff. Conclusion A statewide quality improvement project can increase access to immediate postpartum Long-Acting Reversible Contraception. Implementation and reimbursement require a dedicated team and coordination with all stakeholders. Verification of reimbursement with leaders at TennCare was essential for project sustainment and facilitated improved reimbursement rates. The impact on unintended and short-interval pregnancies requires long-term future investigation.
-
Obstetrics-gynecology resident Long-Acting Reversible Contraception training: the role of resident and program characteristics.
American journal of obstetrics and gynecology, 2019Co-Authors: Jill M. Maples, Eve Espey, Megan L. Evans, Janis L. Breeze, Tony Ogburn, Nikki B. ZiteAbstract:Obstetrics-gynecology residents should graduate with competence in comprehensive contraceptive care, including Long-Acting Reversible Contraception. Lack of hands-on training and deficits in provider education are barriers to Long-Acting Reversible Contraception access. Identifying the number of Long-Acting Reversible Contraception insertions performed by obstetrics-gynecology residents could provide insight into the depth and breadth of Long-Acting Reversible Contraception training available to obstetrics-gynecology residents in Accreditation Council for Graduate Medical Education-accredited residency programs. Our study investigates Long-Acting Reversible Contraception-specific training in obstetrics-gynecology residency programs across the United States, including the self-reported number of Long-Acting Reversible Contraception insertions per resident and the impact of resident demographic characteristics and residency program characteristics on training. Obstetrics-gynecology residents completed a voluntary electronic survey during the 2016 Council on Resident Education in Obstetrics and Gynecology examination. The survey included resident demographic characteristics and residency program characteristics as well as resident education and training in Long-Acting Reversible Contraception (number of intrauterine devices and implants inserted, training in immediate postpartum intrauterine device placement). A binary "Long-Acting Reversible Contraception insertion experience" variable dichotomized respondents as having a low level of Long-Acting Reversible Contraception insertions (0 implants and/or 10 or fewer intrauterine devices ) or a high level of Long-Acting Reversible Contraception insertions (1 or more implants and/or 11 or more intrauterine devices). χ2 tests were used to compare the presence of Long-Acting Reversible Contraception insertion experience by postgraduate year, resident demographic characteristics, and residency program characteristics. Adjusted logistic regression was performed to ascertain the independent effects of gender, race/ethnicity (non-Hispanic white vs other), residency program type (university vs community), and residency program geographic region on the likelihood of "low" overall Long-Acting Reversible Contraception insertion experience. In total, 5055 obstetrics-gynecology residents completed the survey (85%); analysis included only residents in United States obstetrics-gynecology programs (N=4322). Of the total analytic sample, 1777 (41.2%) had low Long-Acting Reversible Contraception insertion experience. As expected, the number of intrauterine device insertions, implant insertions, and overall Long-Acting Reversible Contraception experience increased as residents progressed through training. Long-Acting Reversible Contraception insertion experience varied by residency program geographic region: 169 (27.1%) residents in programs in the West had low Long-Acting Reversible Contraception insertion experience compared with 498 (39.0%) in the South, 473 (45.3%) in the Midwest, and 615 (46.0%) in the Northeast. Only 152 (14.9%) of all postgraduate year 4 residents had low Long-Acting Reversible Contraception insertion experience. Among postgraduate year 4 residents, low Long-Acting Reversible Contraception insertion experience was significantly associated racial/ethnic minority status and community-based residency program type (compared with university-based). Postgraduate year 4 residents in programs located in the Northeast and Midwest had 4.25 (95% confidence interval, 2.04-8.85) and 2.75 (95% confidence interval, 1.27-5.97) times the odds of low Long-Acting Reversible Contraception experience compared with those in residency programs in the West, even after adjusting for other respondent characteristics and other residency program characteristics. Obstetrics-gynecology residents experience a range of Long-Acting Reversible Contraception training and insertions, which differed according to resident race/ethnicity and residency program characteristics (program type and geographic region). Residency programs with low Long-Acting Reversible Contraception training experience should consider opportunities to improve competence in this fundamental obstetrics-gynecology skill. Copyright © 2019 Elsevier Inc. All rights reserved.
-
Statewide quality improvement initiative to implement immediate postpartum Long-Acting Reversible Contraception.
American journal of obstetrics and gynecology, 2019Co-Authors: Megan M Lacy, Suzanne Mcmurtry Baird, Theresa A Scott, Brenda Barker, Nikki B. ZiteAbstract:Women face barriers to obtaining Contraception and postpartum care. In a review of Tennessee birth data from 2014, 56% of pregnancies were unintended, 22.7% were short-interval pregnancies, and 57.9% of women who were not intending to get pregnant were not using Contraception. Offering Long-Acting Reversible contraceptive methods in the immediate postpartum period allows women who desire these effective methods of Contraception to obtain unobstructed access and lower unintended and short-interval pregnancy rates. We report the experience of Tennessee's perinatal quality collaborative that aimed to address unintended and short-interval pregnancy by increasing access to immediate postpartum Long-Acting Reversible Contraception through woman-centered counseling and ensuring reimbursement for devices. This followed a policy change in November 2017 that allowed women who were insured under Tennessee Medicaid programs (TennCare) to achieve access to immediate postpartum Long-Acting Reversible Contraception. From March 2018 to March 2019, 6 hospital sites participated in this statewide quality improvement project that was based on the Institute of Health Improvement Breakout Collaborative model. An evidence-based toolkit was created to provide guidance to the sites. During the year of implementation, monthly huddles occurred, and each facility took a differing amount of time to implement immediate postpartum Long-Acting Reversible Contraception. Various statewide and hospital-specific barriers occurred and were overcome throughout the year. In total, 2012 Long-Acting Reversible Contraception devices were provided to eligible and desiring women. All but 1 institution was able to offer immediate postpartum Long-Acting Reversible Contraception by March 2019. Reimbursement was the biggest statewide barrier because rates were low initially but improved through intensive intervention by dedicated team members at each site and the state level. Even with dedicated team members, false assurances were given repeatedly by billing and claims staff. A statewide quality improvement project can increase access to immediate postpartum Long-Acting Reversible Contraception. Implementation and reimbursement require a dedicated team and coordination with all stakeholders. Verification of reimbursement with leaders at TennCare was essential for project sustainment and facilitated improved reimbursement rates. The impact on unintended and short-interval pregnancies requires long-term future investigation. Copyright © 2019 Elsevier Inc. All rights reserved.
Daniel P. Chiles - One of the best experts on this subject based on the ideXlab platform.
-
Initiation and continuation of Long-Acting Reversible Contraception in the United States military healthcare system
American Journal of Obstetrics and Gynecology, 2016Co-Authors: Daniel P. Chiles, Timothy A. Roberts, David A. KleinAbstract:Background Long-Acting Reversible Contraception is more effective for pregnancy prevention than shorter-acting contraceptive methods and has the potential to reduce healthcare disparities and costs. However, Long-Acting Reversible Contraception is underused in the United States. One population of interest is beneficiaries of the United States military healthcare system who have access to universal healthcare, including no-cost, no-copay Contraception with unlimited method switching, and comprise a large, actual use cohort. Efforts to increase Long-Acting Reversible Contraception initiation and continuation in this population may improve health outcomes and mitigate the profound consequences of unintended or mistimed pregnancy on readiness and cost to the military. Objective We aimed to determine Long-Acting Reversible Contraception initiation and continuation rates among the diverse population with universal healthcare who are enrolled in the US military healthcare system. Study Design This study is a retrospective cohort of >1.7 million women, aged 14–40 years, who were enrolled in the US military healthcare system, TRICARE Prime, between October 2009 and September 2014. Individuals were assessed for Long-Acting Reversible Contraception initiation and continuation with the use of medical billing records. Method continuation and factors that were associated with early method discontinuation were evaluated with the Kaplan-Meier estimator and Cox proportional hazard models. Results During the study dates, 188,533 women initiated Long-Acting Reversible Contraception. Of these, 74.6% women selected intrauterine contraceptives. Method initiation rates remained relatively stable (41.7–50.1/1000 women/year) for intrauterine methods, although the rate for subdermal implants increased from 6.1–23.0/1000 women/year. In analysis of women who selected intrauterine contraceptives, 61.2% continued their method at 36 months, and 48.8% continued at 60 months. Among women who selected the implant, 32.0% continued their method at 36 months; however, 45.8% continued until 33 months (ie, 3 months before the currently recommended expiration date). Compared with intrauterine contraceptive users, implant users were more likely to discontinue their method during the 36 months after insertion (hazard ratio, 1.59; 95% confidence interval, 1.56–1.62; P Conclusion In the US military healthcare system, TRICARE Prime, the initiation of Long-Acting Reversible Contraception is low but increasing, and continuation rates are high. This evidence supports Long-Acting Reversible Contraception as first-line recommendations for women of all ages who seek Contraception.
-
Initiation and continuation of Long-Acting Reversible Contraception in the United States military healthcare system.
American journal of obstetrics and gynecology, 2016Co-Authors: Daniel P. Chiles, Timothy A. Roberts, David A. KleinAbstract:Long-Acting Reversible Contraception is more effective for pregnancy prevention than shorter-acting contraceptive methods and has the potential to reduce healthcare disparities and costs. However, Long-Acting Reversible Contraception is underused in the United States. One population of interest is beneficiaries of the United States military healthcare system who have access to universal healthcare, including no-cost, no-copay Contraception with unlimited method switching, and comprise a large, actual use cohort. Efforts to increase Long-Acting Reversible Contraception initiation and continuation in this population may improve health outcomes and mitigate the profound consequences of unintended or mistimed pregnancy on readiness and cost to the military. We aimed to determine Long-Acting Reversible Contraception initiation and continuation rates among the diverse population with universal healthcare who are enrolled in the US military healthcare system. This study is a retrospective cohort of >1.7 million women, aged 14-40 years, who were enrolled in the US military healthcare system, TRICARE Prime, between October 2009 and September 2014. Individuals were assessed for Long-Acting Reversible Contraception initiation and continuation with the use of medical billing records. Method continuation and factors that were associated with early method discontinuation were evaluated with the Kaplan-Meier estimator and Cox proportional hazard models. During the study dates, 188,533 women initiated Long-Acting Reversible Contraception. Of these, 74.6% women selected intrauterine contraceptives. Method initiation rates remained relatively stable (41.7-50.1/1000 women/year) for intrauterine methods, although the rate for subdermal implants increased from 6.1-23.0/1000 women/year. In analysis of women who selected intrauterine contraceptives, 61.2% continued their method at 36 months, and 48.8% continued at 60 months. Among women who selected the implant, 32.0% continued their method at 36 months; however, 45.8% continued until 33 months (ie, 3 months before the currently recommended expiration date). Compared with intrauterine contraceptive users, implant users were more likely to discontinue their method during the 36 months after insertion (hazard ratio, 1.59; 95% confidence interval, 1.56-1.62; P < .001). Adolescents aged 14-19 years were the least likely age group to discontinue the implant before 36 months; women aged 35-40 years were the least likely to discontinue an intrauterine contraceptive before 60 months. In multivariable analysis that controlled for demographic factors and contraceptive type, early contraceptive method discontinuation was most likely among women aged 20-24 years, implant users, and women with method initiation in military clinics. In the US military healthcare system, TRICARE Prime, the initiation of Long-Acting Reversible Contraception is low but increasing, and continuation rates are high. This evidence supports Long-Acting Reversible Contraception as first-line recommendations for women of all ages who seek Contraception. Published by Elsevier Inc.
Jeffrey F Peipert - One of the best experts on this subject based on the ideXlab platform.
-
Effect of staff training and cost support on provision of Long-Acting Reversible Contraception in community health centers.
Contraception, 2019Co-Authors: Christina Buckel, Jeffrey F Peipert, Ragini Maddipati, Melody S. Goodman, Tessa MaddenAbstract:Abstract Objective To compare the proportion of women receiving same-day Long-Acting Reversible Contraception (LARC) between two different models of contraceptive provision adapted from the Contraceptive CHOICE Project. Study Design We used a controlled time-trend study design to compare 502 women receiving structured contraceptive counseling in addition to usual care (“Enhanced Care”) to 506 women receiving counseling plus healthcare provider education and cost support for LARC (“Complete CHOICE”) at three federally qualified health centers. We provided funds to health centers to ensure an “on-the-shelf” supply and no-cost LARC for uninsured women. We recorded the contraceptive method chosen after contraceptive counseling and the healthcare provider appointment as well as the contraceptive method received that day. Among women choosing LARC, we calculated proportions and performed Poisson regression with robust error variance to estimate relative risks for same-day insertion. Results Participant demographics reflected the health center populations; 69% were black, 66% had a high school diploma or less, 57% were publicly insured, and 75% reported household income less than 101% federal poverty line. There were 153 (30.5%) women in “Enhanced Care” and 273 (54.0%) in “Complete CHOICE” who chose LARC (p Conclusions A contraceptive care model that included healthcare provider education and cost support for LARC in addition to structured contraceptive counseling resulted in higher rates of same-day LARC insertion compared to contraceptive counseling and usual care alone. Implications Contraceptive care provision which includes contraceptive counseling, healthcare provider education, and “on-the-shelf”, Long-Acting Reversible Contraception facilitate same-day initiation of these methods. Interventions that focus solely on contraceptive counseling do not address other structural barriers to same-day contraceptive provision of all methods including cost and provider practice.
-
long acting Reversible Contraception
The New England Journal of Medicine, 2017Co-Authors: Kathryn M. Curtis, Jeffrey F PeipertAbstract:Key Clinical PointsLong-Acting Reversible Contraception Intrauterine devices (IUDs) and hormonal implants are the most effective Reversible methods of Contraception — approximately 20 times as effective as pills, patches, and rings; couples should be counseled and informed about the superior effectiveness of Long-Acting Reversible Contraception (LARC) methods. IUDs and hormonal implants are safe for almost all women, including adolescents, as well as women in the postpartum or postabortion period. The main side effect of IUDs and hormonal implants is a change in bleeding patterns; anticipatory counseling about expected changes in bleeding may increase rates of continuation. Barriers to access to IUDs and hormonal implants remain, including those related to education, provider training, cost, and logistics; successful interventions have been shown to minimize these barriers. Adolescents and adult women should be counseled about Contraception and should have access to the full range of contraceptive methods...
-
Long-Acting Reversible Contraception in adolescents: a systematic review and meta-analysis.
American Journal of Obstetrics and Gynecology, 2016Co-Authors: Justin T. Diedrich, David A. Klein, Jeffrey F PeipertAbstract:Background Among adolescent pregnancies, 75% are unintended. Greater use of highly-effective Contraception can reduce unintended pregnancy. Although multiple studies discuss adolescent contraceptive use, there is no consensus regarding the use of Long-Acting Reversible Contraception as a first-line Contraception option. Objective We performed a systematic review of the medical literature to assess the continuation of Long-Acting Reversible contraceptives among adolescents. Study Design Ovid-MEDLINE, Cochrane databases, and Embase databases were searched using key words relevant to the provision of Long-Acting Contraception to adolescents. Articles published from January 2002 through August 2016 were selected for inclusion based on specific key word searches and detailed review of bibliographies. For inclusion, articles must have provided data on method continuation, effectiveness, or satisfaction of at least 1 Long-Acting Reversible contraceptive method in participants Results This review included 12 studies, including 6 retrospective cohort studies, 5 prospective observational studies, and 1 randomized controlled trial. The 12 studies included 4886 women age Conclusion Adolescents and young women have high 12-month continuation of Long-Acting Reversible contraceptive methods. Intrauterine devices and implants should be offered to all adolescents as first-line contraceptive options.
-
eliminating health disparities in unintended pregnancy with long acting Reversible Contraception larc
American Journal of Obstetrics and Gynecology, 2016Co-Authors: Caitlin Parks, Jeffrey F PeipertAbstract:Significant public health disparities exist surrounding teen and unplanned pregnancy in the United States. Women of color and those with lower education and socioeconomic status are at much greater risk of unplanned pregnancy and the resulting adverse outcomes. Unplanned pregnancies reduce educational and career opportunities and may contribute to socioeconomic deprivation and widening income disparities. Long-Acting Reversible Contraception (LARC), including intrauterine devices and implants, offer the opportunity to change the default from drifting into parenthood to planned conception. LARC methods are forgettable; once placed, they offer highly effective, long-term pregnancy prevention. Increasing evidence in the medical literature demonstrates the population benefits of use of these methods. However, barriers to more widespread use of LARC methods persist and include educational, access, and cost barriers. With increasing insurance coverage under the Affordable Care Act and more widespread, no-cost coverage of methods, more and more women are choosing intrauterine devices and the contraceptive implant. Increasing the use of highly effective contraceptive methods may provide one solution to the persistent problem of the health disparities of unplanned and teen pregnancies in the United States and improve women's and children's health.
-
effectiveness of long acting Reversible Contraception
The New England Journal of Medicine, 2012Co-Authors: B Winner, Jeffrey F Peipert, Qiuhong Zhao, Christina Buckel, Tessa Madden, Jenifer E Allsworth, Gina M SecuraAbstract:METHODS We designed a large prospective cohort study to promote the use of Long-Acting Reversible contraceptive methods as a means of reducing unintended pregnancies in our region. Participants were provided with Reversible Contraception of their choice at no cost. We compared the rate of failure of Long-Acting Reversible Contraception (intrauterine devices [IUDs] and implants) with other commonly prescribed contraceptive methods (oral contraceptive pills, transdermal patch, contraceptive vaginal ring, and depot medroxyprogesterone acetate [DMPA] injection) in the overall cohort and in groups stratified according to age (less than 21 years of age vs. 21 years or older).
Timothy A. Roberts - One of the best experts on this subject based on the ideXlab platform.
-
Initiation and continuation of Long-Acting Reversible Contraception in the United States military healthcare system
American Journal of Obstetrics and Gynecology, 2016Co-Authors: Daniel P. Chiles, Timothy A. Roberts, David A. KleinAbstract:Background Long-Acting Reversible Contraception is more effective for pregnancy prevention than shorter-acting contraceptive methods and has the potential to reduce healthcare disparities and costs. However, Long-Acting Reversible Contraception is underused in the United States. One population of interest is beneficiaries of the United States military healthcare system who have access to universal healthcare, including no-cost, no-copay Contraception with unlimited method switching, and comprise a large, actual use cohort. Efforts to increase Long-Acting Reversible Contraception initiation and continuation in this population may improve health outcomes and mitigate the profound consequences of unintended or mistimed pregnancy on readiness and cost to the military. Objective We aimed to determine Long-Acting Reversible Contraception initiation and continuation rates among the diverse population with universal healthcare who are enrolled in the US military healthcare system. Study Design This study is a retrospective cohort of >1.7 million women, aged 14–40 years, who were enrolled in the US military healthcare system, TRICARE Prime, between October 2009 and September 2014. Individuals were assessed for Long-Acting Reversible Contraception initiation and continuation with the use of medical billing records. Method continuation and factors that were associated with early method discontinuation were evaluated with the Kaplan-Meier estimator and Cox proportional hazard models. Results During the study dates, 188,533 women initiated Long-Acting Reversible Contraception. Of these, 74.6% women selected intrauterine contraceptives. Method initiation rates remained relatively stable (41.7–50.1/1000 women/year) for intrauterine methods, although the rate for subdermal implants increased from 6.1–23.0/1000 women/year. In analysis of women who selected intrauterine contraceptives, 61.2% continued their method at 36 months, and 48.8% continued at 60 months. Among women who selected the implant, 32.0% continued their method at 36 months; however, 45.8% continued until 33 months (ie, 3 months before the currently recommended expiration date). Compared with intrauterine contraceptive users, implant users were more likely to discontinue their method during the 36 months after insertion (hazard ratio, 1.59; 95% confidence interval, 1.56–1.62; P Conclusion In the US military healthcare system, TRICARE Prime, the initiation of Long-Acting Reversible Contraception is low but increasing, and continuation rates are high. This evidence supports Long-Acting Reversible Contraception as first-line recommendations for women of all ages who seek Contraception.
-
Initiation and continuation of Long-Acting Reversible Contraception in the United States military healthcare system.
American journal of obstetrics and gynecology, 2016Co-Authors: Daniel P. Chiles, Timothy A. Roberts, David A. KleinAbstract:Long-Acting Reversible Contraception is more effective for pregnancy prevention than shorter-acting contraceptive methods and has the potential to reduce healthcare disparities and costs. However, Long-Acting Reversible Contraception is underused in the United States. One population of interest is beneficiaries of the United States military healthcare system who have access to universal healthcare, including no-cost, no-copay Contraception with unlimited method switching, and comprise a large, actual use cohort. Efforts to increase Long-Acting Reversible Contraception initiation and continuation in this population may improve health outcomes and mitigate the profound consequences of unintended or mistimed pregnancy on readiness and cost to the military. We aimed to determine Long-Acting Reversible Contraception initiation and continuation rates among the diverse population with universal healthcare who are enrolled in the US military healthcare system. This study is a retrospective cohort of >1.7 million women, aged 14-40 years, who were enrolled in the US military healthcare system, TRICARE Prime, between October 2009 and September 2014. Individuals were assessed for Long-Acting Reversible Contraception initiation and continuation with the use of medical billing records. Method continuation and factors that were associated with early method discontinuation were evaluated with the Kaplan-Meier estimator and Cox proportional hazard models. During the study dates, 188,533 women initiated Long-Acting Reversible Contraception. Of these, 74.6% women selected intrauterine contraceptives. Method initiation rates remained relatively stable (41.7-50.1/1000 women/year) for intrauterine methods, although the rate for subdermal implants increased from 6.1-23.0/1000 women/year. In analysis of women who selected intrauterine contraceptives, 61.2% continued their method at 36 months, and 48.8% continued at 60 months. Among women who selected the implant, 32.0% continued their method at 36 months; however, 45.8% continued until 33 months (ie, 3 months before the currently recommended expiration date). Compared with intrauterine contraceptive users, implant users were more likely to discontinue their method during the 36 months after insertion (hazard ratio, 1.59; 95% confidence interval, 1.56-1.62; P < .001). Adolescents aged 14-19 years were the least likely age group to discontinue the implant before 36 months; women aged 35-40 years were the least likely to discontinue an intrauterine contraceptive before 60 months. In multivariable analysis that controlled for demographic factors and contraceptive type, early contraceptive method discontinuation was most likely among women aged 20-24 years, implant users, and women with method initiation in military clinics. In the US military healthcare system, TRICARE Prime, the initiation of Long-Acting Reversible Contraception is low but increasing, and continuation rates are high. This evidence supports Long-Acting Reversible Contraception as first-line recommendations for women of all ages who seek Contraception. Published by Elsevier Inc.
