Credentialing Internal Medicine Physicians to Expand Long-Acting Reversible Contraceptive Access

Michener, Jennifer L.; Hirsh, David A.; Batur, Pelin; Casas, Rachel S.; Gopinath, Vidya; Pace, Lydia E.; Prifti, Christine; Rusiecki, Jennifer; Schwarz, Eleanor Bimla; Shankar, Megha; Sobota, Mindy; Gomez Kwolek, Deborah

doi:10.7326/m23-1034

Cited by 2 publications

(2 citation statements)

References 7 publications

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“… 3 – 5 In fact, two leading Internal Medicine professional societies endorsed the inclusion of LARC training for internal medicine residents in recent position publications. 6 , 7 Integration into primary care has the potential to promote patient’s reproductive and menstrual autonomy by providing more rapid and direct access to LARC services. It can also potentially conserve resources by decreasing the number of visits and referrals needed per procedure.…”

Section: Introductionmentioning

confidence: 99%

Integrating long-acting reversible contraceptives into primary care internal medicine practices: A clinical innovation to reduce wait time

Quinn,

Goldfarb Terry,

Boock

et al. 2023

Womens Health (Lond Engl)

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Background: Long-acting reversible contraception (LARC) has long been regarded as highly effective and safe. However, access is limited and lengthy when specialty referrals are required. Objectives: To integrate LARC services into an urban internal medicine primary care practice to decrease wait time for LARC procedures. Design/methods: This pre–post with control group study took place at two large urban academic primary care practices (Practices A and B) and included patients ages 18 to 45 years assigned female sex at birth. Pre-implementation baseline data were collected retrospectively from 2019 to 2020 by identifying subjects who requested LARC insertion or removal via their primary care practice and were referred to Obstetrics and Gynecology (Ob/Gyn) for the procedure. Wait time was noted from time of initial request in the medical record to time of procedure. Practice A developed an integrated primary care LARC program in which one of their LARC-trained providers began offering these procedures within their own practice. All other providers within the practice were educated on how to counsel patients about the devices and procedures. Practice B did not have an in-house LARC provider and continued referring patients to Ob/Gyn. Post-implementation data were collected prospectively 2021–2022. Results: Ninety-one patients in Practice A experienced a significant decrease in wait time (87 vs 21 days, p < 0.001) over the observation period, with a majority undergoing procedures on their first visit with the in-house LARC provider. Wait time for the 54 patients in Practice B remained unchanged (57 vs 47 days, p = .59), often requiring multiple specialty visits. Conclusion: Integrating LARC services into a primary care internal medicine practice can significantly reduce wait times for these procedures with the potential to contribute to increased reproductive and menstrual autonomy.

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Section: Introductionmentioning

confidence: 99%

Integrating long-acting reversible contraceptives into primary care internal medicine practices: A clinical innovation to reduce wait time

Quinn,

Goldfarb Terry,

Boock

et al. 2023

Womens Health (Lond Engl)

View full text Add to dashboard Cite

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“… 6 Offering LARC within primary care can help realize this vision, but a persistent barrier is the insufficient numbers of primary care clinicians and facilities offering these methods. 7 Limited availability in primary care reflects a lack of training and credentialing standards, 8 limited institutional support, up-front expense of LARC devices coupled with relatively low reimbursement, and the challenge of incorporating an additional service into overburdened primary care practices. 9 …”

mentioning

confidence: 99%

Massachusetts’ innovative policy approach to expanding contraceptive options in primary care

Ciccariello,

Prakash-Zawisza,

Pace

2023

Health Affairs Scholar

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As health systems pivot toward value-based care and as the reversal of Roe vs. Wade has significantly decreased access to abortion care in the U.S., contraception is increasingly recognized as a high-value health service. However, the United States has a long and troubling history of using contraceptive policies and practices, including forced sterilization, to limit the reproductive rights of people of color and individuals with disabilities. We hope to highlight an innovative program developed by Massachusetts’ Medicaid program, which seeks to expand access to long-acting reversible contraception (LARC) within primary care clinics in a way that promotes both value and reproductive justice. This program provides financial incentives for clinics that serve patients with Medicaid to offer LARC to all patients within the primary care space. Unlike LARC programs that exclusively target patients with Medicaid insurance and provide incentivizes based on number of LARC insertions, this policy has the potential to “lift all boats” and expand access to LARC for all patients regardless of payer. Careful evaluation of this program will be necessary to ensure that the intended outcomes – to increase access to LARC, promote reproductive justice and deliver value to the health system – are achieved.

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Credentialing Internal Medicine Physicians to Expand Long-Acting Reversible Contraceptive Access

Cited by 2 publications

References 7 publications

Integrating long-acting reversible contraceptives into primary care internal medicine practices: A clinical innovation to reduce wait time

Integrating long-acting reversible contraceptives into primary care internal medicine practices: A clinical innovation to reduce wait time

Massachusetts’ innovative policy approach to expanding contraceptive options in primary care

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