From uptake to access: a decade of learning from the ACOG LARC program

Horvath, Sarah; Bumpus, Mica; Luchowski, Alicia T.

doi:10.1016/j.ajog.2019.11.1269

Cited by 20 publications

(8 citation statements)

References 15 publications

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“…Outside of the supportive environment of the collaborative, later adopting states may have had fewer resources for overcoming implementation challenges. Conversely, by incorporating "lessons learned" by states that had implemented prior and guidance from professional organizations, they might be able to deliver IPP LARC more effectively (Horvath, Bumpus, & Luchowski, 2019;Rankin et al, 2016). Finally, challenges to abortion and contraceptive access at the state and federal levels may have heightened postpartum patients' interest in LARC in recent years (Guttmacher Institute, 2018;Pace, Dusetzina, Murray Horwitz, & Keating, 2019).…”

mentioning

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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mentioning

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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“…1 Medicaid reimbursement for immediate postpartum LARC is part of a broader set of policy changes implemented over the last 10 years intended to increase access to LARC. 35 More recently, experts have raised concerns that the enthusiasm for LARC over the last decade may have resulted in the overemphasis of LARC in contraceptive counseling. Biased counseling practices could undermine trust in family planning health care professionals and programs, particularly among racial and ethnic minority groups, perpetuating a long-standing history in the US of reproductive coercion and oppression.…”

Section: Discussionmentioning

confidence: 99%

“…Medicaid reimbursement for immediate postpartum LARC is part of a broader set of policy changes implemented over the last 10 years intended to increase access to LARC . More recently, experts have raised concerns that the enthusiasm for LARC over the last decade may have resulted in the overemphasis of LARC in contraceptive counseling.…”

Section: Discussionmentioning

confidence: 99%

Association of Medicaid Reimbursement for Immediate Postpartum Long-acting Reversible Contraception With Infant Birth Outcomes

2022

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IMPORTANCE Together, preterm birth and low birth weight are the second-leading cause of infant mortality in the US and occur disproportionately among Medicaid-paid births and among the infants of Black birthing persons. In 2012, South Carolina's Medicaid program began to reimburse hospitals for immediate postpartum long-acting reversible contraception (LARC) separately from the global maternity payment. OBJECTIVE To examine the association between South Carolina's policy change and infant health. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study using a difference-in-differences analysis included individuals with a South Carolina Medicaid-paid childbirth between January 2009 and December 2015. Data were analyzed from December 2020 to July 2021. EXPOSURES Medicaid-paid childbirth after March 2012 in South Carolina hospitals that had implemented the policy.MAIN OUTCOMES AND MEASURES Immediate postpartum LARC uptake, subsequent birth within 4 years, subsequent short-interval birth, days to subsequent birth, subsequent preterm, and low-birth-weight birth within 4 years.

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“…3,4 We previously argued an ethical case for either shared decision-making or paternalistic administration of neostigmine. 3 Many respondents endorsed preoperative counseling and shared decision-making, consistent with the American College of Obstetricians and Gynecologists’ embrace of “reproductive justice.” 16 Yet, respondents seldom report applying this approach to NMB antagonism in women of reproductive potential. Anesthesiology has long relied on quantitative research to guide evidence-based clinical decisions.…”

Section: Discussionmentioning

confidence: 99%

Unanticipated Consequences of Switching to Sugammadex: Anesthesia Provider Survey on the Hormone Contraceptive Drug Interaction

Dwan

Raymond

Richardson

2021

Anesthesia &Amp; Analgesia

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BACKGROUND: Sugammadex binds progesterone with high affinity and may interfere with hormonal contraceptive effectiveness. The clinical, economical, and ethical implications of unintended pregnancy should prompt anesthesiologists to actively consider and manage this pharmacologic interaction. We surveyed anesthesiology providers at our institution about knowledge of this potential adverse drug interaction, how they manage it clinically, and the extent to which they involve patients in shared decision-making regarding choice of neuromuscular blocker antagonist. METHODS: A survey instrument was distributed to anesthesiology providers at a large, tertiary-care medical center. The survey explored prior experience using neostigmine and sugammadex, knowledge about potential sugammadex interference with hormonal contraception, pre-/postoperative counseling practices, clinical management, and shared decision-making regarding potential use of neostigmine in lieu of sugammadex to avoid this drug-drug interaction. RESULTS: Of 259 surveys distributed, 155 were fully completed, and 10 were partially completed. Overall response rate was 60% (residents 85%, student nurse anesthetists 53%, certified registered nurse anesthetists 58%, attendings 48%). All but 1 respondent recognized the potential for sugammadex interference with oral hormonal contraception. Far fewer accurately identified potential interference with hormonal intrauterine devices (44%) and hormonal contraceptive implants (55%). The manufacturer’s recommended 7-day duration of alternative contraception was correctly identified by 72% of respondents; others (22%) reported longer durations (range 10–30 days). Most (78% overall) agreed/strongly agreed that potential interference with contraceptive effectiveness should be discussed with patients preoperatively. Despite the majority (86% overall) that endorsed shared decision-making and inviting patient input regarding choice between sugammadex and neostigmine, many respondents reported “rarely/never” having discussed this drug interaction with patients in actual clinical practice, either preoperatively (67%) or postoperatively (80%). Furthermore, most respondents (79%) reported “rarely/never” administering neostigmine to intentionally avoid this drug interaction. CONCLUSIONS: Two years after designating sugammadex as antagonist of choice, physician and nurse anesthesia providers reported seldom inquiring about contraceptive use among women of childbearing potential and rarely discussing potential risk of contraceptive failure from sugammadex exposure. Most lack accurate knowledge of sugammadex interference with hormonal intrauterine and subcutaneous contraceptive devices. Although most endorse preoperative counseling and support patient autonomy or shared decision-making regarding choice of reversal agent, the same respondents report rarely, if ever, actualizing these positions in clinical practice. These conflicting findings highlight the need for education regarding residual neuromuscular block versus adverse drug interactions, collaboration among providers involved in patient counseling, and intentional mindfulness of reproductive justice when caring for women of childbearing potential.

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From uptake to access: a decade of learning from the ACOG LARC program

Cited by 20 publications

References 15 publications

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

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

Association of Medicaid Reimbursement for Immediate Postpartum Long-acting Reversible Contraception With Infant Birth Outcomes

Unanticipated Consequences of Switching to Sugammadex: Anesthesia Provider Survey on the Hormone Contraceptive Drug Interaction

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