Last data update: May 06, 2024. (Total: 46732 publications since 2009)
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Query Trace: Baca KM[original query] |
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Policy change is not enough: Engaging provider champions on immediate postpartum contraception
Okoroh EM , Kane DJ , Gee RE , Kieltyka L , Frederiksen BN , Baca KM , Rankin KM , Goodman DA , Kroelinger CD , Barfield WD . Am J Obstet Gynecol 2018 218 (6) 590 e1-590 e7 Rates of short interval pregnancies resulting in unintended pregnancies remain high in the United States and contribute to adverse reproductive health outcomes. Long-acting reversible contraception (LARC) methods have annual failure rates of less than 1% compared with 9% for oral contraceptive pills, and are an effective strategy to reduce unintended pregnancies. To increase access to LARCs in the immediate postpartum period, several State Medicaid programs, including those in Iowa (IA) and Louisiana (LA), recently established reimbursement policies to remove the barriers to reimbursement of immediate postpartum LARC insertion. We used a mixed-methods approach, to analyze 2013-2015 linked Medicaid and vital records data from both IA and LA, to describe trends in immediate postpartum LARC provision one year prior to and following the Medicaid reimbursement policy change. We also used data from key informant interviews with State program staff to understand how provider champions affected policy uptake. We found that the monthly average for the number of insertions in IA increased from 4.6 per month prior to the policy to 6.6 per month post policy, and in LA, the average increased from 2.6 per month prior to the policy to 45.2 per month. In both states, the majority of insertions occurred at one academic/teaching hospital. In LA, the additional increase may be due to the engagement of a provider champion who worked at both the state and facility level. Recruiting, training, engaging, and supporting provider champions, as facilitators, with influence at state and facility levels, is an important component of a multipart strategy for increasing successful implementation of State-level Medicaid payment reform policies that allow reimbursement for immediate postpartum LARC insertions. |
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