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Preventive and contraceptive counseling in Medicaid-managed care visits: why not both?
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Abstracts / Contraception 94 (2016) 387–434
Thiel de Bocanegra H Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA
Objectives: The waiting room provides an opportunity for patient education. This study tests the effectiveness of a waiting room contraceptive counseling app, miPlan, in increasing knowledge and uptake and behavioral intentions regarding highly effective contraception. Methods: miPlan is a theory-based multimedia app designed with and for young women of color. miPlan addresses all contraceptive methods and includes videos of young women describing their experiences with long-acting reversible contraceptive (LARC) methods. Black and Latina women aged 15–29 not seeking a LARC method attending community reproductive health centers were randomized to either receive the miPlan app prior to the clinic’s standard face-to-face contraceptive counseling (intervention); or standard contraceptive counseling alone (control). Baseline surveys, chart reviews and follow-up at 3 months were conducted with all participants. In addition, miPlan users completed immediate postapp surveys. Results: The trial enrolled 222 young women. Immediately after the intervention, app users had increased overall knowledge of contraceptive effectiveness (M=0.72 preapp vs. M=1.65 postapp; pb.0001) and higher intentions to use the implant (M=1.83 preapp vs. M=2.63 postapp; pb.0001) and the IUD (M=1.81 preapp vs. M=2.53 postapp; pb.0001). No significant differences in immediate LARC method uptake (3.8% vs. 1.0%; p=.168) were observed. miPlan users were more likely to correctly identify IUD effectiveness than controls 3 months postintervention (57.6% vs. 29%; p=.001, Cramer's V=0.29). Conclusions: Mobile apps are an effective tool for increasing contraceptive knowledge and behavioral intentions to use highly effective contraceptive methods. Capitalizing on clinic waiting room downtime via a contraceptive counseling app offers a cost-effective, scalable and accessible intervention to complement existing face-to-face contraceptive counseling.
Bradsberry M, Hulett D, McKeanA, Darney P
http://dx.doi.org/10.1016/j.contraception.2016.07.110
Objectives: We aimed to explore characteristics of Medicaid-managed care visits associated with having both contraceptive and preventive health counseling in 2013. Methods: We conducted a medical record review of 1054 Medicaid-managed care visits among women with a family planning or annual check-up diagnosis or procedure code in 2013 and assessed the association between contraceptive counseling and preventive health counseling on general well-woman topics, weight management and chronic disease management with bivariate and regression analyses. Results: The highest proportion of charts indicating contraceptive counseling, provision and referral were those that had family planning indicated as the visit reason. Increased proportions of charts with primary care or annual check-up as visit reasons indicated preventive health counseling. Provision of contraceptive and preventive counseling was not correlated (Phi = 0.10). We constructed a regression model with visits that had both contraceptive and preventive counseling as the outcome variable (n=106), controlling for age, specialty (Ob/Gyn vs. Primary Care), visit reason, noncontraception medical procedure at the visit and referral. Women over 30 years were significantly less likely, whereas women with family planning as visit reason or who received a referral were significantly more likely to receive both at the same visit. Provider specialty was not significant in the model. Conclusions: In the majority of Medicaid-managed care visits, preventive health and contraceptive counseling are offered in separate contexts. They mainly occur at the same visit when the visit reason is family planning regardless of provider specialty. Providers should be trained to systematically address both preventive and contraceptive topics in women's health visits.
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social communication about contraception were administered. Bivariate and multivariate logistic regression analyses were performed. Results: Teenagers (aged 15–19) were more likely to have discussed birth control with someone they are close to in the past month than any other age group: 94% versus 85% of women aged 20–24 (p=.036); 79% of women aged 25–29 (p=.009); 74% of women aged 30–34 (p=.023); 69% of women aged 35–39 (p=.023); and 61% of women aged 40–45 (p=.015). Teenagers were more likely to have discussed birth control with a friend or a family member in the past month than women aged 40–45 (78% vs. 26%; p=.000 and 44% vs. 13%; p=.009). Asian/ Pacific Islander women were less likely to have discussed birth control with a family member than White women (29% vs. 40%, p=.031). Conclusions: These findings suggest that teenagers discuss contraception with their social networks to a greater extent than older women and provide support for interventions that engage young people’s social networks as a means of disseminating contraceptive information and decision support. http://dx.doi.org/10.1016/j.contraception.2016.07.108
P68 PREVENTIVE AND CONTRACEPTIVE COUNSELING IN MEDICAID-MANAGED CARE VISITS: WHY NOT BOTH?
http://dx.doi.org/10.1016/j.contraception.2016.07.109
P69 EXPLORING THE FEASIBILITY AND EFFECTIVENESS OF A CONTRACEPTIVE COUNSELING WAITING ROOM APP Gilliam M University of Chicago, Chicago, IL, USA Hebert L, Brown R, Akinola M, Hill B, Whitaker A, Quinn M
LONG-ACTING REVERSIBLE CONTRACEPTIVE UPTAKE BEFORE AND AFTER THE AFFORDABLE CARE ACT CONTRACEPTIVE MANDATE AMONG WOMEN UNDERGOING FIRST-TRIMESTER SURGICAL ABORTION Bell KN Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA Meyn LA, Chen BA
Objectives: The Affordable Care Act contraceptive mandate requires private health insurance plans to cover contraception without out-of-pocket costs. We examined uptake of long-acting reversible contraceptive (LARC) methods among women undergoing surgical abortion before and after contraceptive mandate implementation. Methods: We analyzed data from 868 women who underwent a first-trimester surgical abortion in an academic gynecology practice between December 2010 and December 2014 (excluding August to December 2012 to allow mandate implementation). We examined demographic characteristics, insurance type, insurance coverage for LARC methods and postabortion LARC method insertion. Results: Mean age was 28.6 years; 65% were White, and 25% were Black. One third (31%) of women had had a prior abortion; 15% had previously used a LARC method. Among women with private insurance, most had full (78%) or partial (7%) LARC method coverage before the mandate; 92% and 1% had full and partial coverage afterward. We found no difference in LARC method uptake before and after the mandate among all women (46% vs. 48%, p=.54), women with private insurance (n=593, 45% vs. 50%, p=.19) or women with medical assistance (n=151, 46% vs. 51%, p=.63). Women with full or partial private LARC method coverage had higher uptake of a LARC method than women without coverage (p=.018). Among women with private insurance, factors associated with LARC method uptake were Black race, insurance coverage and prior LARC method use (pb.03).
Abstracts / Contraception 94 (2016) 387–434
Thiel de Bocanegra H Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA
Objectives: The waiting room provides an opportunity for patient education. This study tests the effectiveness of a waiting room contraceptive counseling app, miPlan, in increasing knowledge and uptake and behavioral intentions regarding highly effective contraception. Methods: miPlan is a theory-based multimedia app designed with and for young women of color. miPlan addresses all contraceptive methods and includes videos of young women describing their experiences with long-acting reversible contraceptive (LARC) methods. Black and Latina women aged 15–29 not seeking a LARC method attending community reproductive health centers were randomized to either receive the miPlan app prior to the clinic’s standard face-to-face contraceptive counseling (intervention); or standard contraceptive counseling alone (control). Baseline surveys, chart reviews and follow-up at 3 months were conducted with all participants. In addition, miPlan users completed immediate postapp surveys. Results: The trial enrolled 222 young women. Immediately after the intervention, app users had increased overall knowledge of contraceptive effectiveness (M=0.72 preapp vs. M=1.65 postapp; pb.0001) and higher intentions to use the implant (M=1.83 preapp vs. M=2.63 postapp; pb.0001) and the IUD (M=1.81 preapp vs. M=2.53 postapp; pb.0001). No significant differences in immediate LARC method uptake (3.8% vs. 1.0%; p=.168) were observed. miPlan users were more likely to correctly identify IUD effectiveness than controls 3 months postintervention (57.6% vs. 29%; p=.001, Cramer's V=0.29). Conclusions: Mobile apps are an effective tool for increasing contraceptive knowledge and behavioral intentions to use highly effective contraceptive methods. Capitalizing on clinic waiting room downtime via a contraceptive counseling app offers a cost-effective, scalable and accessible intervention to complement existing face-to-face contraceptive counseling.
Bradsberry M, Hulett D, McKeanA, Darney P
http://dx.doi.org/10.1016/j.contraception.2016.07.110
Objectives: We aimed to explore characteristics of Medicaid-managed care visits associated with having both contraceptive and preventive health counseling in 2013. Methods: We conducted a medical record review of 1054 Medicaid-managed care visits among women with a family planning or annual check-up diagnosis or procedure code in 2013 and assessed the association between contraceptive counseling and preventive health counseling on general well-woman topics, weight management and chronic disease management with bivariate and regression analyses. Results: The highest proportion of charts indicating contraceptive counseling, provision and referral were those that had family planning indicated as the visit reason. Increased proportions of charts with primary care or annual check-up as visit reasons indicated preventive health counseling. Provision of contraceptive and preventive counseling was not correlated (Phi = 0.10). We constructed a regression model with visits that had both contraceptive and preventive counseling as the outcome variable (n=106), controlling for age, specialty (Ob/Gyn vs. Primary Care), visit reason, noncontraception medical procedure at the visit and referral. Women over 30 years were significantly less likely, whereas women with family planning as visit reason or who received a referral were significantly more likely to receive both at the same visit. Provider specialty was not significant in the model. Conclusions: In the majority of Medicaid-managed care visits, preventive health and contraceptive counseling are offered in separate contexts. They mainly occur at the same visit when the visit reason is family planning regardless of provider specialty. Providers should be trained to systematically address both preventive and contraceptive topics in women's health visits.
P70
social communication about contraception were administered. Bivariate and multivariate logistic regression analyses were performed. Results: Teenagers (aged 15–19) were more likely to have discussed birth control with someone they are close to in the past month than any other age group: 94% versus 85% of women aged 20–24 (p=.036); 79% of women aged 25–29 (p=.009); 74% of women aged 30–34 (p=.023); 69% of women aged 35–39 (p=.023); and 61% of women aged 40–45 (p=.015). Teenagers were more likely to have discussed birth control with a friend or a family member in the past month than women aged 40–45 (78% vs. 26%; p=.000 and 44% vs. 13%; p=.009). Asian/ Pacific Islander women were less likely to have discussed birth control with a family member than White women (29% vs. 40%, p=.031). Conclusions: These findings suggest that teenagers discuss contraception with their social networks to a greater extent than older women and provide support for interventions that engage young people’s social networks as a means of disseminating contraceptive information and decision support. http://dx.doi.org/10.1016/j.contraception.2016.07.108
P68 PREVENTIVE AND CONTRACEPTIVE COUNSELING IN MEDICAID-MANAGED CARE VISITS: WHY NOT BOTH?
http://dx.doi.org/10.1016/j.contraception.2016.07.109
P69 EXPLORING THE FEASIBILITY AND EFFECTIVENESS OF A CONTRACEPTIVE COUNSELING WAITING ROOM APP Gilliam M University of Chicago, Chicago, IL, USA Hebert L, Brown R, Akinola M, Hill B, Whitaker A, Quinn M
LONG-ACTING REVERSIBLE CONTRACEPTIVE UPTAKE BEFORE AND AFTER THE AFFORDABLE CARE ACT CONTRACEPTIVE MANDATE AMONG WOMEN UNDERGOING FIRST-TRIMESTER SURGICAL ABORTION Bell KN Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA Meyn LA, Chen BA
Objectives: The Affordable Care Act contraceptive mandate requires private health insurance plans to cover contraception without out-of-pocket costs. We examined uptake of long-acting reversible contraceptive (LARC) methods among women undergoing surgical abortion before and after contraceptive mandate implementation. Methods: We analyzed data from 868 women who underwent a first-trimester surgical abortion in an academic gynecology practice between December 2010 and December 2014 (excluding August to December 2012 to allow mandate implementation). We examined demographic characteristics, insurance type, insurance coverage for LARC methods and postabortion LARC method insertion. Results: Mean age was 28.6 years; 65% were White, and 25% were Black. One third (31%) of women had had a prior abortion; 15% had previously used a LARC method. Among women with private insurance, most had full (78%) or partial (7%) LARC method coverage before the mandate; 92% and 1% had full and partial coverage afterward. We found no difference in LARC method uptake before and after the mandate among all women (46% vs. 48%, p=.54), women with private insurance (n=593, 45% vs. 50%, p=.19) or women with medical assistance (n=151, 46% vs. 51%, p=.63). Women with full or partial private LARC method coverage had higher uptake of a LARC method than women without coverage (p=.018). Among women with private insurance, factors associated with LARC method uptake were Black race, insurance coverage and prior LARC method use (pb.03).