- Email: [email protected]
Increasing long-acting reversible contraception uptake through the delivery of Title X Services at federally qualified health centers
Abstracts / Contraception 88 (2013) 297–318 who receive and women who are denied wanted abortions, will be presented. The reported physical health consequences of abortion and birth following unwanted pregnancy will be discussed. Also, data on women's emotional responses to clinic protesters, ultrasound viewing and receiving or being denied a wanted abortion will be presented.
O17 THE CLINICIAN/HEALTH EDUCATOR TEAM AND COUNSELING FOR LONG-ACTING, REVERSIBLE CONTRACEPTION Thompson Kirsten a, Gelt Marsha b, Stern Lisa c a UCSF Bixby Center for Global Reproductive Health, San Francisco, CA, USA b Cardea Services, Oakland, CA, USA c Planned Parenthood Federation of America Medical Affairs, New York, NY, USA
301
Human trafficking is a human rights violation that disproportionately affects women and children. It is not only an international problem, but one that is happening right here in the USA, especially in the border states. Healthcare providers are one of the only groups of professionals who see human trafficking victims before they have even been identified as such. Healthcare providers have a unique opportunity to identify and help these patients while they are still under the control of the criminals who enslave them. The process is very simple and straightforward and does not add significant time or effort to a busy care provider's day. Identifying and helping human trafficking victims is the next logical step in treating victims of sexual violence and domestic violence.
O20 EVIDENCE-BASED CHANGES IN MEDICAL ABORTION PRACTICE Fjerstad Mary WomanCare Global, San Diego, CA, USA
Speidel J Joseph, Harper Cynthia The popularity of long-acting reversible contraception (LARC) is increasing in the USA, but national surveys show that women at highest risk for unintended pregnancy still face barriers to access. This session will present findings on provider LARC knowledge and practice, and tools and resources for patient counseling on LARC from the University of California, San Francisco and Planned Parenthood National Trial of Contraceptive Acceptability. This cluster randomized trial tested the impact of a clinic-wide training at 40 Planned Parenthood health centers across the US. This study is the first to examine the role of health educators in the provision of LARC. The impact of the clinic-wide training on LARC knowledge and practice, including the use of evidence-based criteria for determining client eligibility will be examined. Also, concordance of knowledge between health educators and clinicians, and how it impacts overall clinic practices will be explored. Finally, the presenters will facilitate an interactive session on skills and tools for counseling that is tailored to the concerns of the audience, including selected tools for overcoming clinic flow, billing and counseling barriers.
O18 DE-FUNDING ABORTION PROVIDERS: WHERE WE STAND AND WHAT YOU CAN DO Beck Andrew American Civil Liberties Union, New York, NY, USA Camp Talcott This will be an interactive presentation that covers both the categories of state policies that have de-funded providers of abortion care since 2011, and the track record of challenges to those policies. Attendees will understand and be able to differentiate among the different strategies states have used to render those who provide abortion care ineligible for public contracts and grants to provide non-abortion care, such as contraceptive counseling and services. They will also be able to summarize the status of court challenges to block these de-funding provisions. Finally, they will leave with a sense of how they can join the effort to make funding for providers of abortion more available.
O19 EARLY IDENTIFICATION OF HUMAN TRAFFICKING VICTIMS Poppema Suzanne T International Medical Consulting, Seattle, WA, USA
Since the introduction of mifepristone, medical abortion has been the subject of intense research. The provision of medical abortion is evolving, influenced by new evidence. Recent evidence which has the potential to make medical abortion more accessible to women and improve follow-up are: provision of medical abortion by advanced practice clinicians, medical abortion with home use of misoprostol up to 70 days LMP and methods of follow-up other than a clinic visit, for instance use of a multi-level (semiquantitative) pregnancy test. The World Health Organization now strongly recommends that highly effective hormonal contraception such as contraceptive implants or injectable contraception may be administered on the day of mifepristone; the session will review the scant evidence that supports this recommendation, some of which has not been published. The evidence of the ability of women themselves to determine whether medical abortion was successful based on symptoms alone will also be reviewed.
O21 INCREASING LONG-ACTING REVERSIBLE CONTRACEPTION UPTAKE THROUGH THE DELIVERY OF TITLE X SERVICES AT FEDERALLY QUALIFIED HEALTH CENTERS Hathaway Mark Unity Health Care, Washington DC, USA Klauss Karen, Vollett-Krech Jennifer, Dixon Camille The District of Columbia (DC) has one of the highest unintended pregnancy rates in the country. In 2006, 59% of all pregnancies in DC were unintended, compared with 49% nationally. Intrauterine devices (IUDs) and contraceptive implants, also known as long-acting reversible contraception (LARCs), are the most effective of all reversible methods at preventing unintended pregnancy. As the District's Title X grantee and its largest federally qualified primary care provider, Unity Health Care (Unity) is working to reduce unintended pregnancy rates and increase LARC uptake among urban, underserved communities. In 2012, Unity saw approximately 20% of the female population of reproductive age in DC with over 46,000 family planning encounters. Unity has more than doubled the number of female family planning users (120% increase) and LARC users (117% increase) over the last 5 years. During 2012, 9.2% of all female patients of reproductive age at risk for unplanned pregnancy were using a LARC method, up from 6.4% in 2009. As an FQHC, Unity embeds Title X services within its primary care services at 17 health centers in DC, including three in high schools. System changes, staff development and patient education are three areas of strategic focus that have increased LARC uptake. System changes include availability of IUDs and implants at all 17 sites at all times, on-demand/walk-in family planning, standardized insertion set-up and advocacy for improved insurance
302
Abstracts / Contraception 88 (2013) 297–318
reimbursement. Staff development includes training to support primary care providers (including family practice and pediatrics) to insert LARCs and consistently raising staff awareness about LARC effectiveness. Patient education includes the standardization of materials in multiple languages at every center, exam room contraceptive demo models and development of a birth control learning video. Multiple strategies will be explored with participants through dialogue, presentation and demonstration to foster learning on promoting LARC use by staff and uptake by patients.
O22
being formulated to further promote the role of LARCs as first line contraception options and increase insertions in a single visit.
O24 MULTIPURPOSE PREVENTION TECHNOLOGIES AVAILABLE NOW AND ON THE HORIZON Holt Bethany Young Coalition Advancing Multipurpose Innovations, Folsom, CA, USA Shields Wayne, Manning Judy
IUD TROUBLES: BEST PRACTICES FOR DIFFICULT INSERTIONS, REMOVALS, AND MALPOSITIONED DEVICES Leeman Lawrence University of New Mexico School of Medicine, Albuquerque, NM, USA Hooper Joanna, Yonke Nicole This presentation will begin with a brief overview of the epidemiology regarding intrauterine device utilization and the types of problems that may occur with IUD insertion, removal or incorrect positioning. The audience will be asked to describe challenging situations that they have encountered and approaches to these situations will be presented. A series of slides that demonstrate the ultrasound evaluation of IUDs that are in the correct position or malpositioned will be presented. The use of misoprostol, paracervical blocks and cervical dilation, intrauterine device hooks, alligator forceps and uterine aspiration for these situations will be discussed. Samples of these tools will be available for demonstration. The management of potential complications of these situations will be addressed, including uterine perforation and the need for operative removal. Audience participation will be encouraged throughout the session by the case-based approach and soliciting of clinical challenges from the participants.
O23 LARCS: FIRST LINE, SINGLE VISIT Tyson Nichole Kaiser Permanente Northern California, Roseville, CA, USA
This presentation will feature epidemiologic trends, end-user needs and the rationale for MPTs. Sub-Saharan Africa and South/West Asia will be highlighted as examples of the 2 regions of the world with the greatest overlap of high unmet need for family planning, high HIV and STI rates, and high maternal and under-five mortality rates. In addition, existing technologies and emerging MPTs that can be used to reduce simultaneous sexual and reproductive health risks and outcomes will be explored.
O25 ONE KEY QUESTION: BETTER INTEGRATION OF PREVENTIVE REPRODUCTIVE HEALTH SERVICES INTO PRIMARY CARE Bellanca Helen Oregon Foundation for Reproductive Health, Portland, OR, USA Hunter Michele Stranger One Key Question is an initiative of the Oregon Foundation for Reproductive Health that encourages all primary care clinicians to routinely ask women of reproductive age “Would you like to become pregnant in the next year?” and then follow that up with preconception care or contraception care depending on the answer. The initiative was successful in incorporating this screening into one of the required metrics in Oregon's version of health care reform. This session will discuss the implications of a quality metric in reproductive health as well as opportunities and barriers to implementation of the screening.
O26 Since the first ACOG committee opinion published in 2007 encouraging LARCs as safe and appropriate contraceptive methods for most women and adolescents, there has been a slow and steady increase in LARC use at Kaiser Permanente Northern California (KPNC). However, there have been remarkable disparities in provision of IUDs for all women, and in particular, the adolescent population. In order to document the inconsistencies in IUD practices, a survey was sent to KPNC sites with teen pregnancy prevention programs. The survey results demonstrated clear inconsistencies in LARCs. There were some providers who are unwilling to provide LARCs to adolescents and even more who will not place LARCs in a single visit. To make these findings even more significant, these pronounced disparities were demonstrated in those sites that have teen pregnancy prevention programs and, thus, KPNC sites with providers who are strong advocates for contraception and most “LARC friendly”. Clearly there was a need to implement protocols and education in KPNC to increase access to LARCs for adolescent and adult women. In order to increase uniformity in contraceptive care and reduce barriers to LARC access throughout the KPNC sites, IUD and implant protocols for women's health providers were developed. Additionally, call center guidelines to increase patient access to LARCs and optimize single visit LARC provisions were developed. Lastly, educational programs have already been broadcast across the region as webinars and are currently
POSTPARTUM CONTRACEPTION Torres Leah University of Utah, Salt Lake City, USA Turok David Postpartum contraception is an integral part of women's reproductive healthcare that poses many challenges to both the new mother and her practitioner. These challenges are associated with having a newborn, breastfeeding, maternal medical comorbidities, as well as socioeconomic barriers. While we provide contraception counseling in the postpartum period during their hospital stay, 10–44% of women are at risk of an unplanned pregnancy in the first 12 months postpartum. This session will focus on understanding the medical eligibility criteria for providing contraception in both breastfeeding and non-breastfeeding women, as well as how to provide the most effective method of contraception as soon after delivery as possible. The audience will participate in a discussion regarding overcoming the challenges of post-placental IUD placement and implant placement prior to hospital discharge. Also, affecting a change in scheduling the postpartum visit earlier, as the current tradition is out of date, will be addressed.
O17 THE CLINICIAN/HEALTH EDUCATOR TEAM AND COUNSELING FOR LONG-ACTING, REVERSIBLE CONTRACEPTION Thompson Kirsten a, Gelt Marsha b, Stern Lisa c a UCSF Bixby Center for Global Reproductive Health, San Francisco, CA, USA b Cardea Services, Oakland, CA, USA c Planned Parenthood Federation of America Medical Affairs, New York, NY, USA
301
Human trafficking is a human rights violation that disproportionately affects women and children. It is not only an international problem, but one that is happening right here in the USA, especially in the border states. Healthcare providers are one of the only groups of professionals who see human trafficking victims before they have even been identified as such. Healthcare providers have a unique opportunity to identify and help these patients while they are still under the control of the criminals who enslave them. The process is very simple and straightforward and does not add significant time or effort to a busy care provider's day. Identifying and helping human trafficking victims is the next logical step in treating victims of sexual violence and domestic violence.
O20 EVIDENCE-BASED CHANGES IN MEDICAL ABORTION PRACTICE Fjerstad Mary WomanCare Global, San Diego, CA, USA
Speidel J Joseph, Harper Cynthia The popularity of long-acting reversible contraception (LARC) is increasing in the USA, but national surveys show that women at highest risk for unintended pregnancy still face barriers to access. This session will present findings on provider LARC knowledge and practice, and tools and resources for patient counseling on LARC from the University of California, San Francisco and Planned Parenthood National Trial of Contraceptive Acceptability. This cluster randomized trial tested the impact of a clinic-wide training at 40 Planned Parenthood health centers across the US. This study is the first to examine the role of health educators in the provision of LARC. The impact of the clinic-wide training on LARC knowledge and practice, including the use of evidence-based criteria for determining client eligibility will be examined. Also, concordance of knowledge between health educators and clinicians, and how it impacts overall clinic practices will be explored. Finally, the presenters will facilitate an interactive session on skills and tools for counseling that is tailored to the concerns of the audience, including selected tools for overcoming clinic flow, billing and counseling barriers.
O18 DE-FUNDING ABORTION PROVIDERS: WHERE WE STAND AND WHAT YOU CAN DO Beck Andrew American Civil Liberties Union, New York, NY, USA Camp Talcott This will be an interactive presentation that covers both the categories of state policies that have de-funded providers of abortion care since 2011, and the track record of challenges to those policies. Attendees will understand and be able to differentiate among the different strategies states have used to render those who provide abortion care ineligible for public contracts and grants to provide non-abortion care, such as contraceptive counseling and services. They will also be able to summarize the status of court challenges to block these de-funding provisions. Finally, they will leave with a sense of how they can join the effort to make funding for providers of abortion more available.
O19 EARLY IDENTIFICATION OF HUMAN TRAFFICKING VICTIMS Poppema Suzanne T International Medical Consulting, Seattle, WA, USA
Since the introduction of mifepristone, medical abortion has been the subject of intense research. The provision of medical abortion is evolving, influenced by new evidence. Recent evidence which has the potential to make medical abortion more accessible to women and improve follow-up are: provision of medical abortion by advanced practice clinicians, medical abortion with home use of misoprostol up to 70 days LMP and methods of follow-up other than a clinic visit, for instance use of a multi-level (semiquantitative) pregnancy test. The World Health Organization now strongly recommends that highly effective hormonal contraception such as contraceptive implants or injectable contraception may be administered on the day of mifepristone; the session will review the scant evidence that supports this recommendation, some of which has not been published. The evidence of the ability of women themselves to determine whether medical abortion was successful based on symptoms alone will also be reviewed.
O21 INCREASING LONG-ACTING REVERSIBLE CONTRACEPTION UPTAKE THROUGH THE DELIVERY OF TITLE X SERVICES AT FEDERALLY QUALIFIED HEALTH CENTERS Hathaway Mark Unity Health Care, Washington DC, USA Klauss Karen, Vollett-Krech Jennifer, Dixon Camille The District of Columbia (DC) has one of the highest unintended pregnancy rates in the country. In 2006, 59% of all pregnancies in DC were unintended, compared with 49% nationally. Intrauterine devices (IUDs) and contraceptive implants, also known as long-acting reversible contraception (LARCs), are the most effective of all reversible methods at preventing unintended pregnancy. As the District's Title X grantee and its largest federally qualified primary care provider, Unity Health Care (Unity) is working to reduce unintended pregnancy rates and increase LARC uptake among urban, underserved communities. In 2012, Unity saw approximately 20% of the female population of reproductive age in DC with over 46,000 family planning encounters. Unity has more than doubled the number of female family planning users (120% increase) and LARC users (117% increase) over the last 5 years. During 2012, 9.2% of all female patients of reproductive age at risk for unplanned pregnancy were using a LARC method, up from 6.4% in 2009. As an FQHC, Unity embeds Title X services within its primary care services at 17 health centers in DC, including three in high schools. System changes, staff development and patient education are three areas of strategic focus that have increased LARC uptake. System changes include availability of IUDs and implants at all 17 sites at all times, on-demand/walk-in family planning, standardized insertion set-up and advocacy for improved insurance
302
Abstracts / Contraception 88 (2013) 297–318
reimbursement. Staff development includes training to support primary care providers (including family practice and pediatrics) to insert LARCs and consistently raising staff awareness about LARC effectiveness. Patient education includes the standardization of materials in multiple languages at every center, exam room contraceptive demo models and development of a birth control learning video. Multiple strategies will be explored with participants through dialogue, presentation and demonstration to foster learning on promoting LARC use by staff and uptake by patients.
O22
being formulated to further promote the role of LARCs as first line contraception options and increase insertions in a single visit.
O24 MULTIPURPOSE PREVENTION TECHNOLOGIES AVAILABLE NOW AND ON THE HORIZON Holt Bethany Young Coalition Advancing Multipurpose Innovations, Folsom, CA, USA Shields Wayne, Manning Judy
IUD TROUBLES: BEST PRACTICES FOR DIFFICULT INSERTIONS, REMOVALS, AND MALPOSITIONED DEVICES Leeman Lawrence University of New Mexico School of Medicine, Albuquerque, NM, USA Hooper Joanna, Yonke Nicole This presentation will begin with a brief overview of the epidemiology regarding intrauterine device utilization and the types of problems that may occur with IUD insertion, removal or incorrect positioning. The audience will be asked to describe challenging situations that they have encountered and approaches to these situations will be presented. A series of slides that demonstrate the ultrasound evaluation of IUDs that are in the correct position or malpositioned will be presented. The use of misoprostol, paracervical blocks and cervical dilation, intrauterine device hooks, alligator forceps and uterine aspiration for these situations will be discussed. Samples of these tools will be available for demonstration. The management of potential complications of these situations will be addressed, including uterine perforation and the need for operative removal. Audience participation will be encouraged throughout the session by the case-based approach and soliciting of clinical challenges from the participants.
O23 LARCS: FIRST LINE, SINGLE VISIT Tyson Nichole Kaiser Permanente Northern California, Roseville, CA, USA
This presentation will feature epidemiologic trends, end-user needs and the rationale for MPTs. Sub-Saharan Africa and South/West Asia will be highlighted as examples of the 2 regions of the world with the greatest overlap of high unmet need for family planning, high HIV and STI rates, and high maternal and under-five mortality rates. In addition, existing technologies and emerging MPTs that can be used to reduce simultaneous sexual and reproductive health risks and outcomes will be explored.
O25 ONE KEY QUESTION: BETTER INTEGRATION OF PREVENTIVE REPRODUCTIVE HEALTH SERVICES INTO PRIMARY CARE Bellanca Helen Oregon Foundation for Reproductive Health, Portland, OR, USA Hunter Michele Stranger One Key Question is an initiative of the Oregon Foundation for Reproductive Health that encourages all primary care clinicians to routinely ask women of reproductive age “Would you like to become pregnant in the next year?” and then follow that up with preconception care or contraception care depending on the answer. The initiative was successful in incorporating this screening into one of the required metrics in Oregon's version of health care reform. This session will discuss the implications of a quality metric in reproductive health as well as opportunities and barriers to implementation of the screening.
O26 Since the first ACOG committee opinion published in 2007 encouraging LARCs as safe and appropriate contraceptive methods for most women and adolescents, there has been a slow and steady increase in LARC use at Kaiser Permanente Northern California (KPNC). However, there have been remarkable disparities in provision of IUDs for all women, and in particular, the adolescent population. In order to document the inconsistencies in IUD practices, a survey was sent to KPNC sites with teen pregnancy prevention programs. The survey results demonstrated clear inconsistencies in LARCs. There were some providers who are unwilling to provide LARCs to adolescents and even more who will not place LARCs in a single visit. To make these findings even more significant, these pronounced disparities were demonstrated in those sites that have teen pregnancy prevention programs and, thus, KPNC sites with providers who are strong advocates for contraception and most “LARC friendly”. Clearly there was a need to implement protocols and education in KPNC to increase access to LARCs for adolescent and adult women. In order to increase uniformity in contraceptive care and reduce barriers to LARC access throughout the KPNC sites, IUD and implant protocols for women's health providers were developed. Additionally, call center guidelines to increase patient access to LARCs and optimize single visit LARC provisions were developed. Lastly, educational programs have already been broadcast across the region as webinars and are currently
POSTPARTUM CONTRACEPTION Torres Leah University of Utah, Salt Lake City, USA Turok David Postpartum contraception is an integral part of women's reproductive healthcare that poses many challenges to both the new mother and her practitioner. These challenges are associated with having a newborn, breastfeeding, maternal medical comorbidities, as well as socioeconomic barriers. While we provide contraception counseling in the postpartum period during their hospital stay, 10–44% of women are at risk of an unplanned pregnancy in the first 12 months postpartum. This session will focus on understanding the medical eligibility criteria for providing contraception in both breastfeeding and non-breastfeeding women, as well as how to provide the most effective method of contraception as soon after delivery as possible. The audience will participate in a discussion regarding overcoming the challenges of post-placental IUD placement and implant placement prior to hospital discharge. Also, affecting a change in scheduling the postpartum visit earlier, as the current tradition is out of date, will be addressed.