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Postpartum initiation of highly effective contraception
Abstracts / Contraception 84 (2011) 302–336 exited from the study. All 29 women would have the LNG-IUS placed in this setting again and would recommend this timing of insertion to a friend. Seven women completed all study visits. Conclusions: A study of postpartum insertion of LNG-IUS at greater than 10 min after delivery, but prior to discharge from the hospital, is feasible. Follow-up visits to ensure correct position of LNG-IUS was challenging in our population. Further investigation of LNG-IUS placement at this time frame is warranted.
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IMPACT OF THE RYAN LONG-ACTING REVERSIBLE CONTRACEPTION (LARC) TRAINING INITIATIVE ON RESIDENT EXPOSURE TO CONTRACEPTION PROVISION Turk J University of California, San Francisco, San Francisco, CA, USA
323
contraception and printed prescriptions which were signed by a clinician after checking blood pressures recorded in the patient's medical record. Results: Of the 194 women who consented to use the computer, 36 exited before starting the program and 40 had no need for hormonal contraception. Of the remaining 118 women, 13% (15/118) requested a contraceptive refill. Nine percent (11/118) requested a new contraceptive prescription, of whom 27% (3/11) requested a new prescription for progestin-only pills. Contraindications (most commonly a history of migraine) were identified for 27% (3/ 11) of women requesting a new prescription and 27% (4/15) of women requesting refills. Clinicians spent less than 1 min signing each requested prescription. Of the 92 women who exited the program without requesting a prescription, 77% (71/92) reported they already had birth control. All women (100%) who requested a prescription reported the computer was easy to use, 71% would recommend it to friend and 71% trusted the recommendations made by the computer. About half (46%) would prefer to discuss birth control with a clinician. Conclusions: Patient-operated computer technology appears to be a feasible, acceptable and efficient way to increase access to hormonal contraception outside of traditional family planning clinics.
Grimm M, Fulton M, Simonson K, Landy U, Steinauer J Objectives: To assess the impact of the Ryan LARC training initiative on exposure and clinical competence in contraception skills among obstetrics– gynecology residents. Methods: The Kenneth J. Ryan Residency Training Program offers technical and financial support to obstetrics–gynecology residencies to integrate abortion and contraception into training. The Ryan LARC initiative provides contraceptive implants and IUDs to participating Ryan programs with the goal of increasing patient access to LARC and training opportunities for residents. Residents from Ryan programs complete webbased surveys before and after their family planning rotation, reporting clinical experience in providing contraceptive methods and rating their competence using a five-point Likert scale, with 5 indicating very competent and 1 indicating not at all competent. Results: There are currently 59 Ryan program sites, 42 of which participate in the Ryan LARC initiative. To date, 923 post-rotation resident surveys have been collected, with a response rate of 68%. Residents at participating programs have placed significantly more contraceptive devices than residents at non-LARC Ryan sites. Ryan LARC residents have placed more copper IUDs (p=.06), levonorgestrel IUDs (pb.01) and contraceptive implants (pb.01) than residents at non-LARC sites. Significantly higher competency scores in all contraception-related procedures including contraception counseling (pb.01), post-abortion insertions (pb.01), post-partum IUD insertions (p=.07) and contraceptive implant insertions (pb.01) were reported by Ryan LARC residents than by residents at non-LARC sites. Conclusions: The Ryan LARC initiative has significantly increased exposure to LARC training for residents and has improved resident competence in contraception provision.
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COMPUTER-ASSISTED PROVISION OF HORMONAL CONTRACEPTION IN URGENT CARE SETTINGS Schwarz EB University of Pittsburgh, Pittsburgh, PA, USA Burch EJ, Parisi SM, Tebb KP, Grossman D, Mehrotra A, Gonzales R Objectives: To evaluate the feasibility of using a patient-operated computer program to assist with provision of hormonal contraception in urgent care settings. Methods: Between January and March 2011, while seeking non-contraceptive urgent care, women aged 18 to 50 years were invited to use an interactive computer program to learn about their contraceptive options and request prescriptions. The computer screened for contraindications to hormonal
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POSTPARTUM INITIATION OF HIGHLY EFFECTIVE CONTRACEPTION Salcedo J University of California, Los Angeles, Los Angeles, CA, USA Moniaga N, Harken T, Conly B, Rao K, Narayan A Objectives: To determine the percentage of women indicating a plan for highly effective reversible postpartum contraception (IUD, implant, DMPA) prenatally who establish such contraception within 8 weeks postpartum. Secondarily, to determine factors associated with the attainment of planned highly effective postpartum contraception. Methods: A chart review was performed to collect information on planned and established postpartum contraception for women who had at least one prenatal visit and delivered a viable pregnancy. Demographic data was collected and documented reasons for failure to obtain desired contraception were recorded. Multivariate regression was used for data analysis. Results: Of the 41.5% of women (130/313) who planned highly effective reversible postpartum contraception during their prenatal course, only 36% (47/130) established such a method within 8 weeks postpartum, despite the fact that 78% presented for at least one postpartum appointment. The only factors significantly associated with attainment of planned highly effective postpartum contraception were a plan to use highly effective contraception and the number of postpartum appointments. Ethnicity, marital status, primary language, education, age, gravidity, parity, history of abortion, method of delivery and number of prenatal visits were not associated with attainment of planned highly effective methods. Of the 82.7% of women (91/ 110) who failed to attain a planned postpartum IUD within 8 weeks, 33% planned to return for IUD placement but were subsequently lost to follow-up. Conclusions: Failure to establish planned highly effective postpartum contraception occurs frequently even in settings with high postpartum follow-up rates.
P57
PERCEIVED HEALTH STATUS, RECEIPT OF CONTRACEPTIVE COUNSELING, AND CONTRACEPTIVE USE Lee JK University of Pittsburgh School of Medicine, Pittsburgh, USA Parisi SM, Schwarz EB
P54
IMPACT OF THE RYAN LONG-ACTING REVERSIBLE CONTRACEPTION (LARC) TRAINING INITIATIVE ON RESIDENT EXPOSURE TO CONTRACEPTION PROVISION Turk J University of California, San Francisco, San Francisco, CA, USA
323
contraception and printed prescriptions which were signed by a clinician after checking blood pressures recorded in the patient's medical record. Results: Of the 194 women who consented to use the computer, 36 exited before starting the program and 40 had no need for hormonal contraception. Of the remaining 118 women, 13% (15/118) requested a contraceptive refill. Nine percent (11/118) requested a new contraceptive prescription, of whom 27% (3/11) requested a new prescription for progestin-only pills. Contraindications (most commonly a history of migraine) were identified for 27% (3/ 11) of women requesting a new prescription and 27% (4/15) of women requesting refills. Clinicians spent less than 1 min signing each requested prescription. Of the 92 women who exited the program without requesting a prescription, 77% (71/92) reported they already had birth control. All women (100%) who requested a prescription reported the computer was easy to use, 71% would recommend it to friend and 71% trusted the recommendations made by the computer. About half (46%) would prefer to discuss birth control with a clinician. Conclusions: Patient-operated computer technology appears to be a feasible, acceptable and efficient way to increase access to hormonal contraception outside of traditional family planning clinics.
Grimm M, Fulton M, Simonson K, Landy U, Steinauer J Objectives: To assess the impact of the Ryan LARC training initiative on exposure and clinical competence in contraception skills among obstetrics– gynecology residents. Methods: The Kenneth J. Ryan Residency Training Program offers technical and financial support to obstetrics–gynecology residencies to integrate abortion and contraception into training. The Ryan LARC initiative provides contraceptive implants and IUDs to participating Ryan programs with the goal of increasing patient access to LARC and training opportunities for residents. Residents from Ryan programs complete webbased surveys before and after their family planning rotation, reporting clinical experience in providing contraceptive methods and rating their competence using a five-point Likert scale, with 5 indicating very competent and 1 indicating not at all competent. Results: There are currently 59 Ryan program sites, 42 of which participate in the Ryan LARC initiative. To date, 923 post-rotation resident surveys have been collected, with a response rate of 68%. Residents at participating programs have placed significantly more contraceptive devices than residents at non-LARC Ryan sites. Ryan LARC residents have placed more copper IUDs (p=.06), levonorgestrel IUDs (pb.01) and contraceptive implants (pb.01) than residents at non-LARC sites. Significantly higher competency scores in all contraception-related procedures including contraception counseling (pb.01), post-abortion insertions (pb.01), post-partum IUD insertions (p=.07) and contraceptive implant insertions (pb.01) were reported by Ryan LARC residents than by residents at non-LARC sites. Conclusions: The Ryan LARC initiative has significantly increased exposure to LARC training for residents and has improved resident competence in contraception provision.
P55
COMPUTER-ASSISTED PROVISION OF HORMONAL CONTRACEPTION IN URGENT CARE SETTINGS Schwarz EB University of Pittsburgh, Pittsburgh, PA, USA Burch EJ, Parisi SM, Tebb KP, Grossman D, Mehrotra A, Gonzales R Objectives: To evaluate the feasibility of using a patient-operated computer program to assist with provision of hormonal contraception in urgent care settings. Methods: Between January and March 2011, while seeking non-contraceptive urgent care, women aged 18 to 50 years were invited to use an interactive computer program to learn about their contraceptive options and request prescriptions. The computer screened for contraindications to hormonal
P56
POSTPARTUM INITIATION OF HIGHLY EFFECTIVE CONTRACEPTION Salcedo J University of California, Los Angeles, Los Angeles, CA, USA Moniaga N, Harken T, Conly B, Rao K, Narayan A Objectives: To determine the percentage of women indicating a plan for highly effective reversible postpartum contraception (IUD, implant, DMPA) prenatally who establish such contraception within 8 weeks postpartum. Secondarily, to determine factors associated with the attainment of planned highly effective postpartum contraception. Methods: A chart review was performed to collect information on planned and established postpartum contraception for women who had at least one prenatal visit and delivered a viable pregnancy. Demographic data was collected and documented reasons for failure to obtain desired contraception were recorded. Multivariate regression was used for data analysis. Results: Of the 41.5% of women (130/313) who planned highly effective reversible postpartum contraception during their prenatal course, only 36% (47/130) established such a method within 8 weeks postpartum, despite the fact that 78% presented for at least one postpartum appointment. The only factors significantly associated with attainment of planned highly effective postpartum contraception were a plan to use highly effective contraception and the number of postpartum appointments. Ethnicity, marital status, primary language, education, age, gravidity, parity, history of abortion, method of delivery and number of prenatal visits were not associated with attainment of planned highly effective methods. Of the 82.7% of women (91/ 110) who failed to attain a planned postpartum IUD within 8 weeks, 33% planned to return for IUD placement but were subsequently lost to follow-up. Conclusions: Failure to establish planned highly effective postpartum contraception occurs frequently even in settings with high postpartum follow-up rates.
P57
PERCEIVED HEALTH STATUS, RECEIPT OF CONTRACEPTIVE COUNSELING, AND CONTRACEPTIVE USE Lee JK University of Pittsburgh School of Medicine, Pittsburgh, USA Parisi SM, Schwarz EB