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Trends and variation in LARC use among Planned Parenthood affiliates
Abstracts / Contraception 90 (2014) 298–351 were most preferred (50.0%), followed by condoms plus spermicides (39.1%) and basal body temperature (30.6%). Conclusions: Half of women surveyed preferred to avoid a hormonal contraceptive method. A large percentage of the women wanted to avoid both hormonal methods and the copper IUD. Providers should emphasize the correct and consistent use of barrier methods, spermicides and fertility awareness methods during family planning counseling. Additional efforts should be made to reinforce correct use because these methods are often obtained over the counter. This focused instruction will help reduce the incidence of unintended pregnancy. http://dx.doi.org/10.1016/j.contraception.2014.05.111
P91 BEYOND THE SURFACE: PATIENT POSTINSERTION IMPLANT EXPERIENCE IN A FAMILY-PHYSICIAN-STAFFED FEDERALLY QUALIFIED HEALTH CENTER NETWORK Ravi A Beth Israel, New York, NY, USA Prine L, deFiebre G, Miller N, Rubin S Objectives: With the implementation of the Affordable Care Act, federally qualified health centers are poised to improve reproductive health care access for underserved patients. However, no data exist on the post-IUD insertion experiences of women in such facilities, which could better prepare providers to anticipate their patients’ needs and potentially increase support for resident procedural training in these settings. Our study aims to describe the 6-month postinsertion experience for implant recipients in a federally qualified health center. Methods: We conducted a retrospective chart review of women aged 35 or younger who had implants inserted from January 2011 to June 2013 at a federally qualified health center network of family physician-staffed clinics, including three family medicine residency sites. Charts were reviewed through 6-months postinsertion or until device discontinuation. Results: A total of 256 patients, 42% adolescents and 58% adults, received implants. Forty-seven percent were inserted by family medicine residents. At 6 months postinsertion, 126 patients initiated a total of 229 implant-related visits. The main reasons for a visit were bleeding-related concerns (25%), removal request (19%) and concern about pregnancy (9%). Twenty two patients had the IUD removed, primarily because of bleeding. The most common postremoval contraceptives were pills (n=6) and condoms (n=5). Conclusions: Federally qualified health center providers may anticipate that approximately half of their patients receiving implants may contact them postinsertion, most commonly about bleeding changes, which could be addressed with incorporation of health educators and ancillary staff available in these settings. Our study also highlights the large volume of resident insertions and relatively low removal rate at these health centers. http://dx.doi.org/10.1016/j.contraception.2014.05.112
P92 TRENDS AND VARIATION IN LARC USE AMONG PLANNED PARENTHOOD AFFILIATES Kohn J Planned Parenthood Federation of America, New York, NY, USA
among U.S. women. National data show that 8.5% of women using contraceptives used LARCs in 2009. Given their high efficacy and ease of use, LARCs have great potential to reduce unintended pregnancy. The research objective was to examine trends in LARC use among Planned Parenthood contraceptive clients and variation among Planned Parenthood affiliates. Methods: We analyzed de-identified, aggregate client visit data from 2008 to 2012 to explore trends in use and affiliate variation. Results: From 2008 to 2012, LARC use among contraceptive clients increased 104% (IUCs by 75% and implants by 36%). The proportion of contraceptive clients using LARC increased steadily, from 3.5% in 2008 to 6.9% in 2012. In 2012, use varied widely among affiliates. LARC use ranged from 1% to 20% of all contraceptive clients (mean=6.9%). IUC use ranged from 1% to 19% (mean=5.4%); and implant use, from less than 1% to 6.3% (mean= 1.5%). Clients from 8 of 74 affiliates accounted for more than half of all LARC users. Conclusions: Use of IUCs and implants increased steadily, mirroring national trends. An examination of overall utilization obscures disparities in LARC prevalence between affiliates. Research is needed to determine affiliate- and center-level factors associated with higher LARC utilization. http://dx.doi.org/10.1016/j.contraception.2014.05.113
P93 DOES A CONTRACEPTIVE BRIDGE METHOD AFFECT RATES OF POSTPARTUM IUD PLACEMENT IN A RESIDENT URBAN CLINIC? Berger A Thomas Jefferson University Hospital, Philadelphia, PA, USA Hinz E, Woodhams E Objectives: The intrauterine device (IUD) is a highly effective method requested by many women postpartum. However, there are often barriers to uptake of postpartum IUDs. Our institution encourages postpartum patients to use a contraceptive method to “bridge” to their IUD placement. This study assessed if use of a bridge method affects rates of postpartum IUD insertion. Methods: We conducted a retrospective chart review of patients who delivered at Thomas Jefferson University Hospital from Jan. 1, 2011, through Dec. 31, 2011, who requested an IUD for postpartum contraception (n=199).The primary outcome was documented IUD placement. Multivariable logistic regression determined odds of IUD placement among women who had used an interim contraceptive method. Results: Of the 199 women requesting an IUD, 17% (n=34) received one in the postpartum period; 111 patients chose a bridge method, and 20.7% (n=23) received an IUD 6 months postpartum. Of 87 patients who declined an interim method, 13% received an IUD (n=11). The adjusted odds of receiving an IUD among those using a bridge method were not statistically different from those of women who did not use a bridge method (OR 2.0, CI 0.88–4.6, p=.097). The three main reasons for not receiving an IUD were loss to follow-up (37.7%), change in contraceptive choice (20.1%) and no follow-up for IUD appointment (19.1%). Conclusions: The odds of receiving a postpartum IUD were not altered by use of an interim method. However, uptake of IUDs was poor in general and this early data suggest other barriers, including poor postpartum follow-up and a two-visit policy for IUDs, which merit further investigation.
Unger Z, Benson J, Marks J Objectives: Utilization of long-acting reversible contraceptives (LARCs) — including intrauterine contraceptives (IUCs) and implants — is increasing
325
http://dx.doi.org/10.1016/j.contraception.2014.05.114
P91 BEYOND THE SURFACE: PATIENT POSTINSERTION IMPLANT EXPERIENCE IN A FAMILY-PHYSICIAN-STAFFED FEDERALLY QUALIFIED HEALTH CENTER NETWORK Ravi A Beth Israel, New York, NY, USA Prine L, deFiebre G, Miller N, Rubin S Objectives: With the implementation of the Affordable Care Act, federally qualified health centers are poised to improve reproductive health care access for underserved patients. However, no data exist on the post-IUD insertion experiences of women in such facilities, which could better prepare providers to anticipate their patients’ needs and potentially increase support for resident procedural training in these settings. Our study aims to describe the 6-month postinsertion experience for implant recipients in a federally qualified health center. Methods: We conducted a retrospective chart review of women aged 35 or younger who had implants inserted from January 2011 to June 2013 at a federally qualified health center network of family physician-staffed clinics, including three family medicine residency sites. Charts were reviewed through 6-months postinsertion or until device discontinuation. Results: A total of 256 patients, 42% adolescents and 58% adults, received implants. Forty-seven percent were inserted by family medicine residents. At 6 months postinsertion, 126 patients initiated a total of 229 implant-related visits. The main reasons for a visit were bleeding-related concerns (25%), removal request (19%) and concern about pregnancy (9%). Twenty two patients had the IUD removed, primarily because of bleeding. The most common postremoval contraceptives were pills (n=6) and condoms (n=5). Conclusions: Federally qualified health center providers may anticipate that approximately half of their patients receiving implants may contact them postinsertion, most commonly about bleeding changes, which could be addressed with incorporation of health educators and ancillary staff available in these settings. Our study also highlights the large volume of resident insertions and relatively low removal rate at these health centers. http://dx.doi.org/10.1016/j.contraception.2014.05.112
P92 TRENDS AND VARIATION IN LARC USE AMONG PLANNED PARENTHOOD AFFILIATES Kohn J Planned Parenthood Federation of America, New York, NY, USA
among U.S. women. National data show that 8.5% of women using contraceptives used LARCs in 2009. Given their high efficacy and ease of use, LARCs have great potential to reduce unintended pregnancy. The research objective was to examine trends in LARC use among Planned Parenthood contraceptive clients and variation among Planned Parenthood affiliates. Methods: We analyzed de-identified, aggregate client visit data from 2008 to 2012 to explore trends in use and affiliate variation. Results: From 2008 to 2012, LARC use among contraceptive clients increased 104% (IUCs by 75% and implants by 36%). The proportion of contraceptive clients using LARC increased steadily, from 3.5% in 2008 to 6.9% in 2012. In 2012, use varied widely among affiliates. LARC use ranged from 1% to 20% of all contraceptive clients (mean=6.9%). IUC use ranged from 1% to 19% (mean=5.4%); and implant use, from less than 1% to 6.3% (mean= 1.5%). Clients from 8 of 74 affiliates accounted for more than half of all LARC users. Conclusions: Use of IUCs and implants increased steadily, mirroring national trends. An examination of overall utilization obscures disparities in LARC prevalence between affiliates. Research is needed to determine affiliate- and center-level factors associated with higher LARC utilization. http://dx.doi.org/10.1016/j.contraception.2014.05.113
P93 DOES A CONTRACEPTIVE BRIDGE METHOD AFFECT RATES OF POSTPARTUM IUD PLACEMENT IN A RESIDENT URBAN CLINIC? Berger A Thomas Jefferson University Hospital, Philadelphia, PA, USA Hinz E, Woodhams E Objectives: The intrauterine device (IUD) is a highly effective method requested by many women postpartum. However, there are often barriers to uptake of postpartum IUDs. Our institution encourages postpartum patients to use a contraceptive method to “bridge” to their IUD placement. This study assessed if use of a bridge method affects rates of postpartum IUD insertion. Methods: We conducted a retrospective chart review of patients who delivered at Thomas Jefferson University Hospital from Jan. 1, 2011, through Dec. 31, 2011, who requested an IUD for postpartum contraception (n=199).The primary outcome was documented IUD placement. Multivariable logistic regression determined odds of IUD placement among women who had used an interim contraceptive method. Results: Of the 199 women requesting an IUD, 17% (n=34) received one in the postpartum period; 111 patients chose a bridge method, and 20.7% (n=23) received an IUD 6 months postpartum. Of 87 patients who declined an interim method, 13% received an IUD (n=11). The adjusted odds of receiving an IUD among those using a bridge method were not statistically different from those of women who did not use a bridge method (OR 2.0, CI 0.88–4.6, p=.097). The three main reasons for not receiving an IUD were loss to follow-up (37.7%), change in contraceptive choice (20.1%) and no follow-up for IUD appointment (19.1%). Conclusions: The odds of receiving a postpartum IUD were not altered by use of an interim method. However, uptake of IUDs was poor in general and this early data suggest other barriers, including poor postpartum follow-up and a two-visit policy for IUDs, which merit further investigation.
Unger Z, Benson J, Marks J Objectives: Utilization of long-acting reversible contraceptives (LARCs) — including intrauterine contraceptives (IUCs) and implants — is increasing
325
http://dx.doi.org/10.1016/j.contraception.2014.05.114