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Increasing access to single-visit contraception in urban health care settings: Findings from a multi-site learning collaborative

      Abstract

      Objectives

      Multiple barriers limit access to the full range of contraceptive options. The purpose of this quality improvement initiative was to increase single-visit access to the full range of contraceptive methods in primary care, postabortion, and immediate postpartum settings in New York City (NYC).

      Study Design

      From 2015 to 2018 we convened 2 learning collaboratives, named the Quality Improvement Network for Contraceptive Access, with 17 teams (representing 40 sites) from New York City-based hospitals and health centers using an adaptation of the Institute for Healthcare Improvement's Breakthrough Series Learning Collaborative model. Participating teams sought to implement evidence-informed recommendations to increase access. The goal was to increase the patient-centeredness of services by reducing barriers. In the absence of a way to directly measure access, we measured progress toward implementation of the 4 recommendations and contraceptive care utilization measures as proxies for access, and asked teams to describe facilitating factors.

      Results

      Learning collaborative teams successfully implemented all 4 of the recommendations in 95% of the participating sites. Patients who chose and received a most or moderately effective method increased from 22% to 38% in primary care, and from 0% to 17% in the immediate postpartum period. Patients who chose and received a long-acting-reversible contraceptive increased from 5% to 11% in primary care, and from 0% to 3% in immediate postpartum. Facilitating factors included the involvement of interdisciplinary teams, consideration of costs, utilization of peers to demonstrate change, and champions to drive change.

      Conclusions

      The application of evidence-informed recommendations using a structured quality improvement initiative increases contraceptive access.

      Implications

      This paper identifies key facilitators and factors that influenced the successful implementation of evidence-based recommendations for access to the full range of contraceptive methods in primary care, postabortion, and immediate postpartum settings. Findings can inform future initiatives that seek to increase contraceptive access at the service delivery level, as a component of reproductive autonomy, and contraceptive equity.

      Keywords

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      References

        • American College of Obstetricians and Gynecologists
        Committee Opinion No. 642: increasing access to contraceptive implants and intrauterine devices to reduce unintended pregnancy.
        Obstet Gynecol. 2015; 126: e44-e48
        • Gavin L.
        • Pazol K.
        • Ahrens K.
        Update: providing quality family planning services recommendations from CDC and the U.S. Office of Population Affairs,.
        MMWR Morb Mortal Wkly Rep. 2017; 66: 1383-1385
        • Curtis K.M.
        U.S. Medical Eligibility Criteria for Contraceptive Use.
        MMWR Recomm Rep. 2016; 65 (2016): 1-104
        • American Academy of Pediatrics
        Contraception for Adolescents.
        Pediatrics. 2014; 134: e1244-e1256
        • Beeson T.
        • Wood S.
        • Bruen B.
        • Goldberg D.G.
        • Meet H.
        • Rosenbaum S.
        Accessibility of long-acting reversible contraceptives (LARCs) in Federally Qualified Health Centers.
        Contraception. 2014; 89 (91-6): 91-96
        • Curtis K.M.
        • Jatlaoui T.C.
        • Tepper N.K.
        U.S. Selected practice recommendations for contraceptive use.
        MMWR Recomm Rep. 2016; 2016 (65(No. RR-4)): 1-66
        • Bergin A.
        • Tristan S.
        • Terplan M.
        • Gilliam M.L.
        • Whitaker A.K.
        A missed opportunity for care: two-visit IUD insertion protocols inhibit placement.
        Contraception. 2012; 86: 694-697
        • Higgins T.
        • Dougherty A.
        • Heil S.
        Does a two-visit protocol for long-acting reversible contraception differentially impact socioeconomically disadvantaged women?.
        Contraception. 2016; 94: 413
        • Frost J.J.
        • Singh S.
        • Finer L.B.
        Factors Associated with Contraceptive Use and Nonuse, United States.
        Perspect Sex Reprod Health. 2004; 39 (2007): 90-99
      1. Guttmacher Institute. Improving Contraceptive Use in the United States, 2020. In Brief: Series 2008:8. https://www.guttmacher.org/report/improving-contraceptive-use-united-states (accessed May 1, 2015).

        • Forrest J.D.
        • Frost J.J.
        The family planning attitudes and experiences of low-income women.
        Fam Plann Perspect. 1996; 28: 246
      2. Kaiser Family Foundation. Women's Health Insurance Coverage. https://www.kff.org/womens-health-policy/fact-sheet/womens-health-insurance-coverage-fact-sheet/ (accessed May 5, 2020).

        • Dehlendorf C.
        • Rodriguez M.I.
        • Levy K.
        • Borrero S.
        • Steinauer J.
        Disparities in family planning.
        Am J Obstet Gynecol. 2010; 202: 214-220
        • Diedrich J.T.
        • Zhao Q.
        • Madden T.
        • Secura G.M.
        • Peipert J.F.
        Three-year continuation of reversible contraception.
        Am J Obstet Gynecol. 2015; 213 (662.e1-662.e8): 662.e1-8
        • Masho S.W.
        • Cha S.
        • Karjane N.
        • McGee E.
        • Charles R.
        • Hines L.
        Correlates of postpartum visits among medicaid recipients: an analysis using claims data from a managed care organization.
        J Womens Health. 2018; 27: 836-843
        • Chen B.A.
        • Reeves M.F.
        • Hayes J.L.
        • Hohmann H.L.
        • Perriera L.K.
        • Creinin M.D.
        Postplacental or delayed insertion of the levonorgestrel intrauterine device after vaginal delivery: a randomized controlled trial.
        Obstet Gynecol. 2010; 116: 1079
        • American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice
        Committee Opinion No. 670: immediate postpartum long-acting reversible contraception.
        Obstet Gynecol. 2016; 128: e32-e37
      3. Guttmacher Institute. State Facts About Unintended Pregnancy: New York. Guttmacher Inst 2016. https://www.guttmacher.org/fact-sheet/state-facts-about-unintended-pregnancy-new-york (accessed August 23, 2018).

        • Kost K.
        • Maddow-Zimet I.
        • Kochhar S.
        Pregnancy desires and pregnancies at the state level: estimates for.
        Guttmacher Institute, New York2014 (2018)
        • Rankin K.M.
        • Kroelinger C.D.
        • DeSisto C.L.
        • Pliska E.
        • Akbarali S.
        • Mackie C.N.
        Application of Implementation Science Methodology to Immediate Postpartum Long-Acting Reversible Contraception Policy Roll-Out Across States.
        Matern Child Health J. 2016; 20: 173-179
      4. New York City Health Department. Sexual and Reproductive Health Care Best Practices for Adolescents and Adults. 2020, https://www1.nyc.gov/assets/doh/downloads/pdf/ms/srh-clinical-guide.pdf (accessed September 1, 2015).

        • Briceno A.C.L.
        • Kawatu J.
        • Saul K.
        • DeAngelis K.
        • Frederiksen B.
        • Moskosky S.B.
        From theory to application: using performance measures for contraceptive care in the Title X family planning program.
        Contraception. 2017; 96: 166-174
        • Ross L.
        • Gutierrez E.
        • Gerber M.
        • Silliman J.
        Undivided rights: women of color organize for reproductive justice.
        Haymarket Books, Chicago2016
        • Loretta Ross
        Understanding Reproductive Justice: Transforming the Pro-Choice Movement.
        Off Our Backs. 2006; 36: 4
      5. Institute for Healthcare Improvement. Institute for Healthcare Improvement: The Breakthrough Series: IHI's Collaborative Model for Achieving Breakthrough Improvement n.d. 2020, http://www.ihi.org:80/resources/Pages/IHIWhitePapers/TheBreakthroughSeriesIHIsCollaborativeModelforAchievingBreakthroughImprovement.aspx (accessed August 23, 2018).

        • Higgins J.A.
        Celebration meets caution: LARC's boons, potential busts, and the benefits of a reproductive justice approach.
        Contraception. 2014; 89: 237-241
        • Langley G.J.
        • Moen R.D.
        • Nolan K.M.
        • Nolan T.W.
        • Norman C.L.
        • Provost L.P.
        The improvement guide: a practical approach to enhancing organizational performance.
        2nd ed. Jossey-Bass Publishers, San Francisco2009
        • Curtis K.M.
        U.S. Selected Practice Recommendations for Contraceptive Use.
        MMWR Recomm Rep. 2016; 65 (2016): 1-66
      6. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015 n.d. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm (accessed August 23, 2018).

      7. Office of Population Affairs. Performance Measures | HHS. gov n.d. https://www.hhs.gov/opa/performance-measures/index.html (accessed August 23, 2018).

        • Damschroder L.J.
        • Aron D.C.
        • Keith R.E.
        • Kirsh S.R.
        • Alexander J.A.
        • Lowery J.C.
        Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science.
        Implement Sci. 2009; 4: 50
        • Callegari L.S.
        • Aiken A.R.
        • Dehlendorf C.
        • Cason P.
        • Sonya B.
        Addressing potential pitfalls of reproductive life planning with patient-centered counseling.
        Am J Obstet Gynecol. 2017; 216: 2
        • Dehlendorf C.
        • Henderson J.T.
        • Fittinghoff E.
        • Steinauer J.
        • Hessler D.
        Development of a patient-reported measure of the interpersonal quality of family planning care.
        Contraception. 2018; 97: 34-40