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Six- and twelve-month documented removal rates among women electing postpartum inpatient compared to delayed or interval contraceptive implant insertions after Medicaid payment reform.
- Source :
-
Contraception [Contraception] 2017 Jan; Vol. 95 (1), pp. 71-76. Date of Electronic Publication: 2016 Jul 08. - Publication Year :
- 2017
-
Abstract
- Objective: This study aims to document 6- and 12-month removal rates for women receiving the contraceptive implant inpatient postpartum versus those receiving the same contraceptive method during an outpatient visit, in a setting where postpartum inpatient long-acting reversible contraceptive (LARC) services (devices plus provider insertion costs) are reimbursed by Medicaid.<br />Study Design: We conducted a retrospective cohort study among Medicaid-enrolled women using medical record review for all women receiving the etonogestrel implant between July 1, 2007 and June 30, 2014. We compared the percentage of women with the implant removed at 6 and 12 months as well as reasons for early removal, for inpatient postpartum implant insertions vs. delayed postpartum or interval outpatient implant insertions.<br />Results: A total of 4% of women (34/776 insertions) had documented implant removal within 6 months post-insertion, with no difference between postpartum inpatient and outpatient (delayed postpartum or interval). A total of 12% (62/518 insertions) of women had documented implant removal within 12 months. A lower percentage of women with postpartum inpatient insertions had the implant removed at 12 months post-insertion, compared to outpatient insertions (7% vs. 14%, p=.04). After controlling for age, parity, race and body mass index, women with postpartum inpatient insertions were less likely to have the implant removed within 12 months (OR=0.44, 95% CI 0.20-0.97). The most commonly stated reason for removal was abnormal uterine bleeding, regardless of insertion timing.<br />Conclusion: In a setting with a Medicaid policy that covers postpartum inpatient LARC insertion, a low percentage of women who received an implant immediately postpartum had it removed within 1 year of insertion.<br />Implications: A Medicaid payment policy that removes institutional barriers to offering postpartum inpatient contraceptive implants to women free-of-charge may facilitate meeting women's desires and intentions to delay subsequent pregnancy, as evidenced by low removal rates up to 12 months post-insertion. Further research with women is needed to assess how these services meet their postpartum contraceptive needs and desires to postpone or prevent subsequent pregnancy.<br /> (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Subjects :
- Adolescent
Adult
Contraceptive Agents, Female administration & dosage
Cost Savings
Desogestrel administration & dosage
Female
Hospitals, Teaching
Humans
Logistic Models
Personal Satisfaction
Postpartum Period
Retrospective Studies
South Carolina
Time Factors
United States
Young Adult
Device Removal statistics & numerical data
Inpatients
Intrauterine Devices economics
Medicaid
Outpatients
Subjects
Details
- Language :
- English
- ISSN :
- 1879-0518
- Volume :
- 95
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Contraception
- Publication Type :
- Academic Journal
- Accession number :
- 27400823
- Full Text :
- https://doi.org/10.1016/j.contraception.2016.07.004