Tessa Madden1, Rachel Paul2, Ragini Maddipati2, Christina Buckel2, Melody Goodman3, Jeffrey F Peipert4. 1. Division of Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, 4901 Forest Park Avenue, Mailstop: 8064-37-1005, St. Louis, MO 63108, USA. Electronic address: maddent@wustl.edu. 2. Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, 4901 Forest Park Avenue, Mailstop: 8064-37-1005, St. Louis, MO 63108, USA. 3. College of Global Public Health, New York University, 715 Broadway, 10th Floor, New York, NY 10003, USA. 4. Department of Obstetrics and Gynecology, 550 University Blvd, University Hospital 2440, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Abstract
OBJECTIVES: To compare unintended pregnancy rates at 12 months between women receiving structured contraceptive counseling plus usual contraceptive care and women receiving structured contraceptive counseling, healthcare provider education and cost support for long-acting reversible contraceptive (LARC) methods. STUDY DESIGN: Using a controlled time-trend study design, we first enrolled 502 women receiving structured contraceptive counseling in addition to usual care ("Enhanced Care") and subsequently enrolled 506 women receiving counseling plus healthcare provider education and cost support for LARC methods ("Complete CHOICE") at three federally qualified health centers (FQHCs). Cost support included funds to health centers for "on-the-shelf" LARC methods and no-cost LARC methods for uninsured women. Participants completed in-person baseline surveys and follow-up surveys by telephone at 3, 6 and 12 months. We used Kaplan-Meier survival function to estimate 12-month unintended pregnancy rates and Cox proportional-hazards regression to compare unintended pregnancy rates between the two groups. We imputed pregnancy outcomes for women lost to follow-up (9%) prior to 12 months. RESULTS: "Complete CHOICE" participants were less likely to report an unintended pregnancy at 12 months compared to "Enhanced Care"; 5.3 vs. 9.8 pregnancies per 100 women-years (p=.01). After adjusting for confounders (recruitment site, race, age and federal poverty level), women in "Complete CHOICE" had a 40% lower risk of unintended pregnancy at 12 months (adjusted hazard ratio 0.60; 95% confidence interval 0.37-0.99). CONCLUSIONS: Contraceptive provision that includes cost support and healthcare provider education in addition to patient counseling reduced unintended pregnancy at 12 months compared to counseling plus usual contraceptive care. IMPLICATIONS: A program of contraceptive care that includes comprehensive counseling; healthcare provider education; cost support; and on-the-shelf, long-acting reversible contraception can reduce unintended pregnancy compared to contraceptive counseling in addition to usual health center care in the FQHC setting.
OBJECTIVES: To compare unintended pregnancy rates at 12 months between women receiving structured contraceptive counseling plus usual contraceptive care and women receiving structured contraceptive counseling, healthcare provider education and cost support for long-acting reversible contraceptive (LARC) methods. STUDY DESIGN: Using a controlled time-trend study design, we first enrolled 502 women receiving structured contraceptive counseling in addition to usual care ("Enhanced Care") and subsequently enrolled 506 women receiving counseling plus healthcare provider education and cost support for LARC methods ("Complete CHOICE") at three federally qualified health centers (FQHCs). Cost support included funds to health centers for "on-the-shelf" LARC methods and no-cost LARC methods for uninsured women. Participants completed in-person baseline surveys and follow-up surveys by telephone at 3, 6 and 12 months. We used Kaplan-Meier survival function to estimate 12-month unintended pregnancy rates and Cox proportional-hazards regression to compare unintended pregnancy rates between the two groups. We imputed pregnancy outcomes for women lost to follow-up (9%) prior to 12 months. RESULTS: "Complete CHOICE" participants were less likely to report an unintended pregnancy at 12 months compared to "Enhanced Care"; 5.3 vs. 9.8 pregnancies per 100 women-years (p=.01). After adjusting for confounders (recruitment site, race, age and federal poverty level), women in "Complete CHOICE" had a 40% lower risk of unintended pregnancy at 12 months (adjusted hazard ratio 0.60; 95% confidence interval 0.37-0.99). CONCLUSIONS: Contraceptive provision that includes cost support and healthcare provider education in addition to patient counseling reduced unintended pregnancy at 12 months compared to counseling plus usual contraceptive care. IMPLICATIONS: A program of contraceptive care that includes comprehensive counseling; healthcare provider education; cost support; and on-the-shelf, long-acting reversible contraception can reduce unintended pregnancy compared to contraceptive counseling in addition to usual health center care in the FQHC setting.
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