142nd APHA Annual Meeting and Exposition

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307892
Forewarned is forearmed: The impact of side effect counseling on contraceptive implant continuation at 18 months

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

Carrie Lewis, MPH , Bixby Center for Global Reproductive Health, University of California, San Francisco, Sacramento, CA
Leslie A. Watts, MS , Bixby Center for Global Reproductive Health, University of California, San Francisco, Sacramento, CA
Philip Darney, MD, MSc , Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA
Heike Thiel de Bocanegra, PhD, MPH , Assistant Professor and Director, UCSF Family PACT Evaluation, University of California, San Francisco, Sacramento, CA
The contraceptive implant is a highly cost-effective method that lasts up to 3 years.  Change in menstrual bleeding is the most commonly reported reason for early discontinuation.  We conducted a medical record review of 332 records of clients receiving an implant through Family PACT, California’s Medicaid-funded family planning program, to explore the provision and content of counseling at the implant insertion visit.  Using administrative claims, we searched for evidence of discontinuation after insertion.  We conducted chi-square tests to explore the impact of client demographics, provider characteristics, and insertion visit factors on continuation at 18 months.

By 18 months, 37% of the sample had evidence of discontinuation, for an implant continuation rate of 63%.  Prior to implant placement, 43% of women were using a user-dependent hormonal method, and 38% were using condoms.  Family PACT advises providers to counsel on the characteristic bleeding patterns associated with implant prior to insertion.  The majority of insertion visits (81%) included chart documentation that method–related education and counseling were provided, however only 38% noted detail on the specific implant-related topics discussed.

Of the provider and client characteristics we examined, only prior method was significantly related to continuation at 18 months (x2 = 7.67, p=0.02). Documented receipt of counseling on bleeding patterns was significantly related to continuation (x2 = 7.46, p=0.006) and a trend toward higher continuation among women receiving counseling on systemic hormonal side effects (x2 = 2.19, p=0.13) was observed. We will present the results of logistic regression analyses controlling for covariates.

Learning Areas:

Administer health education strategies, interventions and programs
Assessment of individual and community needs for health education
Conduct evaluation related to programs, research, and other areas of practice
Planning of health education strategies, interventions, and programs
Provision of health care to the public

Learning Objectives:
Identify the education and counseling topics addressed at the insertion visit that are most strongly associated with implant continuation at 18 months. Describe the relationship between prior contraceptive method and implant continuation at 18 months. List three benefits and challenges of using medical records and administrative data to explore counseling during a visit and long term outcomes such as contraceptive continuation.

Keyword(s): Contraception, Family Planning

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked in the field of women's health for over 15 years, focusing on the evaluation of programs and interventions -- most recently as Senior Researcher and Evaluation Manager on the Bixby Center's evaluation of California's Family PACT Program. Among my interests are the impact of provider training on provision of LARC methods, health care reform and women’s access to family planning services, and methods for measuring long-term outcomes of public health programs.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.