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Acad Pediatr. 2019 Apr 6. pii: S1876-2859(18)30698-3. doi: 10.1016/j.acap.2019.03.009. [Epub ahead of print]

Implementation of Recommendations for Long-Acting Contraception Among Women Aged 13 to 18 Years in Primary Care.

Author information

1
Department of Medical Education (SM Arnold Rehring, JH Seidel, and JF Steiner); Department of Pediatrics (SM Arnold Rehring); Department of Pediatrics (SM Arnold Rehring).
2
Institute for Health Research (LM Reifler, KA Glenn, and JF Steiner), Kaiser Permanente Colorado.
3
Department of Medical Education (SM Arnold Rehring, JH Seidel, and JF Steiner); Department of Women's Health (JH Seidel), Colorado Permanente Medical Group.
4
Department of Medical Education (SM Arnold Rehring, JH Seidel, and JF Steiner); Institute for Health Research (LM Reifler, KA Glenn, and JF Steiner), Kaiser Permanente Colorado; Department of Medicine (JF Steiner), University of Colorado Anschutz Medical Campus, Aurora. Electronic address: john.f.steiner@kp.org.

Abstract

OBJECTIVE:

Clinical specialty societies recommend long-acting reversible contraceptives (LARCs) as first-line contraception for adolescent women. We evaluated whether a combined educational and process improvement intervention enhanced LARC placement in primary care within an integrated health care system.

METHODS:

The intervention included journal clubs, live continuing education, point-of-care guidelines, and new patient materials. We conducted a retrospective cohort study across 3 time periods: baseline (January 2013-September 2015), early implementation (October 2015-March 2016), and full implementation (April 2016-June 2017). The primary outcome was the proportion of LARCs placed by primary care clinicians among women aged 13 to 18 years compared with gynecology clinicians.

RESULTS:

Kaiser Foundation Health Plan of Colorado cared for approximately 20,000 women aged 13 to 18 years in each calendar quarter between 2013 and 2017. Overall, LARC placement increased from 7.0 per 1000 members per quarter at baseline to 13.0 per 1000 during the full intervention. Primary care clinicians placed 6.2% of all LARCs in 2013, increasing to 32.1% by 2017 (P < .001), including 45.5% of contraceptive implants. Clinicians who attended educational sessions were more likely to adopt LARCs than those who did not (17.9% vs 6.4% respectively, P = .009). Neither overall LARC placement rates (relative risk, 1.9; 95% confidence interval, 0.7-5.6) nor contraceptive implant rates (relative risk, 3.0; 95% confidence interval, 0.9-9.8) increased significantly in clinicians who attended educational activities.

CONCLUSIONS:

This multimodal intervention was associated with increased LARC placement for adolescent women in primary care. The combination of education and process improvement is a promising strategy to promote clinician behavior change.

KEYWORDS:

adolescence; continuing medical education; dissemination and implementation; long-acting contraception; women's health

PMID:
30959224
DOI:
10.1016/j.acap.2019.03.009

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