Day of Learning: Current Best Practices for Contraceptive Provision

Transcription

1 Day of Learning: Current Best Practices for Contraceptive Provision

2 Thank you to our Sponsors Carnegie Science Center Jewish Healthcare Foundation Allegheny Health Network s Center for Inclusion Health CWRHI Adagio Health Bayer Merck Cooper Surgical

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4 Mission To expand access to high quality reproductive health services and optimize reproductive health outcomes for all individuals in Western Pennsylvania

5 Barriers to contraceptive access Contraception coverage: ACA/Obamacare Grandfathered plans Religious exemptions AHCA/Trumpcare Access: Medically accurate education/information Trained providers in accessible locations Faith-based organizations (1 in 6 hospitals in US) Federal sterilization consent Postpartum tubal ligation Reimbursement model: Postpartum LARC: global fee vs separate fee Placement at time of any visit Value-based care (provider incentives)

6 How RBC can help: Educational workshops Sharing resources Creating networks for professional development Mentorships Industry Relationships (education, pharmaceutical) Research Legal Assistance

7 Disclosure of significant relationships with relevant commercial companies: The speakers listed below have indicated that neither they, nor any member of their immediate family, have an actual or potential conflict of interest in relation to the content of this program: Sonya Borrero, MD, MS Eric Lantzman, MD The speakers listed below have reported an actual or potential conflict of interest in relation to the content of this program:

8 Contraception 101 Eric Lantzman, MD Co-Director of Division of Family Planning Allegheny Health Network

9 Outline How does contraception work? What are all the FDA approved options? What is LARC? Who is a candidate for contraception?

10 How does contraception work? Estrogen stops pituitary from producing FSH/LH Sterilization closes the fallopian tubes Progestin prevents ovulation Progestin and copper prevents sperm from reaching egg Progestin, condoms & diaphragm prevent sperm from entering the cervix

11 More interaction with healthcare system Placeholder for Eric s slides Less (no) interaction with healthcare system

12 Why Options Matter Bridget, 25 Long term OCP user No pharmacy near home, misses refills frequently due to work and childcare obligations Physician requires annual pelvic exam before refilling for next year Carlene, 31 Desires post-partum tubal ligation Told by 2 doctors that she should get an IUD instead Informed at final prenatal visit that she can t schedule procedure due to Medicaidspecific, time-dependent consent requirements Anna, 27 Graduate student at Notre Dame University Uses condoms but is worried about failure rate, wants an IUD Student insurance won t cover IUD can t afford $900 out of pocket Hyeon-Ju, 31 Has migraine w/aura, can t use COC Important to have a regular period, doesn t want LARC Uses withdrawal with longterm partner; accepts risk of pregnancy and would seek abortion if it occurs Lives in rural Texas

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14 Types of IUDs

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16 MISSION: To remove the financial barriers to contraception, promote the most effective methods of birth control, and reduce unintended pregnancy in the St. Louis area. CHOICE Project: Enrollment August Sept 2011 Enrolled 9,256 women Diverse age, education and race Choice of any form of FDA approved contraception at no cost >40% >40%

17 LARC is 10-20x more effective!!!

18 Colorado Family Planning Initiative

19 CDC Medical Eligibility Criteria Evidence based recommendations of contraceptive choices for women Provides inclusion/exclusion criteria for various medical conditions Rank:

20 Medical Eligibility Criteria Includes: Combined hormonal contraception (CHC): pills, injectables, patch, ring Progestin only: pills (POP), injectables, implants IUC: Cu-IUD, LNG-IUD Barrier methods Fertility awareness-based methods Lactational amenorrhea method Sterilization Timing: initiation (I) continuation (C)

21 MEC Summary Chart edpregnancy/pdf/legal_summary%20chart_englis h_final_tag508.pdf

22 MEC:

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24 Thank You Any Questions??? Take home items: Who: MEC What: Bedsider Chart When: Quickstart Algorithm