Aim For the Bullseye: Presented on for the NC Child Fatality Task Force LARC and Pregnancy Prevention in NC
2 What is LARC?
3 L=Long A=Acting R=Reversible C=Contraception
4 Learning Objectives Describe NC and national LARC trends Learn best practice LARC counseling Identify barriers to LARC use in NC
5 Which birth control methods are LARC?
6 Intrauterine Device (IUD) ParaGard Mirena Skyla Liletta
7 Implant Implanon Nexplanon
8 What s the big deal about LARC?
9 What s the big deal about LARC? Most effective methods
10 What s the big deal about LARC? Most effective methods Women use them longer
11 What s the big deal about LARC? Most effective methods Women use them longer Women more satisfied
12 Who can use LARC?
13 Who can use LARC? Most women are medically eligible to use LARC, including: Teens Postpartum moms before they leave the hospital
14 Who can use LARC?: Teens ACOG Committee Opinion, 2012: With top-tier effectiveness, high rates of satisfaction and continuation, and no need for daily adherence, LARC methods should be first-line recommendations for all women and adolescents http://www.acog.org/~/media/committee%20opinions/commit tee%20on%20adolescent%20health%20care/co539.pdf
15 Who can use LARC?: Teens AAP Recommendation, 2014: the first-line contraceptive choice for adolescents who choose not to be abstinent is a Long Acting Reversible Contraceptive (LARC), which is an intrauterine device or a subdermal implant. The past decade has demonstrated that LARCs, which provide 3 to 10 years of contraception, are safe for adolescents. https://www.aap.org/en-us/about-the-aap/aap-press- room/pages/aap-updates-recommendations-on-teen- Pregnancy-Prevention.aspx
16 Who is using LARC in NC? Current Trends
Percentage who use method 17 LARC at NC local health departments ALL AGES 9 8 7 6 5 4 3 2 1 0 8.2 7.2 6.7 7 6.8 6.2 5.7 4.7 4 3.6 3.1 3.3 3.2 2.3 1.4 1 1.1 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 IUD Implant HIS, FP 066 Report, FY2007 to FY 2015
Percentage who use method 18 LARC at NC local health departments TEENS 7 6 5 5.6 5 6.4 4 3 2 3.8 2.8 2.8 2.9 2.3 2.3 IUD Implant 1 0 2011 2012 2013 2014 2015 HIS, FP 066 Report, FY2011 to FY 2015
19 Peak Year of NC LARC use Fiscal Year 2012, ALL AGES 13.1 8.2 3.1 24.4 31.7 IUD Implant Pills Injection Condoms Percentage who use method HIS, FP 066 Report, FY2012
20 Peak Year of NC LARC use Fiscal Year 2015, TEENS 7.1 2.3 6.4 25 24 IUD Implant Pills Injection Condoms Percentage who use method HIS, FP 066 Report, FY2015
21 Who is Using LARC Nationally? US Trends
22 Methods US Women use All ages http://www.cdc.gov/nchs/data/databriefs/db173.pdf
Counseling + Methods Available = LARC use http://www.choiceproject.wustl.edu/~/media/fil es/choiceproject/study-findings-20120917.ashx
24 How do we teach/counsel patients on LARC?
25 Counseling: Step by Step Providing Quality Family Planning Services (QFP) From Page 8, http://www.cdc.gov/mmwr/pdf/rr/rr6304.pdf
26 Counseling: Reproductive Life Plan Providing Quality Family Planning Services (QFP) From Page 7: http://www.cdc.gov/mmwr/pdf/rr/rr6304.pdf
27 Counseling: Tiered Approach http://www.cdc.gov/reproductivehealth/unintendedpregnancy/pdf/family-planning-methods-2014.pdf
28 LARC barriers and solutions in NC
29 LARC in NC Barrier Some providers hesitant to provide LARC, especially to teens Solution Provider education from other providers, clinic staff, national guidelines
30 LARC in NC Barrier Providers not always using best practice approach to counseling Solution Education and practice with best practice counseling: Interactive approach Reproductive life planning Tiered counseling
31 LARC in NC Barrier Financial barriers to offering same-day LARC insertion Solution Encourage clinics to have LARC in stock and offer same-day insertion when appropriate Secure stable funding for clinics to purchase LARCs
32 LARC in NC Barrier Lack of funding for all patients who desire to use LARC Solution Encourage Be Smart enrollment when patients eligible Clinics can seek grant opportunities Maternal Child Health Initiative, Infant Mortality Reduction
33 LARC in NC Barrier Medicaid reimbursement challenges, especially for immediate postpartum LARC Solution Collaborate with other states who have resolved this issue, including SC Support current work on this issue by NC DMA and Hospital Association
34 Thank you for your time! Presented by: Questions? Debbie Farb, RN, BSN, MPH, IBCLC Family Planning Nurse Consultant Women s Heath Branch 919-707-5719 debbie.farb@dhhs.nc.gov