Improving postpartum contraceptive uptake A targeted prenatal counseling

Improving postpartum contraceptive uptake: A targeted prenatal counseling intervention to facilitate resident-patient shared decision-making Liza 1 Straub , Christina 1 Cronk , 1 Orrey , 2 Evans , 2 Newton , 2 Farahi , Danielle Kelly Lacy Kim Narges 1 School of Medicine, University of North Carolina at Chapel Hill 2 Department of Family Medicine, University of North Carolina at Chapel Hill Jodi 2 Roque Table 3: Patient survey results Background: Half of all pregnancies in the United States and North Carolina are unintended [1]. Women may be more receptive to changing their contraceptive method during the prenatal period and place increased importance on reliability and ease of use [2]. Studies demonstrate that women have higher rates of satisfaction and continuation using long-acting reversible contraception (LARC) [3]. The purpose of this project is to evaluate if targeted prenatal contraceptive counseling with the use of written, visual, and tactile aids improves postpartum uptake, particularly of LARC, as well as resident-patient shared decision-making. Question Average Pre-counseling Post-counseling P-value (n=15) How much do you know about contraception in general? (1=None to 4=A lot) How much do you know about IUDs? (1=None to 4=A lot) How much do you know about implants (such as Nexplanon)? (1= None to 4=A lot) Initial Results: 2. 98 3. 25 0. 30 2. 60 3. 18 0. 04 1. 79 2. 97 0. 001 Tyler Warmack Table 1: Summary of postpartum contraceptive uptake PP Visit? Yes Study Methods: References: 1. Holliday, Joe L. , MD, MPH. "Expanding Medicaid Income Eligibility for Family Planning: An Opportunity to Improve Reproductive Outcomes and Lower Medicaid Costs. " North Carolina Medical Journal 65. 3 (2004): 170 -72. Print. 2. Cwiak, C. , T. Gellasch, and M. Zieman. "Peripartum Contraceptive Attitudes and Practices. " Contraception 70. 5 (2004): 383 -86. Print. 3. Peipert, Jeffrey F. , et al. "Continuation and satisfaction of reversible contraception. " Obstetrics and gynecology 117. 5 (2011): 1105. Percent Intervention* (n=6) 83. 3 Contraception used Control (n=69) Intervention* (n=5) 40. 0 IUD 20. 3 40. 0 Implant 15. 9 BTL 4. 3 Vasectomy 7. 2 20. 0 Vaginal Ring 1. 4 Patch 0. 0 COC 8. 7 Mini-pill 4. 3 Depo 13. 0 Condoms 13. 0 Rhythm *Note: The intervention group data is 2. 9 still being collected Undecided/None 8. 7 Tyler Warmack • Residents counseled patients at 30 to 36 weeks using a contraceptive basket containing samples of Nexplanon , Mirena , Para. Gard , and Nuva. Ring ; written materials; and a diagram of a uterus with an IUD. • Patients completed surveys before and after counseling. • Residents completed pre- and post-study surveys. • At the 6 week postpartum visit, the type of contraception in place was recorded. • The intervention group was compared to a control group of women who delivered in the same time frame one year prior. Percent Control (n=84) 82. 1 Conclusions: *Note: Intervention group data are currently being collected. Table 2: Resident survey results Question How comfortable do you feel educating patients about contraception? (1=Uncomfortable to 4=Very comfortable) How much of an understanding do you feel patients have about LARC after counseling? (1=None to 4=A lot) How effective do you feel facilitating shared decision-making regarding contraception? (1= Not effective to 4=Very effective) Average Pre-study Post-study (n=6) (n=25) P-value 2. 96 3. 83 0. 04 3. 12 3. 67 0. 03 We expect to find that targeted contraceptive counseling during the prenatal period yields higher rates of uptake, particularly of LARC. Initial results indicate patients report significantly improved understanding of LARC after targeted counseling. Residents report significantly improved shared decision-making. Challenges facing this study include limited time during patient visits to participate. UNC Family Medicine Residency is seeking a residency training grant through get. LARC that would facilitate training and provide devices free of cost. If obtained, this study would provide a framework for contraceptive counseling. Acknowledgments: • UNC Family Medicine Residency Program • Photos by Danielle Orrey 2. 88 3. 67 Note: Only residents involved in the intervention completed the post-survey. 0. 04