Long-Acting Reversible ContraceptionChad Rodgers, MD, FAAP

Vice President and Chief Medical OfficerAFMC

Objectives

• Problem of teen pregnancy in the United States

• Importance of LARC to reduce teen pregnancy

• Description of LARC options

• Highlight educational materials for patients and providers

• AFMC’s project and outreach

• Impact of intervention

• Troubleshoot barriers

Medicaid Outreach Quality Improvement Project 2015-2016

Long-Acting and Reversible Contraception (LARC)• Increase awareness of the safety and reliability• Increase education and awareness to reduce

unplanned pregnancies

National data unplanned pregnancy • 6.6 million pregnancies per year in the United States

• 3.4 million are unintended

• Majority are adolescent and young women who have an increased risk of poor health outcomes for mothers and their babieso Delayed access to prenatal careo Higher risk for preterm birtho Decreased spacing between births

• Preventing and/or lowering unintended pregnancy can affect the present and future wellbeing of teens and families, while also contributing to the economic health of our state

Percent change in the birth rate for females 15-19 years old from 2007-2014

Arkansas

• In 2013, there were 613,330 women of reproductive age (aged 13–44) in Arkansas, 321,220 of whom were in need of contraceptive services and supplies

• 44,590 were in need of publicly supported services because they were sexually active teenagers

• 155,620 had incomes below 250% of the federal poverty level

• In 2012–2013, 28% of women aged 15–44 in Arkansas were uninsured, while 17% were enrolled in Medicaid

Birth Rates 15-19 years 2010-2014

Arkansas: Unintended pregnancy 2012-2013

Teen pregnancy

Arkansas: Highest teen birth rate in the nation

• 40 births per 1,000 teens (2014)

o 76 births per 1,000 girls ages 18-19

o 16 births per 1,000 for girls ages 15-17

Nationwide rate

• 24 births per 1,000 (2014)

o 44 births per 1000 girls ages 18-19

o 11 births per 1000 girls ages 15-17

Cost of teen pregnancy

• Public cost: $9.4 billion in 2010o $2 billion health care costs (mostly MCD)

o $3 billion child welfare costs

o $2 billion in incarceration

• AR costs: $3.3 billion (2010)o Medicaid paid average $12,770 for teen birth

o Average cost of contraception $239

Lifetime impact

Increased risk for teen and their children• Perpetuates the cycle of poverty • Education interrupted

o40% earn a high school education by age 22oOnly 2% finish college by age 30

• Poor healthoAnemia, preterm birth, low-weight babies, higher infant

mortality, increased risk for STIsoPhysical abuse, alcohol and tobacco use

• Behavioral problems and developmental delays

Long-acting reversible contraception (LARC)

• Recommended as the first choice for birth control o American Academy of Family Physicians (AAFP)

o American Academy of Pediatrics (AAP)

o American College of Obstetricians and Gynecologists (ACOG)

• 6.6 million pregnancies per year in the United States

• 3.4 million are unintended

• Majority are adolescent and young women who have an increased risk of poor health outcomes for mothers and their babieso Delayed access to prenatal careo Higher risk for preterm birtho Decreased spacing between births

• Preventing and/or lowering unintended pregnancy can affect the present and future wellbeing of teens and families, while also contributing to the economic health of our state

Long-acting reversible contraception (LARC)

Dispelling myths

• IUDs do not cause …o Infertility

o PID

o Ectopic pregnancy

Contraceptive options

Continuation rates after 1 year

The CHOICE Project

Impact

Women with unintended pregnancies

The CHOICE Project

LARC options

• Subdermal implanto Etonogesterel

• Intrauterine device

o Coppero Levonorgestrel

Medicaid Outreach Quality Improvement Project

• Outreach efforts focused on two- and four-year colleges and university health clinics and Federal Qualified Health Centers

• Educational tools and materials: flip chart, brochure, white board video, uterine model, implant model, IUD models provided for all focus groups

• Educational programs for primary care, MDs, ODs, OBGyns, APNs, PAs to increase awareness of LARC methods to decrease unintended pregnancies and preterm birth through proper spacing

Long-acting reversible contraception (LARC)

Lowering unintended pregnancy rates requires a multifaceted approach from the community, state and local government, pediatricians, health care providers, school-based clinics, local health clinics, universities and colleges

LARC flip chart

LARC booklet

White board video

www.afmc.org/LARC

Arkansas Department of Higher Education

www.youractionplanAR.com

LARC project reach

• ## Academic detailing and LARC tool kits

• ## Physicians and NPs trained on implants

• ## Private practice academic detailing

• ## Hits to AFMC LARC website

• ## Orders of LARC materials/tools

• ## Views of LARC video

Barriers

• Lack of awareness about the effectiveness and safety

• Lack of provider knowledge and training

• Up-front costs

• Inadequate insurance reimbursement

• Inability to offer same-day insertion

• Billing and coding issues

Finding solutions

• Efforts to reduce barrierso Payment issues

o Availability of devices in Health Department and other health care settings

• AFMC outreach specialisto Notify your AFMC representative of any issues

Thank you for your attention!

Questions?