TY - JOUR
T1 - Comparison of unintended pregnancy at 12 months between two contraceptive care programs; a controlled time-trend design
AU - Madden, T.
AU - Paul, Rachel
AU - Maddipati, Ragini
AU - Buckel, Christina
AU - Goodman, Melody
AU - Peipert, Jeffrey F.
N1 - Funding Information:
This research was supported by (1) the Patient Centered Outcomes Research Institute (PCORI, grant number CD12114586 ) and (2) the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD, grant number K23HD070979 ). The funders had no role in the study design; collection, analysis and interpretation of data; writing of the report; or the decision to submit the article for publication. The contents are solely the responsibility of the authors and do not necessarily represent the official view of PCORI or the NICHD.
Funding Information:
We would like to thank Kathleen Payne and Sydney Ashby for their tremendous support of this research study and for their contributions to the management of the study at the participating health centers. This research was supported by (1) the Patient Centered Outcomes Research Institute (PCORI, grant number CD12114586) and (2) the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD, grant number K23HD070979). The funders had no role in the study design; collection, analysis and interpretation of data; writing of the report; or the decision to submit the article for publication. The contents are solely the responsibility of the authors and do not necessarily represent the official view of PCORI or the NICHD. Dr. Madden serves on a data safety monitoring board for phase 4 safety studies of Bayer contraceptive products. Dr. Peipert receives research funding from Bayer Healthcare Pharmaceuticals, CooperSurgical/TEVA and Merck & Co, Inc. and serves on an advisory board for CooperSurgical Pharmaceuticals and Bayer Healthcare Pharmaceuticals. The other authors do not have any potential conflicts of interest to report.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/9
Y1 - 2019/9
N2 - Objectives: To compare unintended pregnancy rates at 12 months between women receiving structured contraceptive counseling plus usual contraceptive care and women receiving structured contraceptive counseling, healthcare provider education and cost support for long-acting reversible contraceptive (LARC) methods. Study design: Using a controlled time-trend study design, we first enrolled 502 women receiving structured contraceptive counseling in addition to usual care (“Enhanced Care”) and subsequently enrolled 506 women receiving counseling plus healthcare provider education and cost support for LARC methods (“Complete CHOICE”) at three federally qualified health centers (FQHCs). Cost support included funds to health centers for “on-the-shelf” LARC methods and no-cost LARC methods for uninsured women. Participants completed in-person baseline surveys and follow-up surveys by telephone at 3, 6 and 12 months. We used Kaplan–Meier survival function to estimate 12-month unintended pregnancy rates and Cox proportional-hazards regression to compare unintended pregnancy rates between the two groups. We imputed pregnancy outcomes for women lost to follow-up (9%) prior to 12 months. Results: “Complete CHOICE” participants were less likely to report an unintended pregnancy at 12 months compared to “Enhanced Care”; 5.3 vs. 9.8 pregnancies per 100 women-years (p=.01). After adjusting for confounders (recruitment site, race, age and federal poverty level), women in “Complete CHOICE” had a 40% lower risk of unintended pregnancy at 12 months (adjusted hazard ratio 0.60; 95% confidence interval 0.37–0.99). Conclusions: Contraceptive provision that includes cost support and healthcare provider education in addition to patient counseling reduced unintended pregnancy at 12 months compared to counseling plus usual contraceptive care. Implications: A program of contraceptive care that includes comprehensive counseling; healthcare provider education; cost support; and on-the-shelf, long-acting reversible contraception can reduce unintended pregnancy compared to contraceptive counseling in addition to usual health center care in the FQHC setting.
AB - Objectives: To compare unintended pregnancy rates at 12 months between women receiving structured contraceptive counseling plus usual contraceptive care and women receiving structured contraceptive counseling, healthcare provider education and cost support for long-acting reversible contraceptive (LARC) methods. Study design: Using a controlled time-trend study design, we first enrolled 502 women receiving structured contraceptive counseling in addition to usual care (“Enhanced Care”) and subsequently enrolled 506 women receiving counseling plus healthcare provider education and cost support for LARC methods (“Complete CHOICE”) at three federally qualified health centers (FQHCs). Cost support included funds to health centers for “on-the-shelf” LARC methods and no-cost LARC methods for uninsured women. Participants completed in-person baseline surveys and follow-up surveys by telephone at 3, 6 and 12 months. We used Kaplan–Meier survival function to estimate 12-month unintended pregnancy rates and Cox proportional-hazards regression to compare unintended pregnancy rates between the two groups. We imputed pregnancy outcomes for women lost to follow-up (9%) prior to 12 months. Results: “Complete CHOICE” participants were less likely to report an unintended pregnancy at 12 months compared to “Enhanced Care”; 5.3 vs. 9.8 pregnancies per 100 women-years (p=.01). After adjusting for confounders (recruitment site, race, age and federal poverty level), women in “Complete CHOICE” had a 40% lower risk of unintended pregnancy at 12 months (adjusted hazard ratio 0.60; 95% confidence interval 0.37–0.99). Conclusions: Contraceptive provision that includes cost support and healthcare provider education in addition to patient counseling reduced unintended pregnancy at 12 months compared to counseling plus usual contraceptive care. Implications: A program of contraceptive care that includes comprehensive counseling; healthcare provider education; cost support; and on-the-shelf, long-acting reversible contraception can reduce unintended pregnancy compared to contraceptive counseling in addition to usual health center care in the FQHC setting.
KW - Contraceptive counseling
KW - Contraceptive implant
KW - Intrauterine device
KW - Long-acting reversible contraception
KW - Unintended pregnancy
UR - http://www.scopus.com/inward/record.url?scp=85067426464&partnerID=8YFLogxK
U2 - 10.1016/j.contraception.2019.05.009
DO - 10.1016/j.contraception.2019.05.009
M3 - Article
C2 - 31132346
AN - SCOPUS:85067426464
SN - 0010-7824
VL - 100
SP - 196
EP - 201
JO - Contraception
JF - Contraception
IS - 3
ER -