The University of Tennessee Medical Center is helping women obtain better access to long-term family planning protocols, particularly immediately postpartum.
Nikki Zite, MD, Professor and Obstetrics and Gynecology Residency Program Director, has been awarded a grant from the National Institute of Reproductive Health to help women gain better access to long-acting reversible contraception (LARC). Dr. Zite is collaborating with Vanderbilt University Medical Center in Nashville, Tennessee, and SisterReach, a Reproductive Justice organization, in Memphis, Tennessee, on a multi-phase project known as “LARC Access and Infrastructure in Tennessee: Building a sustainable culture of patient-centered immediate postpartum LARC through collaboration, education, and dissemination.”
Common types of LARC currently available at the medical center include Nexplanon, a contraceptive implant placed in the arm and effective for 3 years; hormonal intrauterine devices (IUDs) such as Liletta and Mirena and effective for 5 years; and non-hormonal IUDs such as ParaGard, a copper IUD effective for 10 years.
While these contraceptives are available in the U.S., access to them has been a challenge both for women in low-income families and women of higher socio-economic status on private health insurance. In the absence of insurance coverage for LARC, out-of-pocket expenses include the cost of the device ($800-$1,000), insertion fees, and then when desired, removal costs. Total costs without insurance or with plans that exclude LARC can reach thousands of dollars.
Dr. Zite says there have been many policy change “wins” in Tennessee for Tenncare and CoverKids recipients in terms of contraceptive access over the last few years. However, policy change alone does not result in increased LARC access, particularly immediately postpartum (IPP), which is a convenient time to have contraceptive needs met, and these policy changes do not improve access for all women.
“While academic centers like UT Medical Center and Vanderbilt have been able to implement changes in order to offer IPP LARC relatively quickly for some women, we need champions across the entire state at the provider, pharmacy, nursing, billing, and electronic health record levels to improve access for more women,” Dr. Zite said.
To assist hospitals in developing protocols to offer IPP LARC, Dr. Zite said they are creating a tool-kit with examples of barriers in implementing LARC that hospitals have experienced and overcome to act as guidance.Dr. Zite said, “The current focus of the project is to overcome billing and cost barriers for all women. Another priority is to emphasize patient-centered counseling in order to help women fully understand the pros and cons of IPP LARC, and how and where to have the device removed if they desire to do so.”
Pictured: Dr. Nikki Zite (middle) teaches Obstetrics and Gynecology residents about Mirena, a long-acting reversible contraception.
Posted February 11, 2019
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