Incorporating Long-acting Reversible Contraception Into Primary Care: A Training and Practice Innovation

Abstract

As the Affordable Care Act (ACA) reduces cost sharing as a barrier to long-acting reversible contraceptive (LARC) use (Becker & Polsky, 2015), attention has turned to other barriers that limit LARC’s availability to patients (Weisman & Chuang, 2014). Two key barriers are the limited availability of on-site LARC services at primary care clinics, and inadequate numbers of providers trained in LARC insertion and removal, particularly among non–obstetrician-gynecologists. The importance of expanding the number of providers and facilities offering LARC is widely recognized by women’s and adolescent health experts (Harper, et al., 2013; Lunde, et al., 2014; Potter, Koyama, & Coles, 2015). However, LARC provision in the context of primary care by non–obstetrician-gynecologists has received less attention, despite the Institute ofMedicine’s emphasis that contraception is an essential preventive service for women (Committee on Preventive Services for Women, 2011). As the ACA improves access to primary care, including for younger patients, expanding LARC’s availability in primary care settings is of critical importance (Pace, Cohen & Schwarz, 2011). Across specialties, many outpatient primary care practices do not offer LARC and require patients seeking LARC to be referred elsewhere (Beeson et al., 2014; Centers for Disease Control and Prevention, 2011). In 2011, only 56% of office-based obstetricians/gynecologists, family practitioners, and adolescent medicine specialists offered on-site IUDs; only 32% offered implants (Centers for Disease Control and Prevention, 2011). Although we are not aware of published estimates, on-site availability of LARC