Increasing Accessibility to Long-Acting Reversible Contraception in a Public Health Setting

Abstract

ObjectiveTo increase access to long-acting reversible contraception (LARC) by developing and implementing evidence-based criteria for LARC insertions at a public health clinic. DesignA quality improvement pilot project aimed at improving access to LARC for women of reproductive age and decrease associated costs. Setting/Local ProblemEligibility criteria for LARC at a public health clinic in rural Georgia required two clinic visits and unnecessary screening tests for women interested in these methods. These criteria limited eligibility of candidates who desired LARC, increased time between requests for and insertion of LARC, and increased costs. ParticipantsFifteen women of reproductive age who were uninsured or underinsured had a LARC inserted during project implementation. Intervention/MeasurementsThe average number of days between visits based on the old (2007) criteria was compared with the average number of days between visits after implementation of the new (2017) criteria, with specific focus on the number of same-day LARC insertions. A secondary analysis of cost savings was calculated. ResultsAfter implementation of the 2017 criteria, a statistically significant (p < .01) decrease in the mean number of days between request for and insertion of LARC was noted. Every woman who requested a LARC received it, and more than half of LARC insertions were provided the same day. Furthermore, the clinic noted savings of nearly $1,000 on LARC insertions. ConclusionThe wait time for LARC insertion substantially decreased, and more than half of women had a LARC inserted the same day they requested it. By decreasing the wait time between request for and insertion of a LARC and implementing a policy to advocate for same-day insertion, use of the 2017 criteria decreased women’s risk for unintended pregnancy.