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. 2018 Apr;108(4):550-556.
doi: 10.2105/AJPH.2017.304299. Epub 2018 Feb 22.

Contraceptive Method Use During the Community-Wide HER Salt Lake Contraceptive Initiative

Jessica N Sanders  1 , Kyl Myers  1 , Lori M Gawron  1 , Rebecca G Simmons  1 , David K Turok  1
Affiliations

Contraceptive Method Use During the Community-Wide HER Salt Lake Contraceptive Initiative

Jessica N Sanders et al. Am J Public Health. 2018 Apr.

Abstract

Objectives: To describe a community-wide contraception initiative and assess changes in method use when cost and access barriers are removed in an environment with client-centered counseling.

Methods: HER Salt Lake is a prospective cohort study occurring during three 6-month periods (September 2015 through March 2017) and nested in a quasiexperimental observational study. The sample was women aged 16 to 45 years receiving new contraceptive services at health centers in Salt Lake County, Utah. Following the control period, intervention 1 removed cost and ensured staffing and pharmacy stocking; intervention 2 introduced targeted electronic outreach. We used logistic regression and interrupted time series regression analyses to assess impact.

Results: New contraceptive services were provided to 4107 clients in the control period, 3995 in intervention 1, and 3407 in intervention 2. The odds of getting an intrauterine device or implant increased 1.6 times (95% confidence interval [CI] = 1.5, 1.6) during intervention 1 and 2.5 times (95% CI = 2.2, 2.8) during intervention 2, relative to the control period. Time series analysis demonstrated that participating health centers placed an additional 59 intrauterine devices and implants on average per month (95% CI = 13, 105) after intervention 1.

Conclusions: Removing client cost and increasing clinic capacity was associated with shifts in contraceptive method mix in an environment with client-centered counseling; targeted electronic outreach further augmented these results.

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Figures

FIGURE 1—
FIGURE 1—
Participant Flow Diagram: Community-Wide HER Salt Lake Contraceptive Initiative, Salt Lake City, UT, January 2014—March 2017 Note. DNQ = did not qualify; EMR = electronic medical record; IUD = intrauterine device; PPAU = Planned Parenthood Association of Utah.
FIGURE 2—
FIGURE 2—
Contraceptive Method Distribution in All Planned Parenthood Association of Utah Health Centers: HER Salt Lake Contraceptive Initiative, Salt Lake City, UT, January 2014—March 2017 Note. DMPA = depot medroxyprogesterone acetate; IUD = intrauterine device; LARC = long-acting reversible contraception; PPR = pills, patches, and rings.
FIGURE 3—
FIGURE 3—
Intrauterine Device (IUD) and Implant Uptake at HER Participating and Non-HER Participating Health Centers, Seasonally Adjusted: HER Salt Lake Contraceptive Initiative, Salt Lake City, UT, January 2014—March 2017
See this image and copyright information in PMC

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