A systematic comparison of implementation strategies at three U.S. clinic settings that expanded access to self-administered injectable contraception

Abstract

Objectives: To describe experiences and systematically compare three U.S. clinics that initiated or expanded access to depot medroxyprogesterone acetate-subcutaneous (DMPA-SC) for self-administration during the COVID-19 pandemic.

Study design: We used the Expert Recommendations for Implementing Change (ERIC) framework to systematically compare three case studies of implementation projects that expanded use of self-administered DMPA-SC in the United States during the COVID-19 pandemic.

Results: All three settings used multiple implementation strategies and common strategies fell into five main categories including (1) increasing provider awareness about self-administration of DMPA-SC and continuing education for clinical staff, (2) providing patient education and counseling tailored to patients' needs, (3) supporting changes in clinic workflow, (4) addressing insurance coverage and payment, and (5) reducing barriers to filling prescriptions for self-administered DMPA-SC. Ongoing implementation challenges identified include mitigating additional payment barriers for DMPA-SC and increasing access points beyond physical clinical sites.

Conclusion: The implementation strategies described in this study may be generalizable to other settings and help U.S.-based clinics and health care providers meet current recommendations for ensuring access to self-administration of DMPA-SC.

Implications: Three sites that successfully expanded access to self-administration in the U.S. demonstrate the importance of the following implementation strategies: (1) increasing provider awareness about self-administration of DMPA-SC and continuing education for clinical staff, (2) providing patient education and counseling tailored to patient's needs, (3) supporting changes in clinic workflows, (4) addressing insurance coverage and payment, and (5) reducing barriers to filling prescriptions for self-administered DMPA-SC.

Keywords: Contraceptive agents; Implementation strategies; Medroxyprogesterone acetate; Patient-centered care; Self-administration.