Use of A Standardized Education Tool to Increase Patient Selection of Highly Effective Contraception
Repository Posting Date2016-11-07T20:41:51Z
Author DetailsJulee Avram, DNP, RNC, WHNP-BC,; Denise G. Link, PhD, NP, FAAN, FAANP
Lead Author Sigma AffliationNon-member
Purpose: The purpose of this project was to increase patient acceptance of LARC through the use of a standardized educational tool that has been demonstrated to be effective in assisting women to make informed decisions when choosing from among the most reliable and effective contraception methods available to them.
Summary:The Centers for Disease Control and Prevention recommend that all women use highly effective contraceptive methods, such as LARC to reduce unintended pregnancy. Research has demonstrated that standardized approaches to counseling are the most effective at increasing LARC use. In a small, private OB-GYN practice with one physician and two women's health nurse practitioners, contraception counseling was not standardized and the selection of LARC was low among clients enrolled in the state Medicaid health insurance program. Providers and staff participated in a one hour in-service that included information about LARC and the benefits of standardized patient education for contraception. Patients of the practice that were enrolled in the state Medicaid health insurance program and expressed interest in changing or initiating contraception were invited to participate in the project. After obtaining consent, the participants were counseled about contraceptive methods using a standardized script tested in the Contraceptive CHOICE project. Chart reviews were completed, comparing patients' contraceptive choices pre and post intervention
Outcomes: In the EBP project, 80% of participants chose LARC - a key comparison point with the CHOICE study where 75% chose LARC. Ethnicity was similar between the 2 studies. EBP project participants were older than CHOICE participants and were > 50% more likely to be parous. Frequency of LARC uptake in pre and post-intervention chart reviews was analyzed and compared between those patients on AHCCCS, (Arizona's Medicaid program) who received contraceptive counseling and chose LARC using the standardized education script with those patients on other insurance plans to identify any biases that could have impacted our data, such as the total number of patient visits or percentage of patients on AHCCCS that visited the clinic before and during the study time frame. The pre- and post- intervention groups were comparable so we don't believe that selection bias or patient visit volume impacted the project outcomes.
Implications for Women's Health: Unintended pregnancy is associated with adverse effects for women and children. Increasing the use of highly effective contraceptives such as LARC is recommended for women as the most effective means of reducing unintended pregnancies. Offering women complete and accurate information about the most effective and reliable contraceptive methods is a critical first step to assisting women to carry out their reproductive life plans. Nurse Practitioners who provide primary care and women's health care to women of childbearing age may find standardized contraception education tools helpful when collaborating with patients to help them make the best choices for themselves and their families.