Visits to Registered Nurses: An Opportunity to Increase Contraceptive Access in California.

BACKGROUND: In 2013, California passed Assembly Bill (A.B.) 2348, approving registered nurses (RNs) to dispense patient self-administered hormonal contraceptives and administer injections of hormonal contraceptives. The Family Planning, Access, Care and Treatment (Family PACT) program, which came into effect in 1997 to expand low-income, uninsured California resident access to contraceptives at no cost, is one program in which qualified RNs can dispense and administer contraceptives. AIMS: The aims of this study were to (a) describe utilization of RN visits within California's Family PACT program and (b) evaluate the impact of RN visits on client birth control acquisition during the first 18 months after implementation of A.B. 2348 (January 1, 2013 to June 30, 2014). METHODS: A descriptive observational design using administrative databases was used. Family PACT claims were retrieved for RN visits and contraception. Paid claims for contraceptive dispensing and/or administration visits by physicians, nurse practitioners, certified nurse midwives, and physician assistants were compared before and after the implementation of A.B. 2348 at practice sites where RN visits were and were not utilized. Contraceptive methods and administration procedures were identified using Healthcare Common Procedure Coding System codes, National Drug Codes, and Common Procedural Terminology codes. Claims data for healthcare facilities were abstracted by site location based on a unique combination of National Provider Identifier (NPI), NPI Owner, and NPI location number. RESULTS: RN visits were found mainly in Northern California and the Central Valley (73%). Sixty-eight percent of RN visits resulted in same-day dispensing and/or administration of hormonal (and/or barrier) methods. Since benefit implementation, RN visits resulted in a 10% increase in access to birth control dispensing and/or administration visits. RN visits were also associated with future birth control acquisition and other healthcare utilization within the subsequent 30 days. DISCUSSION: RN visits, though underutilized across the state, have resulted in increased access to contraception in some communities, an effect that may continue to grow with time and can serve as a model for other states.

In a California program, quality and utilization reports on reproductive health services spurred providers to change.

The use of performance indicators has the potential to improve service quality and avert costs, yet such indicators have typically not been used to assess family planning and reproductive health services. An exception is California's Family PACT (Planning, Access, Care, and Treatment) Program, a statewide family planning and reproductive health services program. Our study assessed whether the behavior of providers participating in this program was influenced by performance reports that used both quality improvement and utilization management indicators. We examined three indicators in each category from 2005 to 2009 and found that change occurred in five of six indicators among private providers and in three of six indicators among public providers. Chlamydia screening rates in women age twenty-five and younger, for example, increased significantly among both private and public providers. Despite the challenges enumerated in this article, we conclude that the methodology used in the program could serve as a starting point for the development of a uniform set of provider-focused reproductive health quality and utilization reports that could be instituted by state family planning programs, state Medicaid programs and health plans, and other health care delivery systems.