RESUMO
OBJECTIVES: We sought to determine the association between intrapartum severe maternal morbidity and receipt of postpartum contraception within 60 days among Medicaid recipients in Oregon and South Carolina. STUDY DESIGN: We conducted a historical cohort study of all Medicaid births in Oregon and South Carolina from 2011 to April 2018. Intrapartum severe maternal morbidity was measured using diagnosis and procedure codes according to the Center for Disease Control's classifications. Our primary outcome of interest was receipt of postpartum contraception within 60 days of birth. We captured permanent and reversible forms of contraception. We examined the association of intrapartum severe maternal morbidity with receipt of postpartum contraception, and whether this varied by type of Medicaid (Traditional vs Emergency). We used Poisson regression models with robust (sandwich) estimation of variance to calculate relative risk (RR) for each model. RESULTS: Our analytic cohort included 347,032 births. We identified 3079 births with evidence of intrapartum severe maternal morbidity (0.9% of all births). When adjusted for maternal age, rural vs urban status, and state of residence, Medicaid beneficiaries with births complicated by intrapartum severe maternal morbidity are 7% less likely to receive any contraception (RR 0.93, 95% CI (0.91, 0.95)) by 60 days postpartum. Among births complicated by severe maternal morbidity we found that Emergency Medicaid recipients were 92% less likely than Traditional Medicaid recipients to receive any method of contraception (RR 0.08, 95% CI (0.08, 0.08)). CONCLUSIONS: Medicaid recipients experiencing intrapartum severe maternal morbidity are less likely to receive contraception within 60 days than Medicaid beneficiaries with uncomplicated births. IMPLICATIONS: Medicaid recipients with intrapartum severe maternal morbidity are less likely to receive postpartum contraception, than Medicaid beneficiaries without severe maternal morbidity.
RESUMO
BACKGROUND: Tumor treating fields (TTF) harness magnetic fields to induce apoptosis in targeted regions. A 2015 landmark randomized phase III trial of newly diagnosed glioblastoma (GBM) patients demonstrated TTF + temozolomide to be superior to temozolomide alone. Given these results, we sought to assess practice patterns of providers in TTF utilization for GBM. METHODS: A survey was administered to practices in the United States self-identifying as specializing in radiation oncology, medical oncology, neuro-oncology, neurosurgery, and/or neurology. Responses were collected anonymously; analysis was performed using Fisher's exact test. RESULTS: A total of 106 providers responded; a minority (36%) were in private practice. Regarding case volume, 82% treated at least six high-grade gliomas/year. The provider most commonly certified to offer TTF therapy to GBM patients was the neuro-oncologist (40%), followed by the radiation oncologist (34%); 31% reported no TTF-certified physician in their practice. TTF users were more likely to have high volume, and be aware of TTF inclusion in National Comprehensive Cancer Network (NCCN) guidelines (p < 0.05). CONCLUSIONS: More than 80% of TTF for GBM in the United States is performed by groups who treat at least six high-grade gliomas per year; unfortunately more than 30% were in practices bereft of anyone certified to offer TTF therapy. These results indicate that there remains fertile soil for TTF therapy nationwide to be introduced into practices for GBM treatment. Providers seeking to refer newly diagnosed GBM patients for TTF should seek out practices with TTF user-associated characteristics to ensure optimal access for their patients.