A qualitative study of clinicians' perspectives on a law that allows for a 12-month supply of short-acting contraceptives in Massachusetts: Barriers and facilitators to implementation.

OBJECTIVE: To explore clinicians' perspectives regarding the Massachusetts 2017 law, 'An Act Relative to Advancing Contraceptive Coverage and Economic Security in Our State' (ACCESS), including awareness of the law, perceived barriers and facilitators to successful implementation, and recommendations to improve uptake. ACCESS requires all insurers, except self-insured businesses, to cover short-acting reversible contraceptives (SARCs) at no cost to patients and for a 12-month supply to be prescribed/dispensed if desired after the completion of a three-month trial. DATA SOURCES AND STUDY SETTING: We collected primary data from clinicians in Massachusetts from February 1 to July 31, 2021. STUDY DESIGN: Semi-structured interviews of a purposeful sample of Massachusetts clinicians who provide primary and/or women's health care were conducted via Zoom. DATA COLLECTION/EXTRACTION METHODS: Interview guide and codebook were created using the Theoretical Domains Framework. Interviews were analyzed using framework analysis, including deductive and inductive approaches. Major themes and subthemes were organized by a four-level model of the health care system: patient, care team (clinician), organization, and environment. PRINCIPAL FINDINGS: Most (58.1%) of the 31 participants were not aware of the law. Perceived advantages of this law included decreasing burden on patients, unnecessary clinical visits, and administrative burden on staff for refill requests. Perceived disadvantages focused on concerns that patients would lose their medications or devices (patient-level) and decreased clinician contact with patients (provider-level). Perceived organization- and environmental-level barriers to implementation included lack of electronic medical record (EMR) prescription defaults and insurance coverage issues. Many felt EMR modifications and more training for clinicians and pharmacists could lead to a change in practice. CONCLUSION: Our study identifies potentially modifiable barriers to the implementation of the ACCESS law. Massachusetts clinicians' lack of awareness of the law demonstrates the need for statewide education, which may allow more eligible patients to obtain a 12-month SARC supply.

Online survey of consumer awareness and perceptions of a Massachusetts law for 12-month supply of contraception.

OBJECTIVES: This study aimed to characterize awareness of a 2017 Massachusetts (MA) law that ensures access to a 12-month supply of short-acting contraceptive methods (e.g., pill, patch, and vaginal ring) among short-acting contraceptive users in MA and to identify perceived benefits and concerns of a 12-month supply. STUDY DESIGN: An online survey was administered to a Qualtrics panel of MA women who were using short-acting contraceptive methods and were insured by an eligible health plan. The survey's primary outcome was general awareness of the law; interest in, receipt of, and perceived benefits and risks of a 12-month supply were also elicited. Analysis included descriptive statistics and bivariate and multivariable analyses examining factors associated with awareness of the law. RESULTS: Among the 207 survey respondents, 76% were aware of the law, and 93% expressed interest in receiving a 12-month supply of a short-acting method; however, only 9% received it. Respondents identified as White (66%), privately insured (59%), and pill users (44%). Concerns about a 12-month supply included privacy, product expiration, and change in personal medical status. Perceived benefits included avoiding multiple trips to pharmacy and increased compliance. Multivariable analyses showed general awareness of the law was only associated with employer-based insurance, with those respondents having 75% lower odds of being aware of the law than respondents with Medicaid coverage. CONCLUSION: Although a high percentage of women surveyed were aware of the law and most were interested in receiving a 12-month supply of their short-acting method, the low percentage who have received a 12-month supply suggests barriers to policy uptake. IMPLICATIONS: This study describes perceptions of the 12-month supply provision of the contraception Act Advancing Contraceptive Coverage and Economic Security in our State law. Addressing consumer concerns may be important to improve the implementation and dissemination of this state policy change.

Informing Policy Change: A Study of Rapid Repeat Pregnancy in Adolescents to Increase Access to Immediate Postpartum Contraception.

Background: Rapid repeat pregnancy (RRP) is common among adolescents and is associated with adverse maternal and infant outcomes. Despite evidence that use of long-acting forms of contraception before hospital discharge can help minimize RRP rates, barriers to placement existed within the state of Indiana. We sought to determine state-specific RRP and induced abortion rates for adolescents based on chosen postpartum contraception to inform policy change. Methods: We examined a retrospective cohort of 227 adolescents (ages 12-18 years) who gave birth in Indiana between 2010 and 2012. Demographics, postpartum contraception, and subsequent pregnancies or abortions after the sentinel delivery were obtained. Rates of RRP based on type of immediate postpartum contraception, etonogestrel (ENG) contraceptive implant, depo-medroxyprogesterone acetate (DMPA) injection, and short-acting methods were compared. Bivariate and logistic regression analyses were conducted. Results: RRP rates were 3.7% for those with ENG contraceptive implant, 22.6% for those with DMPA, and 39.1% for those who choose short-acting methods (p = 0.01). Adolescents who did not choose an ENG contraceptive implant were significantly more likely to have an RRP (adjusted odds ratio [aOR] = 11.8, 95% confidence interval: 2.74-110.3), compared with other contraceptive methods, even after adjusting for covariates such as age, prior pregnancies, and postpartum visit attendance. Conclusions: Immediate postpartum receipt of ENG implant was significantly associated with a lower likelihood of RRP in adolescents in Indiana. These data facilitated state policy change regarding insurance reimbursement to improve statewide access for all women, regardless of age, showing how local data can inform policy change.