Integration of contraceptive services into anticoagulation management services improves access to long-acting reversible contraception

  • Contraception, Volume 98, No. 6, Year 2018

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Study Justification:
– The study aimed to evaluate the impact of integrating contraceptive services into an anticoagulation management clinic in Eldoret, Kenya.
– This strategy was evaluated to determine its effectiveness in increasing access to long-acting reversible contraception (LARC) among women requiring anticoagulation.
– The study focused on a high-risk population of women with cardiovascular disease who needed anticoagulation.
Highlights:
– The study found that integrating contraceptive counseling and provision into the anticoagulation management clinic resulted in a significant increase in LARC use.
– Contraceptive implant use increased from 10% to 19%, and injectable contraceptive use increased from 14% to 24%.
– There was a decrease in the use of no method/abstinence from 57% to 39%.
– Factors such as younger age, having at least one child, and discussing family planning with a partner were predictive of LARC use.
Recommendations:
– The study recommends implementing similar models of care in other sites for chronic disease management.
– This model of care can effectively improve LARC and overall highly effective contraceptive use among women with cardiovascular disease requiring anticoagulation.
– Implementing this model may help prevent maternal morbidity and mortality in this high-risk population.
Key Role Players:
– Healthcare providers: Doctors, nurses, and other healthcare professionals involved in anticoagulation management and contraceptive counseling.
– Policy makers: Government officials and policymakers responsible for healthcare policies and funding.
– Community leaders: Individuals who can advocate for the integration of contraceptive services into existing healthcare systems.
– Non-governmental organizations (NGOs): Organizations that can provide support, resources, and funding for the implementation of integrated services.
Cost Items for Planning:
– Training: Budget for training healthcare providers on integrating contraceptive services into anticoagulation management.
– Equipment and supplies: Budget for necessary equipment and supplies for providing contraceptive counseling and provision.
– Outreach and awareness campaigns: Budget for promoting the integrated services to the target population and raising awareness about the benefits.
– Monitoring and evaluation: Budget for monitoring and evaluating the effectiveness of the integrated services and making necessary adjustments.
– Collaboration and coordination: Budget for facilitating collaboration and coordination between different healthcare providers and organizations involved in the implementation.

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Objective: Integration of services is a promising way to improve access to contraception in sub-Saharan Africa, but few studies have evaluated this strategy to increase access to contraception among women requiring anticoagulation. Our objective was to evaluate a model of care integrating contraceptive counseling and provision within an anticoagulation management clinic in Eldoret, Kenya, to determine the impact on long-acting reversible contraception (LARC) use. Study design: We performed a prospective observational study of reproductive-age women referred for integrated services from the anticoagulation management clinic at Moi Teaching and Referral Hospital from March 2015 to March 2016. All participants received disease-specific contraceptive counseling and provision, free reversible methods (excluding hormonal intrauterine devices [IUDs]) and follow-up care. We compared LARC use 3 months postintervention to preintervention using the proportions test. Logistic regression analysis was used to determine factors related to use of contraceptive implants and copper IUDs. Results: Of 190 participants, 171 (90%) completed 3-month follow-up. There was a significant increase in contraceptive implant use from 10% to 19%, p=.02, and injectable contraceptive use from 14% to 24%, p=.013. There was a concomitant decrease in the use of no method/abstinence from 57% to 39% (33% decrease, p<.001). Younger age, having at least one child and discussing family planning with a partner were predictive of LARC use. Conclusion: Integrating contraceptive services into an anticoagulation management clinic increases the use of highly effective contraception for women with cardiovascular disease. Implementation of similar models of care should be evaluated within other sites for chronic disease management. Implications: A model of care integrating contraceptive counseling and provision into anticoagulation management services is an effective strategy to improve LARC and overall highly effective contraceptive use among women with cardiovascular disease requiring anticoagulation. This model of care may be utilized to prevent maternal morbidity and mortality among this high-risk population.

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The recommendation to improve access to maternal health is to integrate contraceptive services into anticoagulation management services. This recommendation was evaluated through a prospective observational study conducted in Eldoret, Kenya. The study aimed to determine the impact of integrating contraceptive counseling and provision within an anticoagulation management clinic on the use of long-acting reversible contraception (LARC).

The study found that integrating contraceptive services into the anticoagulation management clinic led to a significant increase in the use of contraceptive implants and injectable contraceptives. The use of no method/abstinence decreased as a result. Factors such as younger age, having at least one child, and discussing family planning with a partner were found to be predictive of LARC use.

The conclusion of the study suggests that integrating contraceptive services into anticoagulation management clinics is an effective strategy to improve LARC and overall highly effective contraceptive use among women with cardiovascular disease requiring anticoagulation. This model of care has the potential to prevent maternal morbidity and mortality in this high-risk population.

The publication where this recommendation was published is titled “Integration of contraceptive services into anticoagulation management services improves access to long-acting reversible contraception” and was published in the journal Contraception in 2018.
AI Innovations Description
The recommendation to improve access to maternal health is the integration of contraceptive services into anticoagulation management services. This recommendation was evaluated through a prospective observational study conducted in Eldoret, Kenya. The study aimed to determine the impact of integrating contraceptive counseling and provision within an anticoagulation management clinic on the use of long-acting reversible contraception (LARC).

The study found that integrating contraceptive services into the anticoagulation management clinic led to a significant increase in the use of contraceptive implants and injectable contraceptives. The use of no method/abstinence decreased as a result. Factors such as younger age, having at least one child, and discussing family planning with a partner were found to be predictive of LARC use.

The conclusion of the study suggests that integrating contraceptive services into anticoagulation management clinics is an effective strategy to improve LARC and overall highly effective contraceptive use among women with cardiovascular disease requiring anticoagulation. This model of care has the potential to prevent maternal morbidity and mortality in this high-risk population.

The publication where this recommendation was published is titled “Integration of contraceptive services into anticoagulation management services improves access to long-acting reversible contraception” and was published in the journal Contraception in 2018.
AI Innovations Methodology
To simulate the impact of integrating contraceptive services into anticoagulation management services on improving access to maternal health, you could consider the following methodology:

1. Study Population: Select a representative sample of women with cardiovascular disease requiring anticoagulation who are seeking contraceptive services in a similar setting as Eldoret, Kenya.

2. Intervention Group: Implement the integrated model of care, where contraceptive counseling and provision are integrated into the anticoagulation management clinic. Ensure that all participants receive disease-specific contraceptive counseling and provision, including free reversible methods (excluding hormonal intrauterine devices [IUDs]), and follow-up care.

3. Control Group: Establish a control group receiving standard care without the integration of contraceptive services into the anticoagulation management clinic. This group should receive standard contraceptive counseling and access to contraceptive methods through separate services.

4. Data Collection: Collect data on the use of long-acting reversible contraception (LARC) and other contraceptive methods at baseline (pre-intervention) and at a specified follow-up period (e.g., 3 months post-intervention). Also, collect demographic information and factors related to contraceptive use, such as age, parity, and discussions about family planning with a partner.

5. Analysis: Compare the proportion of LARC use in the intervention group before and after the integration of contraceptive services using a proportions test. Additionally, use logistic regression analysis to identify factors associated with the use of contraceptive implants and copper IUDs.

6. Ethical Considerations: Ensure that the study adheres to ethical guidelines, including obtaining informed consent from participants, protecting their privacy and confidentiality, and ensuring the study does not harm the participants.

7. Interpretation: Analyze the results to determine the impact of integrating contraceptive services into anticoagulation management services on improving access to maternal health. Assess the significance of the increase in LARC use and the decrease in the use of no method/abstinence. Consider the factors associated with LARC use to understand the predictors of successful integration.

By following this methodology, you can simulate the impact of integrating contraceptive services into anticoagulation management services on improving access to maternal health. This will provide valuable insights into the effectiveness of this model of care and its potential to prevent maternal morbidity and mortality in high-risk populations.

Statistics:
Citations: 6
Authors: 7
Identifiers:
DOI: 10.1016/j.contraception.2018.07.139
ISSN: 00107824
Research Areas:
Community Interventions, Health System and Policy, Maternal and Child Health, Noncommunicable Diseases, Quality of Care, Sexual and Reproductive Health
Study Countries:
Kenya
Study Design:
Cohort Study, Cross Sectional Study
Study Approach:
Quantitative
Participants Gender:
Female
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