Implementation of Recommendations for Long-Acting Contraception among Women Aged 13-18 in Primary Care

ABSTRACT Objectives Clinical specialty societies recommend long-acting reversible contraceptives (LARC) as first-line contraception for adolescent women. We evaluated whether a combined educational and process improvement intervention enhanced LARC placement in primary care within an integrated health care system. Methods The intervention included journal clubs, live continuing education, point-of-care guidelines and new patient materials. We conducted a retrospective cohort study across three time periods: baseline (January 2013 - September 2015), early implementation (October 2015 – March 2016) and full implementation (April 2016 – June 2017). The primary outcome was the proportion of LARCs placed by primary care clinicians among women aged 13-18, compared to gynecology clinicians. Results KPCO cared for approximately 20,000 women aged 13-18 in each calendar quarter between 2013-2017. Overall, LARC placement increased from 7.0 per 1000 members per quarter at baseline to 13.0 per 1000 during the full intervention. Primary care clinicians placed 6.2% of all LARCs in 2013, increasing to 32.1% by 2017 (p Conclusions This multi-modal intervention was associated with increased LARC placement for adolescent women in primary care. The combination of education and process improvement is a promising strategy to promote clinician behavior change.