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Implementing Immediate Postpartum Long-Acting Reversible Contraception Programs

Hofler, Lisa G., MD, MPH, MBA; Cordes, Sarah, MPH; Cwiak, Carrie A., MD, MPH; Goedken, Peggy, MPH; Jamieson, Denise J., MD, MPH; Kottke, Melissa, MD, MPH, MBA

doi: 10.1097/AOG.0000000000001798
Contents: Clinical Practice and Quality

OBJECTIVE: To understand the most important steps required to implement immediate postpartum long-acting reversible contraception (LARC) programs in different Georgia hospitals and the barriers to implementing such a program.

METHODS: This was a qualitative study. We interviewed 32 key personnel from 10 Georgia hospitals working to establish immediate postpartum LARC programs. Data were analyzed using directed qualitative content analysis principles. We used the Stages of Implementation to organize participant-identified key steps for immediate postpartum LARC into an implementation guide. We compared this guide to hospitals' implementation experiences.

RESULTS: At the completion of the study, LARC was available for immediate postpartum placement at 7 of 10 study hospitals. Participants identified common themes for the implementation experience: team member identification and ongoing communication, payer preparedness challenges, interdependent department-specific tasks, and piloting with continuing improvements. Participants expressed a need for anticipatory guidance throughout the process. Key first steps to immediate postpartum LARC program implementation were identifying project champions, creating an implementation team that included all relevant departments, obtaining financial reassurance, and ensuring hospital administration awareness of the project. Potential barriers included lack of knowledge about immediate postpartum LARC, financial concerns, and competing clinical and administrative priorities. Hospitals that were successful at implementing immediate postpartum LARC programs did so by prioritizing clear communication and multidisciplinary teamwork. Although the implementation guide reflects a comprehensive assessment of the steps to implementing immediate postpartum LARC programs, not all hospitals required every step to succeed.

CONCLUSION: Hospital teams report that implementing immediate postpartum LARC programs involves multiple departments and a number of important steps to consider. A stage-based approach to implementation, and a standardized guide detailing these steps, may provide the necessary structure for the complex process of implementing immediate postpartum LARC programs in the hospital setting.

Hospital teams report that implementing immediate postpartum long-acting reversible contraception programs involves multiple hospital departments and a number of steps to consider.

Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.

Corresponding author: Lisa G. Hofler, MD, MPH, MBA, Department of Obstetrics and Gynecology, University of New Mexico, 1 University of New Mexico, MSC10 5580, Albuquerque, NM 87131; email:

Supported by a grant from the Society of Family Planning Research Fund.

Financial Disclosure Dr. Cwiak has received research funding for an intrauterine device clinical trial from Medicines 360 and has served as a faculty trainer on Nexplanon for Merck. Dr. Kottke has served as a faculty trainer on Nexplanon for Merck, has served as a consultant for CSL Behring, and has served on the advisory board for Evofem, Inc. The other authors did not report any potential conflicts of interest.

Presented at the 2016 North American Forum on Family Planning, November 4–7, 2016, Denver, Colorado.

The authors thank Sandra Naoom, PhD, MSPH, from the National Implementation Research Network, University of North Carolina, Chapel Hill, for her assistance with topic development for this study.

The Society of Family Planning Research Fund had no involvement in the study design; data collection, interpretation, or analysis; writing of the report; or the decision to submit for publication.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2016 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.