Medicaid and receipt of interval postpartum long-acting reversible contraception
Medicaid and receipt of interval postpartum long-acting reversible contraception
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DOI：
10.1016/j.contraception.2018.08.017
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发表时间：
2019-01-01
期刊：
影响因子：
2.9
通讯作者：
Arora, Kavita Shah
中科院分区：
文献类型：
--
作者：
Wilkinson, Barbara;Ascha, Mustafa;Arora, Kavita Shah
目的：我们试图评估保险类型的影响，收到一个间隔产后LARC，控制人口和临床factors.Study设计：这是一个回顾性队列研究的1072名妇女与记录计划的LARC避孕产后出院时。这是对2012年1月1日至2014年12月31日期间在俄亥俄州的一家城市教学医院分娩20周或以上的8654名妇女的二次分析。LARC接收分娩后90天内，接收时间，并在未接收后的后续怀孕率进行了比较的妇女与医疗补助和私人保险的妇女。胎盘后LARC是不可用的研究完成时。结果：187 822医疗保险和43 131个私人保险的妇女接受了LARC产后（22.7%比32.8%，P= 0.02）。在多变量分析中，私人保险状况与LARC接收无显著相关性（OR 1.29，95% C.I. 0.83-1.99），但产前护理充足（OR 2.33，95% C.I. 1.42-4.00）。妇女谁想要，但没有收到LARC，208 635（32.8%）医疗补助患者和19 88（21.6%）私人保险的患者在1年内怀孕（P= 0.02）。结论：在收到间隔产后[ARC]的差异不显着的妇女与医疗补助保险与私人保险调整后的临床和人口因素。充足的产前护理与LARC接收相关。医疗补助的病人谁没有收到LARC更有可能成为怀孕的一年内分娩比那些与私人insurance.Implications：虽然保险相关的障碍已经减少了最近的政策变化，获得护理仍然是产后LARC提供和随后的意外怀孕的一个重要决定因素。(C)2018爱思唯尔公司All rights reserved.
Objective: We sought to evaluate the impact of insurance type on receipt of an interval postpartum LARC, controlling for demographic and clinical factors.Study design: This is a retrospective cohort study of 1072 women with a documented plan of LARC for contraception at time of postpartum discharge. This is a secondary analysis of 8654 women who delivered at 20 weeks or beyond from January 1, 2012, through December 31, 2014, at an urban teaching hospital in Ohio. LARC receipt within 90 days of delivery, time to receipt, and rate of subsequent pregnancy after non-receipt were compared between women with Medicaid and women with private insurance. Postplacental LARC was not available at the time of study completion.Results: One hundred eighty-seven of 822 Medicaid-insured and 43 of 131 privately insured women received a LARC postpartum (22.7% vs 32.8%, P=.02). In multivariable analysis, private insurance status was not significantly associated with LARC receipt (OR 1.29, 95% C.I. 0.83-1.99) though adequate prenatal care was (OR 2.33, 95% C.I. 1.42-4.00). Of women who wanted but did not receive a LARC, 208 of 635 (32.8%) Medicaid patients and 19 of 88 (21.6%) privately insured patients became pregnant within 1 year (P=.02).Conclusion: Differences in receipt of interval postpartum [ARC were not significant between women with Medicaid insurance versus private insurance after adjusting for clinical and demographic factors. Adequate prenatal care was associated with LARC receipt. Medicaid patients who did not receive a LARC were more likely to become pregnant within one year of delivery than those with private insurance.Implications: While insurance-related barriers have been reduced given recent policy changes, access to care remains an important determinant of postpartum LARC provision and subsequent unintended pregnancy. (C) 2018 Elsevier Inc. All rights reserved.