Research Evaluates Long-acting Reversible Contraceptives in Medicaid Patients

Young woman sitting with doctor

A MedStar research study has found that in 15- to 44-year-old women who receive Medicaid, both implantable long-acting reversible contraceptives and intrauterine devices had high continuation rates and low complication rates after one year of use.

“Continuation of long-acting reversible contraceptives among Medicaid patients” was a retrospective study recently published in Contraception. The research team was Max Romano, MD; Patryce A. Toye, MD; and Loral Patchen, PhD, MSN, MA, CNM. This collaborative research was conducted and supported by researchers at MedStar Franklin Square Medical Center, MedStar Washington Hospital Center, MedStar Family Choice, and MedStar Health Research Institute. 

Unintended pregnancy is a major health concern in the United States despite increasing availability of effective contraception. The goal of this research was to compare continuation rates of different types of long-acting reversible contraceptives based on insurance claims data within the MedStar Family Choice Medicaid program in Maryland and Washington, DC. 

The cohort of 3103 women from ages 15 to 44 received long-acting reversible contraceptives between 2012 and 2015, including 1335 subdermal drug-eluting implants and 1970 intrauterine devices (IUDs). The research found that in young women (age 15 to 19), there was a higher rate of implant over IUD usage.

The analysis found that there was a higher continuation of use for those who received implants as compared to IUDs. Continuation rates were not significantly different for implants versus IUDs among subjects 15 to 19 years old. Patients 20 to 24 years old using either implants or IUDs had lower continuation rates than younger and older subjects in the first year of use. “This may be due to higher rates of early discontinuation for desired pregnancy, to greater sensitivity to adverse side effects, or to other unique characteristics of this age group,” said the study authors.

Both contraception options had low rates of claims for complications, with no statistically significant difference between the two types. The researchers also noted that most providers who inserted the long-action contraceptives were obstetricians, gynecologists, and midwives (2412 out of the 3305 cases).

Future studies on this topic can address the noted selection bias. The study noted that they found “clear differences among provider specialties and LARC use, which may suggest differences in patient populations as well as in patterns of care.” This study was also limited to a specific population of one Medicaid plan, however, one strength was that all care interactions that resulted in claims were part of the data set, regardless of the medical institution that the patient visited.

“I believe this research represents the exceptional collaborative opportunity in our integrated academic health system,” said Loral Patchen, PhD, MSN, MA, CNM, who is vice chair of Obstetrics and Gynecology and executive director of the Teen Alliance for Prepared Parenting (TAPP) Program at MedStar Washington Hospital Center.

This research was included in the Advancing Health Report as part of the “Resident and Fellows Raise the Bar” section. This research was also presented at the 6th MedStar Health Research Symposium on May 1, 2017, and placed third for resident submissions in the post-graduate years 1-3 category.

This work was financially supported by MedStar Family Choice, a Medicaid managed care organization operating in Maryland and Washington, DC. The funder supplied insurance claims data for the project and provided oversight for the analysis, interpretation, and writing of the final manuscript.

Contraception, 2018. DOI: 10.1016/j.contraception.2018.04.012