Implementation of Immediate Postpartum Long Acting Reversible Contraception Programs in Hospitals across Georgia, United States of America: A Qualitative Study Öffentlichkeit

Abstract

Objective: To understand how hospitals implement steps to offer Long Acting Reversible Contraception (LARC) devices in the immediate postpartum period within the state of Georgia and identify barriers to and facilitators of immediate postpartum LARC implementation programs.

Methods: We conducted focus group discussions with 8 immediate postpartum LARC hospital implementation teams across the state of Georgia. Grounded theory principles were applied to data collection and analysis. We used the Immediate Postpartum LARC Implementation Guide stage-based approach developed by Hofler (2017) to understand hospital execution of implementation steps and validated it.

Results: The study demonstrated that implementation of immediate postpartum LARC programs is cyclical and requires multidisciplinary coordination to execute individual steps. Hospital immediate postpartum LARC implementation teams identified four essential themes for successful implementation and sustainability of immediate postpartum LARC programs: (1) early multidisciplinary buy-in and establishment of a hospital implementation team; (2) continuous training of key stakeholders including the hospital implementation team and patient education; (3) payer preparedness for sustaining and expanding LARC programs; establishment of a functional reimbursement system and monitoring of the implementation process; (4) engaging stakeholders beyond the hospital. Hospital implementation teams feedback also revealed key areas for improvement of Georgia's Immediate Postpartum LARC toolkit. Recommendations for the revision of the toolkit were made to reflect these findings including identified anticipated barriers.

Conclusion: Application of our findings in the revision of the toolkit will allow us to: improve anticipatory guidance provided to states, hospitals considering implementation and sustainability of their programs. A holistic framework may facilitate sustainability of immediate postpartum LARC programs by analyzing the interaction of the enabling environment, supply side, and demand side of each stage in the implementation process.

Table of Contents

TABLE OF CONTENTS

CHAPTER 1: INTRODUCTION …………………………………………………………......1

Introduction and Rationale …………………………………………………………………....1

Problem Statement ……………………………………………………………………………..9

Purpose Statement …………………………………………………………………………….10

Significance Statement ………………………………………………………………………..11

Definition of Terms ……………………………………………………………………………12

Acronyms……………………………………………………………………………………….13

CHPATER 2: LITERATURE REVIEW……………………………………………………..15

Barriers ………………………………………………………………………………………...16

Facilitators ……………………………………………………………………………………..18

CHAPTER 3: METHODS …………………………………………………………………....26

CHAPTER 4: RESULTS ……………………………………………………………………...32

Study Population……………………………………………………………………………….32

Stages of Implementation……………………………………………………………………...34

Exploration Stage ……………………………………………………………………………………….34

Installation Stage………………………………………………………………………………………….37

Implementation and Sustainability Stage……………………………………………………………44

Other Findings……………………………………………………………………………….....49

Application of Results - Recommendations for Revision of Georgia's Immediate

Postpartum Long Acting Reversible Contraception (LARC) Toolkit………………………51

CHAPTER 5: DISCUSSION AND CONCLUSION…………………………………………55

Stages of Implementation………………………………………………………………………57

Exploration Stage………………………………………………………………………………..57

Installation Stage………………………………………………………………………………...59

Implementation and Sustainability Stage ……………………………………………………....61

Limitations……………………………………………………………………………………….67

Strengths………………………………………………………………………………………....67

Conclusion…………………………………………………………………………………….....69

CHAPTER 6: POLICY IMPLICATIONS/ RECOMMENDATIONS ……………………...70

REFERENCES …………………………………………………………………………………72

APPENDIX …………………………………………………………………………………......75

Appendix I: Implementation of Immediate Postpartum LARC in Georgia Presentation

and Focus Group Discussion Guide …………………………………………………………...75

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Stichwort	Georgia Postpartum IPPLARC Reimbursement Immediate Postpartum Long Acting Reversible Contraception LARC
Committee Chair / Thesis Advisor	Winskell Enger, Kate, Emory University
Committee Members	Kottke, Melissa, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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