Same-day long-acting reversible contraceptive (LARC) placement: a systematic review of the benefits and barriers in the United States
摘要
Increasing same-day placement rates of long-acting reversible contraceptives (LARCs) for individuals who are medically eligible and desire to do so is a key component of contraceptive access. The objective of this literature review was to characterize data on the effectiveness and economic impact of programs aimed at increasing same-day LARC placement in the United States (US).
MethodsA systematic literature review was conducted January 2023 to identify relevant literature from 2012 onwards using Medline, EMBASE, and CINAHL databases. Studies reporting rates of same-day LARC placement, economic benefits related to specific programs or policies, or factors affecting access to same-day LARC placement were included. Key recommendations, including actionable insights to improve access to same-day LARC, were summarized.
ResultsThirty-three publications, representing 31 unique studies investigating same-day LARC placement across 21 states were included. Seven studies evaluated outcomes pre- and post-implementation of programs for same-day LARC placement, and all reported an increase in the rate of same-day LARC placements post-program implementation. Two studies estimated cost savings (USD) associated with same-day LARC placement, one estimated savings of $2,117 per adolescent per year when compared to requiring a second visit, and the second estimated savings of approximately $80 million through an assumed statewide scale-up of the evaluated program. Actionable insights to promote same-day LARC placement included staff and provider training, streamlining pregnancy and screening requirements, increasing LARC availability, and providing financial assistance.
ConclusionsPrograms for increasing same-day LARC placement were associated with increases in same-day LARC uptake and cost savings.