Same-Day Access to Full Range of Contraceptive Methods
Clinical Service Goal
Low or no-cost contraception, provided with same-day access in accordance with medical eligibility and practice recommendations, reduces barriers often faced by adolescents. This includes improving access to intrauterine devices and implants, also known as long-acting reversible contraception (LARC). It is critical to use a patient-centered approach to support reproductive autonomy and health equity.
Strategies
Implementation Tips
Design policies to be consistent with CDC Contraceptive Guidance for Health Care Providers and to reinforce practices that minimize barriers to the full range of contraceptive methods for the adolescent patient, including
- Most contraceptive methods can be started on the same day if desired by the adolescent patient and if reasonably certain that the patient is not pregnant
- Follow recommendations for exams and tests needed for contraceptive method initiation. (Few, if any exams are needed before providing contraception.*)
- Stock and offer a broad range of methods so that the needs of individual adolescent patients can be met. (Optimally, all methods are available onsite to be able to provide same-day access but strong referrals can serve to make methods accessible when having all methods available onsite is not possible.)
- Recognize that LARC methods (intrauterine devices [IUDs] and implants) are safe contraceptive options for adolescents
- Provide or prescribe emergency contraception to adolescent patients for future use
- Provide or prescribe a 1-year supply of oral contraceptives
- Provide condoms onsite, available for free or at low-cost
- Offer contraception at every visit regardless of reason for visit (e.g., urgent, preventive, sports physical) to prevent missed opportunities
Tools & Resources
Sample policy that establishes that same-visit initiation of contraception should be available and in accordance with current standards of care; language can be adapted to fit health center needs
LARC-specific Resources
Checklist to assess an organization’s current LARC policies
IUD policy and procedure for clinical use
Progestin implant policy and procedure for clinical use
Implementation Tips
- Look to community-based organizations, academic institutions, and professional organizations for training opportunities
- Consider factors such as travel logistics and care team member schedules when determining if trainings should be on-site, off-site, online, or virtual
- Select trainings that include content on CDC Contraceptive Guidance for Health Care Providers (U.S. Medical Eligibility Criteria for Contraceptive Use, U.S. Selected Practice Recommendations for Contraceptive Use, Quality Family Planning)
Tools & Resources
Set of presentations covering the US Medical Eligibility Criteria for Contraceptive Use, 2016 and US Selected Practice Recommendations for Contraceptive Use, 2016, and application of this guidance for adolescents
Training program to increase care team member knowledge and skills and improve patient access to the full range of contraceptive methods
Implementation Tips
- Look to community-based organizations, academic institutions, and professional organizations for training opportunities
- Ensure supplies are in stock by time of LARC insertion/removal training
- Build an ongoing precepting/mentoring component (e.g., see one, do one)
Tools & Resources
Online library of LARC trainings and LARC-related resources offered by a variety of organizations
Brief videos on a variety of clinical topics related to the provision of LARC methods
Guide about LARC clinical mentoring with a number of resources, including a mentor self-assessment on pages 8-10 and performance assessment on LARC insertion and removal on pages 15-18
Implementation tips
- Use process mapping techniques or co-design to document current clinic workflow and identify opportunities to free up clinician availability to provide same-day access to the full range of contraceptive methods
- Use staffing strategies such as utilizing health educators, nurses, or medical assistants to provide contraceptive counseling to free up clinician availability for same-day appointments
- Maintain sufficient stock of the full range of contraceptive methods to be prepared for same-day appointments
- To decrease charting burden, develop electronic health record templates to document procedures, orders, patient education, and coding
- Create a mobile cart with needed LARC supplies and devices
Tools & Resources
Tool to help determine how well clinic flow is working at a site(s) and identify actions for improving clinic flow in order to provide comprehensive services in the most efficient way
Guide that provides strategies and resources on clinic workflows to ensure sufficient time during the visit to provide contraceptive methods on pages 21-30.
Tool for examining how frequently eligible patients are being offered contraceptive counseling and same-day contraception without requirement of unnecessary tests or subsequent visits
Checklist of supplies needed for LARC insertion and removal
Tool to calculate future demand for expanded contraceptive services, including the number of potential counseling interactions and LARC insertions on a weekly and yearly basis
Clinical guide to quick start contraception
Toolkit that offers strategies and tools that support provision of the full range of contraceptive methods on the same day requested by the patient
Checklist that outlines strategies for providing the full range of contraceptive methods during the same visit requested by the patient
Implementation tips
- Develop and share written reimbursement protocols specific to LARC acquisition and stocking costs and insertion, removal, and reinsertion costs. These should provide guidance on existing LARC reimbursement policies and actively implement payment strategies to address implementation challenges.
Tools & Resources
List of frequently used ICD-10 codes for contraceptive visits, sexually transmitted infection services, and other selected services
List of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes for family planning services
Tool for understanding the net cost of providing LARC services; requires a free registration
Checklist of actions to maximize financing for LARC services
Informational bulletin regarding approaches some states have used for Medicaid reimbursement of LARCs
Recommendations for successful documentation and charge capture process for LARC services, including service bundle samples
* Most women do not require additional STD screening at the time of IUD insertion. If a woman with risk factors for STDs has not been screened for gonorrhea and chlamydia according to CDC’s STI Treatment Guidelines (available at https://www.cdc.gov/std/treatment), screening can be performed at the time of IUD insertion, and insertion should not be delayed. Women with current purulent cervicitis or chlamydial infection or gonococcal infection should not undergo IUD insertion.3
3.Curtis KM, Tepper NK, Jatlaoui TC, Berry-Bibee E, Horton LG, Zapata LB, Simmons KB, Pagano HP, Jamieson DJ, Whiteman MK. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR Recommendations and Reports. 2016;65(3):1-103. doi:10.15585/mmwr.rr6503a1
