Evidence-based Promotion Increases IUC Use in a Managed Care Setting Above National Rates

Intrauterine contraception (IUC) is underutilized in the United States despite being a highly cost-effective method, with some non-contraceptive benefits and high user satisfaction. Misconceptions about IUC safety and initial costs appear to contribute to low use of IUC in the US. In this managed care setting the costs of IUC are a covered benefit and there has been active promotion of evidence-based use of IUC among clinicians and a diverse clinical and demographic population of women. A retrospective observational study was conducted comparing IUC use between 459,181 Kaiser Permanente, Northern California (KPNC) members in 2006 to the data collected in the 2002 National Survey of Family Growth (NSFG). KPNC electronic outpatient procedures and clinic administered medication records were used to determine the rate of IUC use among 459,181 women aged 15-44. IUC rate comparisons were made using Z tests.The KPNC IUC rate (5.55%, 95% CI: 5.48 - 5.61%) was 4.3 times the NSFG rate (1.30%, 95% CI: 1.30 – 1.30%) for women aged 15-44 (p<.0001). Even though IUC use varied by age group, these statistically significant differences persisted across each age group studied from 2.6 times higher in women aged 15-24 to 7.3 times higher in women aged 35-44. Of all contraception options, including all long-acting methods, IUC is the most cost-effective. An evidence-based approach to promotion of IUC among clinicians and women coupled with the health plan coverage of cost, resulted in higher rates of IUC use in KPNC compared to previously reported national IUC use.