Forewarned is forearmed: The impact of side effect counseling on contraceptive implant continuation at 18 months

The contraceptive implant is a highly cost-effective method that lasts up to 3 years.  Change in menstrual bleeding is the most commonly reported reason for early discontinuation.  We conducted a medical record review of 332 records of clients receiving an implant through Family PACT, California’s Medicaid-funded family planning program, to explore the provision and content of counseling at the implant insertion visit.  Using administrative claims, we searched for evidence of discontinuation after insertion.  We conducted chi-square tests to explore the impact of client demographics, provider characteristics, and insertion visit factors on continuation at 18 months.

By 18 months, 37% of the sample had evidence of discontinuation, for an implant continuation rate of 63%.  Prior to implant placement, 43% of women were using a user-dependent hormonal method, and 38% were using condoms.  Family PACT advises providers to counsel on the characteristic bleeding patterns associated with implant prior to insertion.  The majority of insertion visits (81%) included chart documentation that method–related education and counseling were provided, however only 38% noted detail on the specific implant-related topics discussed.

Of the provider and client characteristics we examined, only prior method was significantly related to continuation at 18 months (x² = 7.67, p=0.02). Documented receipt of counseling on bleeding patterns was significantly related to continuation (x² = 7.46, p=0.006) and a trend toward higher continuation among women receiving counseling on systemic hormonal side effects (x² = 2.19, p=0.13) was observed. We will present the results of logistic regression analyses controlling for covariates.