Visits to Registered Nurses: An Opportunity to Increase Contraceptive Access in California.
Emese C Parker, Kevin Kong, Leslie A Watts and 3 others
PMID 28604507WHAT IT FOUND
California RN visits for contraception reached 13,410 clients but only 7% of public family planning sites.
At sites using RN visits, birth control claims rose, while they fell overall. This is association, not proof RN visits caused the rise.
Key findings
01From the first paid claim in October 2013 through the next 18 months, 14,272 RN visits were paid and 13,410 clients were served, but only 74 of 1,073 public Family PACT sites (7%) implemented RN visits.
02At RN visits, 10,088 of 14,272 visits (71%) dispensed or administered both hormonal and barrier methods, and 651 clients picked up Tier 2 or Tier 3 birth control at a pharmacy within 30 days.
03Paid claims for physician, NP, CNM, or PA contraception dispensing or administration decreased overall, but increased at sites where RN visits were utilized.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 74 of 1,073 public Family PACT sites (7%) implemented RN visits, so results reflect early adopters, not all clinics. The study used administrative claims, not medical records, so it could not assess counseling quality or reasons for method choices. Claims data miss services never billed and include some erroneous claims. No RN visit claims were found before October 2013, even though the benefit was retroactive to January 1, 2013. Follow-up was only 30 days, and picking up birth control is not the same as starting or using it. RN visits were not counted as unique clients, and clients may have had other family planning visits before an RN visit. The study was observational and compared sites with and without RN visits, so it cannot separate the effect of RN visits from other site differences.
Declared interests
The authors reported no conflicts of interest. The analysis was part of a program evaluation contract with institutional review board approval.
The easy way to misread this
Do not conclude that RN visits caused the increase in birth control claims. The study was observational, compared sites that did and did not implement RN visits, and followed clients for only 30 days.