title: Randomized Controlled Trial of Home-Based Hormonal Contraceptive Dispensing for Women At Risk of Unintended Pregnancy.
abstract: Women frequently experience barriers to obtaining effective contraceptives from clinic-based providers. Allowing nurses to dispense hormonal methods during home visits may be a way to reduce barriers and improve -effective contraceptive use.
  
  
  
  Between 2009 and 2013, a sample of 337 low-income, pregnant clients of a nurse home-visit program in Washington State were randomly selected to receive either usual care or enhanced care in which nurses were permitted to provide hormonal contraceptives postpartum. Participants were surveyed at baseline and every three months postpartum for up to two years. Longitudinal Poisson mixed-effects regression analysis was used to examine group differences in gaps in effective contraceptive use, and survival analysis was used to examine time until a subsequent pregnancy.
  
  
  
  Compared with usual care participants, enhanced care participants had an average of 9.6 fewer days not covered by effective contraceptive use during the 90 days following a first birth (52.6 vs. 62.2). By six months postpartum, 50% of usual care participants and 39% of enhanced care participants were using a long-acting reversible contraceptive (LARC). In analyses excluding LARC use, enhanced care participants had an average of 14.2 fewer days not covered by effective contraceptive use 0-3 months postpartum (65.0 vs. 79.2) and 15.7 fewer uncovered days 4-6 months postpartum (39.2 vs. 54.9).
  
  
  
  Home dispensing of hormonal contraceptives may improve women's postpartum contraceptive use and should be explored as an intervention in communities where contraceptives are not easily accessible.
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Melnick
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland.
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Rdesinski
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland.
authors.forename: Miguel
authors.initials: M
authors.lastname: Marino
authors.affiliation: Qualitative health research consultant, BJF Research, Seattle.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Jacob-Files
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland.
authors.forename: Teresa
authors.initials: T
authors.lastname: Gipson
authors.affiliation: Department of Health and Human Services, Hillsboro, OR.
authors.forename: Marni
authors.initials: M
authors.lastname: Kuyl
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland.
authors.forename: Eve
authors.initials: E
authors.lastname: Dexter
authors.affiliation: University of Colorado, Aurora.
authors.forename: David
authors.initials: D
authors.lastname: Olds
mesh_terms: D003267:Contraception / Q000379:methods; D003271:Contraceptive Agents, Female / Q000627:therapeutic use; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000451:nursing*; D005193:Family Planning Services / Q000458:organization & administration*; D005260:Female; D006266:Health Education / Q000458:organization & administration; D006801:Humans; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D012044:Regression Analysis; D012646:Self Administration; D014861:Washington; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D003278:Contraceptives, Oral, Hormonal