title: Home or office etonogestrel implant insertion after pregnancy: a randomized trial.
abstract: To evaluate whether home visits for contraceptive implant insertion result in an increase in postpartum uptake compared to clinic insertion and to assess the feasibility of home insertions.
  
  
  
  We randomized women within 10 weeks of a birth or dilation and curettage (D&C) for abortion or miscarriage to home or standard office insertion. The primary outcome was successful insertion of the implant. To achieve 80% power to detect a 40% difference in visit attendance, 20 women were assigned to each group. The secondary outcome was attendance of the 4-week postpartum visit.
  
  
  
  From June 2013 through February 2014, we screened 45 women and 40 were randomly assigned to home and office insertion visits. We enrolled 37 postpartum women and 3 women post-D&C. Because of the significant under enrollment of the latter, we chose to report results of only the postpartum women. The results were similar whether we included or excluded post-abortion women. A majority of women desired a home visit for their implant insertion appointment at time of enrollment. Postpartum appointment attendance rates were similar between home and office visits at 53% and 50% (p=1.00), respectively. Home visits resulted in a trend toward increased implant uptake [12/19 (63%) vs 6/18 (33%), p=.10].
  
  
  
  Home insertion of the contraceptive implant may be a feasible option. Future studies that examine the feasibility and uptake in both postpartum and post-D&C women are warranted.
  
  
  
  Women reported preference for home insertion visits in this pilot study. We also showed that a greater proportion of women received the etonogestrel implant at a home visit compared to the current standard of care, which may warrant larger studies that would have sufficient power to evaluate smaller differences.
authors.affiliation: Boston Medical Center, Department of Obstetrics & Gynecology, 85 E. Concord St, 6th Floor, Boston, MA 02118. Electronic address: Suji.Uhm@bmc.org.
authors.forename: Suji
authors.initials: S
authors.lastname: Uhm
authors.affiliation: Baylor College of Medicine, Department of Obstetrics & Gynecology, One Baylor Plaza, Houston, TX 77030.
authors.forename: Rachel
authors.initials: R
authors.lastname: Pope
authors.affiliation: Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Schmidt
authors.affiliation: Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA.
authors.forename: Corinne
authors.initials: C
authors.lastname: Bazella
authors.affiliation: Thomas Jefferson University School of Medicine, Department of Obstetrics & Gynecology, 833 Chestnut St, Philadelphia, PA 19107.
authors.forename: Lisa
authors.initials: L
authors.lastname: Perriera
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D017135:Desogestrel / Q000008:administration & dosage*; D005260:Female; D006792:House Calls; D006801:Humans; D009819:Office Visits; D009820:Ohio; D057240:Patient Preference; D010865:Pilot Projects; D049590:Postpartum Period; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; C044815:etonogestrel; D017135:Desogestrel
keywords: Contraception; Contraceptive implant; Etonogestrel implant; Global fee; Home visit; Postpartum