Laura Mills

Date Approved


Degree Type

Open Access Project

Degree Name

Doctor of Nursing Practice (DNP)



Committee Member

Lydia McBurrows, DNP, RN, CPNP-PC, Project Lead

Committee Member

Marija Grahovac, MD FACOG

Committee Member

Elizabeth Loomis, DNP, APRN, FNP-BC

Committee Member

Tsu-Yin Wu, PhD., RN, FAAN


Background and Review of Literature: Long-acting reversible contraception (LARC) is an effective form of contraception that has been shown to have high rates of satisfaction and few contraindications for patients. However, patients with Medicaid coverage may face barriers and challenges in obtaining LARC. Often, providers in small obstetrics and gynecology (OBGYN) private practices are unable or unwilling to provide LARC placement due to financial burdens as a result of limited Medicaid reimbursement. Regardless of insurance carrier or size of practice, patients should have access to the contraception method of their choice.
Purpose: This project aims to determine the feasibility and acceptability of a quality improvement (QI) process in a privately owned OBGYN office where patients received initial LARC placement from a partnering clinic, returning to their private OBGYN for follow-up and continuation of care.
Methods: A mixed methods study was completed to measure the success of the process change. Two neighboring clinics were approached to develop and implement a straightforward and seamless QI process for patients to receive a LARC that includes education, referral, and follow-up. Utilizing Quality From the Patient’s Perspective (QPP) questionnaire and open-ended questions, interviews were performed, and data were analyzed to determine feasibility and acceptability.
Results: Three patients out of seven patients from the QI group obtained a LARC and returned for the follow-up. While these patients had positive feedback about the process, they disliked having to leave their established practice for LARC placement.
Implications/Conclusions: The results showed an increase in satisfaction among the three women surveyed in the referral process for LARC and is therefore acceptable. Feasibility in the allotted 4-month timeframe was not determined. However, it was deemed that this QI process has implications for future use.

Included in

Nursing Commons