ArticleJAMA network open2025
Contraceptive Prescribing and Dispensing After the Defense Health Agency's Policy Change.
Article in JAMA network open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Importance: The Defense Health Agency Procedural Instruction (DHA-PI) 6200.02, introduced in May 2019, aimed to improve contraception access and knowledge among eligible beneficiaries. However, the policy's association with contraception prescribing and dispensing practices has not been fully evaluated. Objective: To evaluate changes in contraceptive prescribing and dispensing practices associated with DHA-PI 6200.02, focusing on extended day supply of long-acting reversible contraception (LARC), short-acting reversible contraception (SARC), and permanent contraception. Design, Setting, and Participants: This retrospective cohort study was conducted utilizing interrupted time-series analysis to examine changes in contraception care practices before and after policy implementation. The study period was between January 1, 2016, and September 30, 2022. Participants were active-duty servicewomen (ADSW) aged 18 to 55 years, with an assigned sex of female in medical records who were enrolled in TRICARE. Exposure: The implementation of the DHA-PI 6200.02 policy in May 2019. Main Outcomes and Measures: The primary outcomes included rates of extended contraceptive supply and utilization of LARC, SARC, and permanent contraception. Five performance measures were employed to assess the associations between DHA-PI 6200.02 and changes in contraceptive supply. Segmented regression models were unadjusted and used to estimate level and trend changes in monthly MOPs. Results: Among 429 194 ADSWs (mean [SD] age 24.5 [7.0] years; 148 104 [34.5%] Army, 101 299 [32.6%] Navy, 115 288 [26.86%] Air Force, and 35 352 [8.24%] Marine Corps), the proportion of SARC users receiving extended supply increased from 1.1% prepolicy to 5.3% postpolicy. Extended SARC use increased from 16.3% (95% CI, 16.0%-16.7%) at baseline to 19.7% (95% CI, 17.9%-21.6%) at the end of follow-up, and dispensed extended SARC rose from 8.2% (95% CI, 7.9%-8.5%) to 9.3% (95% CI, 7.4%-11.1%), both reflecting significant post-policy upward trends. The overall proportion of ADSW with any extended contraceptive supply showed no meaningful change and declined significantly in trend. Prescriber provision of extended supply rose modestly without sustained trend change, and among contraceptive users extended supply increased but without significant policy-related effects. Conclusions and Relevance: In this cohort study of ADSWs, DHA-PI 6200.02 was associated with increased access to extended day supply for SARC but no corresponding increases were observed in overall extended contraceptive supply across all methods (SARC, LARC placement, and permanent contraception). These findings underscore challenges in policy uptake and highlight the need for enhanced efforts to ensure comprehensive implementation of DHA-PI 6200.02.
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