Weekly prenatal injections of 17 Alpha-hydroxyprogesterone caproate (17P) reduce the risk of recurrent preterm birth, but are underutilized and new pricing structures have created additional barriers. We queried prenatal care providers about their use of 17P and aimed to identify barriers to patients obtaining the recommended regimen.METHODS:
All twenty-six obstetric practices throughout Rhode Island were invited to complete a survey either on paper or online.RESULTS:
Twenty-two practices completed the survey, including private practices and community- and hospital-based clinics. All practices reported prescribing 17P to patients for whom it was indicated. Overall, when practices were asked to what extent patients were prevented from getting the recommended regimen of 17P because of any access issues, 9% of practices answered “very much,” 18% answered “somewhat,” 36% answered “a little,” and 36% answered “not at all.” Barriers faced in prescribing 17P reported by more than half of practices included lack of insurance coverage and insurance restrictions. There were slightly more barriers reported for patients with private insurance than those with public insurance. Practices reported that at least some patients expressed concern or declined treatment with 17P for the following reasons: cost to patient (13/22 practices), schedule of weekly injections (12/22), dislike or fear of needles (10/22), fear of reaction or side effects of injection (10/22), transportation to clinic for injection (7/22).CONCLUSION:
To ensure women are receiving a recommended regimen of 17P when indicated, it is important to improve patient education, streamline the insurance authorization process, and reduce barriers to obtaining 17P.