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Patient and Provider Perspectives on Acceptability, Access, and Adherence to 17-Alpha-Hydroxyprogesterone Caproate
Stephanie M Garcia1, Katherine S Kellom1, Rupsa C Boelig2
1PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Insights
17-Alpha-hydroxyprogesterone caproate (17OHPC) can prevent recurrent preterm birth (PTB). Patient-provider communication and coordinated care facilitate 17OHPC use, while pain and administrative complexity are key barriers for Medicaid patients.
Area of Science:
- Maternal Health
- Reproductive Health
- Health Services Research
Background:
- Preterm birth (PTB) presents significant maternal and child health challenges, exacerbated by racial disparities in care.
- 17-Alpha-hydroxyprogesterone caproate (17OHPC) is a key intervention for recurrent PTB prevention.
- Factors influencing 17OHPC use among Medicaid beneficiaries remain under-explored.
Purpose of the Study:
- To investigate patient and provider perspectives on 17OHPC acceptability, access, and adherence.
- To identify facilitators and barriers to 17OHPC administration and receipt in a Medicaid population.
- To inform strategies for improving PTB prevention therapies.
Main Methods:
- Individual semistructured interviews with 17OHPC-eligible pregnant women and obstetric providers in Philadelphia.
- Purposive sampling of patients receiving, declining, or discontinuing 17OHPC.
- Thematic analysis of interview transcripts to identify key factors.
Main Results:
- Patient facilitators for 17OHPC included prior PTB severity, provider counseling, and care coordination.
- Patient barriers included pain; provider-perceived barriers included social adversity and patient commitment.
- Provider facilitators included clinical experience and guidelines; barriers included administrative complexity and service coordination.
Conclusions:
- Patient-provider communication significantly impacts 17OHPC acceptability and adherence.
- Addressing patient-reported pain and provider-identified administrative hurdles is crucial.
- Enhanced, patient-centered consultations can improve uptake of PTB prevention therapies.
Abstract:
Background: Preterm birth (PTB) is a pressing maternal and child health issue with long-standing racial inequities in outcomes and care provision. 17-Alpha-hydroxyprogesterone caproate (17OHPC) has been one of few clinical interventions for recurrent PTB prevention. Little is known about the factors influencing successful administration and receipt of 17OHPC among mothers in the Medicaid program. Materials and Methods: We conducted individual semistructured interviews with 17OHPC-eligible pregnant women and obstetric providers from two academic medical centers in Philadelphia, PA. Patient participants were publicly insured, eligible for 17OHPC treatment, and purposively sampled as either (1) actively receiving treatment or (2) declining/discontinuing treatment. Providers had experience providing care to Medicaid-enrolled patients. Interview transcripts were coded and analyzed to identify themes related to treatment acceptability, access, and adherence. Results: Of the 17 patient participants, the mean age was 30 years. Ten providers (MDs, nurse practitioners, and registered nurses) were also interviewed. Factors facilitating 17OHPC uptake and adherence among patients included severity of prior PTB, provider counseling, and coordination among the clinic, pharmacy, and insurance. Pain was cited as the most significant barrier to 17OHPC for patients, while providers perceived social adversity and beliefs about patients' commitment to treatment to be primary patient barriers. For providers, clinical experience and practice guidelines contributed to their use of 17OHPC. Administrative complexity and coordination of services were the primary provider barrier to 17OHPC administration. Conclusions: Patient-provider communication is a primary driver of 17OHPC acceptability and adherence. Comprehensive patient-centered consultation may improve uptake of clinical therapies among pregnant women at high risk for PTB.
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