Minnesota Nursing magazine

Martha Trevey

Barriers to birth control

DNP project improves access to contraceptive implant
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by: 
Brett Stursa

As a family nurse practitioner, Martha Trevey has seen the paradigm around birth control methods shift to those that are long acting, like the contraceptive implant and intrauterine devices.

But as someone who practices in homeless shelters, she saw that her patients often faced barriers accessing long-term birth control. At one Minneapolis clinic, only about 14 percent of the women who were referred to an off-site clinic to get an implant actually went on to get it.

Trevey, who’s a student in the Doctor of Nursing Practice program, wondered why. She decided to explore this health inequity as she began her scholarly project, which is an evidence-based project to advance system level change.

“I wanted to make sure that we were able to decrease the barriers to contraception for these women so they can be empowered and choose options that are good for them long-term,” said Trevey, who is employed by Hennepin Healthcare for the Homeless.

Women whom she saw at the clinic were juggling many responsibilities and often struggled to find time for additional appointments. “They were really stressed and pressed for time,” said Trevey. To address these barriers, the project sought to offer women the contraceptive implant at the clinic on-site during same-day appointments. “Offering the contraception during same-day appointments was really important in meeting women where they were at and not providing any more stress,” she said.

The project required administrative paperwork, contractual agreements and policy changes. In the process, Trevey learned that the clinic wouldn’t be reimbursed for the implants if they were offered the same day, so instead the clinic created a budget for the project. “Our team was very committed to health equity and was interested in pursuing the project despite the cost,” said Trevey.

During the 12-week evaluation period, successful implant rates increased from 14 percent to 80 percent.

She said she was surprised to see that when access to the implant was improved, more women desired getting one. “This suggests that when the contraceptive implant is more accessible, women are more willing to obtain this method,” said Trevey.

For her work on the project, Trevey was awarded the Sandra R. Edwardson Award for Excellence in Doctor of Nursing Practice Leadership. “She is a change agent inspired by the needs of those she serves and her passion for her work is an inspiration to those she encounters,” said Clinical Associate Professor Jeanne Pfeiffer, who was Trevey’s project adviser.

While the clinic continues to offer the same-day, on-site appointments, Trevey is working to implement additional policy changes so the clinic can be reimbursed for the implant. “Offering access to these options to women and empowering them is really important,” said Trevey.

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Above: Family nurse practitioner Martha Trevey, DNP, APRN, FNP, talks with a patient at a Hennepin Healthcare for the Homeless clinic in Minneapolis.