Abstract
Objective Examine adherence to treatment guidelines and rates of recurrent spontaneous preterm
birth (SPTB) in managed Medicaid patients prescribed 17 α-hydroxyprogesterone caproate
(17P).
Study Design A retrospective observational study of women receiving 17P between July 2004 and
May 2010 through one of Centene's managed Medicaid programs. Included for analysis
were singleton pregnancies without cerclage having SPTB history and prescribed 17P
by their physician. Compounded 17P was administered through an outpatient program
inclusive of patient education, weekly home nurse visits, and 24-7 telephonic nurse
access. A health plan–directed pregnancy management program, Start Smart for Your
Baby®, supported the therapy with case management activities.
Results Of the 790 patients studied, 58.6% initiated 17P in the recommended 16- to 20.9-week
gestational age window. Elective discontinuation of 17P occurred in 18.6%. Of the
10,583 17P injections administered, 97.5% were administered within the recommended
injection interval of 6 to 10 days. Recurrent SPTB occurred in 28.2% of women studied.
Conclusion Managed Medicaid patients enrolled in an outpatient 17P administration program supported
with maternal case management have high rates of treatment compliance. Their pregnancy
outcomes compare favorably to previously published reports that include both Medicaid
and commercially insured patients.
Keywords
17 alpha-hydroxyprogesterone caproate (17P) - recurrent spontaneous preterm birth
- Medicaid - managed care - case management
