Courtney L Crain1, Anne E DeFruscio2, Preeya T Shah2, Laura Hunt3, Jennie L Yoost4. 1. Marshall University Department of Obstetrics & Gynecology Huntington, WV. 2. Marshall University School of Medicine Huntington, WV. 3. West Virginia Department of Health and Human Resources Charleston, WV. 4. Marshall University Department of Obstetrics & Gynecology Huntington, WV. Electronic address: yoost@marshall.edu.
Abstract
STUDY OBJECTIVE: To assess how the addition of a Pediatric and Adolescent Gynecologist (PAG) in an area where one has not previously been available impacts the use of long acting reversible contraceptive (LARC) among girls age 13-24. DESIGN: Retrospective Chart Review SETTING: Academic practice including 12 general practice OBGYNs (GP) and one PAG, and Title X clinics in three neighboring counties in West Virginia. PARTICIPANTS: Patients receiving an intrauterine device (IUD) or implant during 2010-2016. INTERVENTIONS: Subject charts were reviewed for age and date at insertion, provider (GP, PAG and Title X), device type, parity, discontinuation and sequential LARC placement. MAIN OUTCOME MEASURES: Frequencies of LARC and RR with 95% confidence interval were calculated for the 13-17 and 18-24 year age groups and compared between provider type. RESULTS: Frequency of LARC increased over time for all providers for subjects 13-24; the PAG had the highest frequency of LARC among age 13-17. The RR for IUD provision for the PAG provider among 13-17 year olds was 3.1 and 32.5 times greater compared to GP and Title X (p<0.001). Title X providers were 2.9 (2.27, 3.79) and 2.8 (2.06, 3.81) times more likely to provide implants to patients age 13-17 compared to PAG and GP, respectfully (p<0.001). CONCLUSIONS: A PAG provider can have a positive impact on LARC uptake among adolescents in a community where this specialist has not previously been available. This is most noted among 13-17 year old patients receiving IUDs.
STUDY OBJECTIVE: To assess how the addition of a Pediatric and Adolescent Gynecologist (PAG) in an area where one has not previously been available impacts the use of long acting reversible contraceptive (LARC) among girls age 13-24. DESIGN: Retrospective Chart Review SETTING: Academic practice including 12 general practice OBGYNs (GP) and one PAG, and Title X clinics in three neighboring counties in West Virginia. PARTICIPANTS: Patients receiving an intrauterine device (IUD) or implant during 2010-2016. INTERVENTIONS: Subject charts were reviewed for age and date at insertion, provider (GP, PAG and Title X), device type, parity, discontinuation and sequential LARC placement. MAIN OUTCOME MEASURES: Frequencies of LARC and RR with 95% confidence interval were calculated for the 13-17 and 18-24 year age groups and compared between provider type. RESULTS: Frequency of LARC increased over time for all providers for subjects 13-24; the PAG had the highest frequency of LARC among age 13-17. The RR for IUD provision for the PAG provider among 13-17 year olds was 3.1 and 32.5 times greater compared to GP and Title X (p<0.001). Title X providers were 2.9 (2.27, 3.79) and 2.8 (2.06, 3.81) times more likely to provide implants to patients age 13-17 compared to PAG and GP, respectfully (p<0.001). CONCLUSIONS: A PAG provider can have a positive impact on LARC uptake among adolescents in a community where this specialist has not previously been available. This is most noted among 13-17 year old patients receiving IUDs.