Telemedicine for Adolescent and Young Adult Long-Acting Reversible Contraception Post-insertion Visits: Outcomes over 1 Year - 23/05/24

Doi : 10.1016/j.jpag.2024.04.004

Amanda E. Bryson, MD, MPH ^1,^{^{†
Present address: Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California.},}^⁎ , Carly E. Milliren, MPH ², Sarah A. Golub, MD, MPH ³, Sofya Maslyanskaya, MD ⁴, Michelle Escovedo, MD ⁵, Claudia Borzutzky, MD ^5,^{^{‡
Present address: Planned Parenthood Los Angeles, Los Angeles, California.}}, Sarah A.B. Pitts, MD ^1,^{^{#
These authors contributed as co-senior authors.}}, Amy D. DiVasta, MD, MMSc ^1,^{^{#
These authors contributed as co-senior authors.}}
¹ Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
² Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts
³ Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington
⁴ Division of Adolescent Medicine, Children's Hospital at Montefiore, New York, New York
⁵ Division of Adolescent/Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California

^⁎Address correspondence to: Amanda E. Bryson, MD, MPH, Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158.Division of Adolescent and Young Adult MedicineDepartment of PediatricsUniversity of California, San Francisco550 16th Street, 4th FloorSan FranciscoCA94158

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 23 May 2024

Abstract

Study Objective

Telemedicine for long-acting reversible contraception (LARC) care is understudied given the rapid implementation of these services in response to the COVID-19 pandemic. We compared outcomes over 1 year of adolescents and young adults (AYAs) attending a LARC post-insertion visit via telemedicine vs in person.

Design

Longitudinal cohort study.

Setting

Four academic adolescent medicine clinics in the United States.

Participants

AYAs (ages 13-26 years) who received LARC between 4/1/20 and 3/1/21 and attended a post-insertion visit within 12 weeks.

Interventions

none.

Main outcome measures

Outcomes over 1 year were compared between AYAs who completed this visit via telemedicine vs in person. We analyzed the data using descriptive statistics, bivariate analyses, and regression models.

Results

Of 194 AYAs (ages 13.9-25.7 years) attending a post-insertion visit, 40.2% utilized telemedicine. Menstrual management (odds ratio (OR) = 1.02; confidence interval (CI): 0.40-2.60), acne management (P = .28), number of visits attended (relative risk (RR) = 1.08; CI: 0.99-1.19), and LARC removal (P = .95) were similar between groups. AYAs attending via telemedicine were less likely than those attending in person to have STI testing (P = .001). Intrauterine device expulsion or malposition and arm symptoms with implant in situ were rare outcomes in both groups.

Conclusion

Roughly 40% of AYAs attended a post-insertion visit via telemedicine during the first year of the COVID-19 pandemic and had similar 1-year outcomes as those attending in person. The decreased likelihood of STI testing for those using telemedicine highlights the need to provide alternative options, when indicated, such as asynchronous or home testing. Our results support the use of telemedicine for AYA LARC post-insertion care and identify potential gaps in telemedicine care which can help improve clinic protocols.

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Keywords : Long-acting reversible contraception, Telemedicine, Adolescent, Young adult