Journal article
Pediatric Practice Transformation and Long-Acting Reversible Contraception (LARC) Use in Adolescents
Academic pediatrics, v 22(2), 296
Mar 2022
PMID: 34758402
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Long acting reversible contraceptives (LARCs) are recommended as highly effective for adolescents. Although the uptake of LARCs has increased, overall use remains low due to barriers for both providers and patients. We evaluate whether pediatric medical home transformation, including implant placement in pediatrics, may increase LARC use or decrease adolescent pregnancy rates.
Retrospective interrupted time-series analysis of adolescents ages 11 to 19 years at 2 pediatric practices in academically affiliated community health centers during 2005–2015. The intervention practice underwent medical home transformation including team-based care with family planning and health coaching, youth-friendly policies, and contraceptive implant placement. The control practice continued usual care. Differential changes in population event rates were evaluated using a segmented longitudinal regression model.
The study population included 4946 adolescent females at the intervention practice and 1992 at the control practice. Following practice transformation, LARC use increased significantly more at the intervention practice compared to the control (1.73 versus 0.28 events per 1000 patients quarterly P = 0.004). Pregnancy rate declined at both practices without temporal correlation to the LARC intervention. During the medical home transformation period, the intervention practice showed a greater decline in pregnancy rate, though this difference did not reach statistical significance (2.01 versus 0.81 events per 1000 patients quarterly P = 0.090).
Adolescents had higher LARC use where implant placement was offered within the pediatric practice as part of medical home transformation. Although LARC did not impact pregnancy rate, the process of practice transformation may have accelerated its decline through heightened adolescent health focus.
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Details
- Title
- Pediatric Practice Transformation and Long-Acting Reversible Contraception (LARC) Use in Adolescents
- Creators
- Katherine H. Schiavoni - Massachusetts General HospitalJourdyn Lawrence - Harvard T. H. Chan School of Public Heath, Department of Social and Behavioral Sciences (J Lawrence), Boston, MassJiayin Xue - Massachusetts General HospitalMilton Kotelchuck - Massachusetts General HospitalAlexy Arauz Boudreau - Massachusetts General Hospital
- Publication Details
- Academic pediatrics, v 22(2), 296
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics
- Web of Science ID
- WOS:000819728800020
- Scopus ID
- 2-s2.0-85121742760
- Other Identifier
- 991021448025504721
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- Web of Science research areas
- Pediatrics