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Pediatric Practice Transformation and Long-Acting Reversible Contraception (LARC) Use in Adolescents
Journal article   Peer reviewed

Pediatric Practice Transformation and Long-Acting Reversible Contraception (LARC) Use in Adolescents

Katherine H. Schiavoni, Jourdyn Lawrence, Jiayin Xue, Milton Kotelchuck and Alexy Arauz Boudreau
Academic pediatrics, v 22(2), 296
Mar 2022
DOI: https://doi.org/10.1016/j.acap.2021.10.014
PMID: 34758402
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

adolescent health contraception long acting reversible contraception patient centered medical home primary care transformation
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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2 citations in Web of Science
2 citations in Scopus

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being
#5 Gender Equality

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Collaboration types
Domestic collaboration
Web of Science research areas
Pediatrics
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