Missed Opportunities for Discussing Contraception in Adolescent Primary Care.

Woods, Jennifer Leigh; Sheeder, Jeanelle L

BACKGROUND Over half of adolescents are sexually active by age 18 and represent half of STI, but they do not obtain routine medical care so discussing contraception at each visit becomes imperative. Our study objectives were to determine the frequency of visits before contraception was discussed/initiated, and to assess factors affecting primary care contraception provision. METHODS A retrospective chart review (January 2009-June 2019) was conducted for preventive, follow-up and sick visits; Title X confidential visits were excluded. Questions about method at start, end of visit were asked. Nonparametric median tests (for continuous variables) and chi-squared tests (for categorical variables) assessed for differences for age, race, patient gender, insurance type, visit type, provider gender. The IRB approved the study as exempt. RESULTS Patients (n=12,619; median=15 years; 58% female) were seen in primary care clinic and providers asked about contraception for 82% of visits and averaged three visits before contraception was discussed. For patients asked about contraception, 60% were using a contraceptive method; 15% left on a new method (24.9% LARC). For patients not using contraception, 39.9% left on a method. Patients asked about contraception were female, older, Hispanic, had public insurance, and were seen by female provider (p<.001). Follow up/sick visits represented < 20% of patients asked about contraception. CONCLUSIONS Multiple visits occur before contraception is discussed in adolescent primary care, and factors including age, race, gender affect these discussions. Strategies to increase contraception discussions at all visits is essential as adolescents do not always present for yearly visits.