ABSTRACT
Background: Telemedicine for adolescent and young adult (AYA) long-acting reversible contraception (LARC) care is understudied, as telemedicine was quickly implemented in response to the COVID-19 pandemic. We compare outcomes of AYA LARC follow-up care via telemedicine vs. in-person visits over 1 year. Method(s): This cohort (IRBP00030775) includes patients who 1) had an intrauterine device (IUD) or implant inserted between 4/1/20-3/31/21 and 2) attended an initial LARC follow-up visit (defined as the first visit within 12 weeks of insertion) at 1 of 4 US Adolescent Medicine clinics. Eligible patients were 13-26 years old with a LARC method inserted without sedation and in situ for at least 12 weeks. We compared outcomes over 1 year between AYAs attending the initial follow-up visit via telemedicine (telemedicine attendees) to those who completed the visit in-person (in-person attendees). Outcomes included patient-reported symptoms, menstrual management, acne management, sexually transmitted infection (STI) testing and results, and LARC removal. Descriptive statistics described the sample and compared groups. Adjusted Poisson regression examined factors associated with number of visits and adjusted logistic regression models examined the association between initial visit modality and initiation of menstrual management. Result(s): Our study included 194 AYAs, ages 13.9-25.7 years, who attended an initial follow-up visit. Most AYAs (86.6%) attended only 1 visit in the first 12 weeks post-insertion. Telemedicine attendees comprised 40.2% of the sample. Telemedicine and in-person attendees were similar with regards to site, age, race/ethnicity, prior pregnancy, concurrent medical/mental health diagnoses, and reason for LARC (Table 1). In-person attendees were more likely to have the IUD than telemedicine attendees (Table 1). Patient-reported symptoms over 1 year were similar between groups (Table 2). Menstrual management (OR = 1.02, CI: 0.40-2.60), number of visits attended (RR = 1.08, CI: 0.99-1.19), acne management (p =.28), and LARC removal (p =.95) were similar between groups. In-person attendees were more likely to have STI testing than telemedicine attendees (p =.001). However, no positive STI tests were captured in either group. Conclusion(s): Approximately 40% of AYAs attended their LARC follow-up visit via telemedicine. LARC type may have influenced modality of visit. While in-person attendees were more likely to have STI testing, there were no positive STI tests detected in either group during the study period. More research is needed to determine if the decrease in STI testing is clinically significant. Other outcomes were similar between visit modalities, suggesting telemedicine may be useful for AYA LARC care. Supporting Figures or Tables: https://www.scorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1370854-1-ANY.docx https://www.scorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1370854-2-ANY.docxCopyright © 2023
ABSTRACT
Purpose: Telemedicine for adolescent and young adult (AYA) care, including long-acting reversible contraception (LARC) care, was quickly implemented in response to the COVID-19 pandemic. Therefore, outcomes of telemedicine LARC care is understudied. We compare outcomes of AYAs receiving LARC follow-up care via telemedicine and in-person over 1 year. Methods: This cohort study includes patients who had LARC, intrauterine device (IUD) or implant, inserted between 4/1/20-3/31/21 and attended an initial LARC follow-up visit at 4 US Adolescent Medicine clinics. Initial LARC follow-up visit was defined as the first visit within 12 weeks of insertion. Eligible patients were 13-26 years old, had LARC inserted without sedation, and had LARC in place for at least 12 weeks. We compared outcomes over 1 year between patients attending the initial follow-up visit via telemedicine (telemedicine attendees) to those who completed the visit in-person (in-person attendees). Outcomes included patient-reported side effects, medical menstrual management, acne management, IUD malposition or expulsion, sexually transmitted infection (STI) testing and results, and LARC removal. Descriptive statistics described the sample and compared groups. Adjusted Poisson regression examined factors associated with number of visits and adjusted logistic regression models examined the association between initial visit modality and initiation of medical menstrual management. Site-specific institutional review board approvals were obtained. Results: Our study included 194 AYAs, ages 13.9-25.7 years (mean 18.7 years, SD = 2.3) who attended an initial follow-up visit. Most AYAs (n = 168, 86.6%) attended only one visit in the 12 weeks post-insertion. Telemedicine attendees comprised 40.2% of the sample. Telemedicine and in-person attendees were similar with regards to site of LARC insertion (p =.43), age (p =.17), race/ethnicity (p =.25), prior pregnancy (p =.95), complex medical diagnoses (p =.32), menstrual diagnoses (p =.11), and reason for LARC (p =.82). In-person attendees were more likely to have the IUD than telemedicine attendees (p =.003). Bivariate analyses showed similar frequency of patient-reported symptoms over 1 year between groups. Outcomes of menstrual management (OR = 1.02, CI: 0.40-2.60), number of visits attended (RR = 1.08, CI: 0.99-1.19), acne management (p =.28), IUD expulsion (p =.13), IUD malposition (p =.51), and LARC removal (p =.95) were similar between groups. In-person attendees were more likely to have STI testing done (p =.001) than telemedicine attendees. However, no positive STI tests were captured in either group. Conclusions: Roughly two-fifths of patients presenting to an initial LARC follow-up visit did so via telemedicine. Type of LARC may influence modality of follow-up visit. Except for STI testing, outcomes over 1 year were similar regardless of the first visit modality. Reassuringly, no positive STI tests were detected in either group over 1 year of follow-up. More research is needed to determine if the decrease in STI testing for patients seeking care via telemedicine is clinically significant. Telemedicine may play an important role in AYA LARC follow-up care, and more research is needed in this area. Sources of Support: N/a.