Contraceptive method usage pattern and percentage of new pregnancies among adolescent and young adult family planning patients: a mixed-methods retrospective study.

OBJECTIVES: Despite increased access to contraceptive methods (CM), the US still has the highest rate of adolescent pregnancy among industrialized nations, and adolescents from historically marginalized groups are disproportionately affected. In this study, we sought to (1) understand if differences in CM usage were associated with differential percentages of new pregnancies among adolescents and young adult patients attending a family planning (FP) clinic at an urban community practice and (2) identify areas of improvement in our FP counseling. METHODS: Mixed-methods study design consisting of (1) a 12-month retrospective chart review and (2) a self-answered cross-sectional survey of FP patients. Chi-square, Fisher's exact tests, and risk ratio were performed to analyze the percentage of new pregnancies according to CM usage. RESULTS: The percentage of new pregnancies was 11 among our FP patients (N=555) during this study period. As anticipated, pregnancy was associated with no CM use, CM discontinuation, and, interestingly, multiple CM changes (p<0.001). The probability of no-pregnancy significantly decreased among patients on no method, who discontinued their CM or made multiple CM changes compared to those with continuous CM use. There was no association between the percentage of new pregnancies and any particular CM type. CONCLUSION: Despite adequate access to FP patient services and high patient satisfaction levels, our findings indicate a need to adopt a more patient-centered approach in our FP counseling that addresses patient's reproductive life plans, preferences, and method side effects to increase CM uptake and satisfaction and decrease frequency of CM changes which is associated with increased risk of mistimed pregnancy during method switching.

A Previsit Screening Checklist Improves Teamwork and Access to Preventive Services in a Medical Home Serving Low-Income Adolescent and Young Adult Patients.

Publicly insured adolescents and young adults experience significant obstacles in accessing primary care services. As a result, they often present to their medical appointments with multiple unmet needs, adding time and complexity to the visit. The goal of this project was to optimize team work and access to primary care services among publicly insured adolescents and young adults attending an urban primary care clinic, using a previsit screening checklist to identify patient needs and delegate tasks within a care team to coordinate access to health services at the time of the visit. We conducted an interventional quality improvement initiative in a PDSA (Plan-Do-Study-Act) cycle format; 291 patients, 13 to 25 years old were included in the study over an 8-months period. The majority of patients were receptive to the previsit screening checklist; 85% of services requested were provided; nonclinician staff felt more involved in patient care; and providers' satisfaction increased.