Adolescent Long-Acting Reversible Contraceptive Use, Same-Day Insertions, and Pregnancies Following a Quality Initiative.

OBJECTIVE: To compare long-acting reversible contraceptive (LARC) use, pregnancy rate, and same-day LARC insertion among adolescents before and after a Kaiser Permanente Northern California quality initiative. METHODS: A 2016 Kaiser Permanente Northern California initiative aimed to increase adolescent LARC access. Interventions included patient education resources, electronic protocols, and insertion training for pediatric, family medicine, and gynecology providers. This study examined a retrospective cohort of adolescents aged 15-18 years who used contraception before (2014-2015, n = 30,094) and after (2017-2018, n = 28,710) implementation. Contraceptive types included LARC (intrauterine device or implant), injectable, and contraceptive pill, patch, or ring. We reviewed a random sample of LARC users (n = 726) to identify same-day insertions. Multivariable analysis examined the effects of year of provision, age, race, ethnicity, LARC type, and counseling clinic. RESULTS: Preintervention, 12.1% of adolescents used LARC, 13.6% used injectable, and 74.3% used pill, patch, or ring. Postintervention, the proportions were 23.0%, 11.6%, and 65.4%, respectively, with the odds of LARC provision of 2.57 (95% confidence interval (CI) 2.44-2.72). The pregnancy rate decreased from 2.2% to 1.4% (p < .0001). Higher rates of pregnancy were observed with injectable contraception and in Black and Hispanic adolescents. Same-day LARC insertion rate was 25.1% without significant variation post intervention (OR 1.44, 95% confidence interval 0.93-2.23). Contraceptive counseling in gynecology clinics increased the odds of same-day provision, while non-Hispanic Black race lowered odds. DISCUSSION: A multifaceted quality intervention was associated with a 90% increase in LARC use and a 36% decrease in teenage pregnancy rate. Future directions may include promoting same-day insertions, targeting interventions in pediatric clinics, and focusing on racial equity.

The Effect of Menstrual Issues on Young Women with Angelman Syndrome.

STUDY OBJECTIVE: To characterize menstrual health issues and their effect in young women with Angelman syndrome (AS). Our secondary objective was to compare them with young women with autism spectrum disorders (ASDs). DESIGN: Cross-sectional convenience sample survey. SETTING: An institutional review board-approved Web-based survey of young female members of the Angelman Syndrome Foundation. PARTICIPANTS: Caregivers of young women with AS, aged 12-25 years. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Symptom characterization and effect of menses on young women with AS. RESULTS: Menstrual and premenstrual symptoms were common among young women with AS, but infrequently caused problems at home or school. Less than half of the subjects used hormones to control their flow. Of those who used hormones, 75% used them continuously. Caregivers were satisfied with their method to control periods. Girls with seizures were more likely to use hormonal methods to control menses than those without seizures. Menstrual-associated morbidity in young women with ASD and AS was fairly similar, but with greater morbidity in the ASD group than in the AS group. However, girls with AS had more problems with menstrual hygiene with almost all of them requiring full assistance for managing hygiene. CONCLUSION: In this group of young women with AS, who have moderate to severe neurodevelopmental disabilities and cannot manage their own hygiene, menstruation is not associated with significant problems. Menstrual management by hormones is used by less than half. When hormonal therapy is used, it is most commonly used continuously to suppress menses.

Online availability of hormonal contraceptives without a health care examination: effect of knowledge and health care screening.

BACKGROUND: The study was conducted to investigate whether the knowledge of women using an online resource to obtain hormonal contraceptives (HCs) without a health care examination is similar to women who obtain HC in the clinic. STUDY DESIGN: Women who accessed HC prescriptions online or through a clinic visit were offered an anonymous self-administered survey regarding the contraindications to and possible complications of HC. Tests of equivalence were used to compare the mean scores between the two populations. RESULTS: Online users (n=243) were older, more affluent, more educated, and more likely to be insured than clinic patients (n=161). The two populations demonstrated equivalent HC knowledge [contraindications (mean score, 95% confidence interval): clinic 81.1% (77.2-85.0%), online 85.0% (82.0-88.0%); complications: clinic 77.6% (72.7-82.6%), online 82.1% (78.8-85.5%)]. The online population remained equivalent or superior to the clinic population in an age-restricted analysis. CONCLUSION: Women who self-select to obtain HC prescriptions online demonstrate at least equivalent knowledge of potential HC risks as women seen in a clinic encounter without a pelvic examination.