Resident Kaiser Permanente Santa Clara Medical Center Kaiser Permanente Santa Clara Medical Center Santa Clara, California, United States
Background: Same-day LARC insertions reduce unintended pregnancy, abortion, and healthcare spending. In 2016, Kaiser Permanente Northern California (KPNC) implemented a quality initiative to increase adolescent LARC access among primary care providers.
Objective: To examine same-day LARC provision among adolescents pre- and post-quality initiative to increase LARC provision at KPNC.
Design/Methods: Retrospective cohort study of adolescents aged 15-18 who used contraception between 2014-2015 (pre-intervention, n=30,094) or 2017-2018 (post-intervention, n=28,710). Contraceptive types included LARC (intrauterine device or implant), injectable, and contraceptive pill, patch, or ring (PPR). Chart review was completed for a random sample of sexually active adolescents who used LARC to identify the number of days between counseling and insertion. Generalized linear mixed models examined the effects of year of provision, age, race/ethnicity, LARC type, and counseling clinic (pediatric, gynecology, or family medicine).
Results: Among adolescents using contraception pre-intervention, 12.1% used LARC, 13.6% used injectable, and 74.3% used PPR. Post-intervention, the proportions were 23.0%, 11.6%, and 65.4%, respectively. Chart review revealed that 182 out of 726 adolescents received LARC on the same day as contraceptive counseling (25.1%). Among adolescents who received counseling in gynecology, pediatric, and family medicine clinics, 48.7%, 13.8%, and 9.7%, respectively, underwent same-day insertion. The median number of days between counseling and insertion for adolescents who underwent delayed insertion was 77.5 days. Most adolescents received counseling in pediatric clinics (62.8%). Multivariate models found no effect on same-day insertions by year of insertion or LARC type. Adolescents who received counseling in gynecology clinics had higher odds of same-day insertion than those who received counseling in pediatric clinics (aOR 8.41, CI 5.40-13.10). Non-Hispanic Black and multiracial adolescents had lower odds of same-day insertion compared to white adolescents (aOR 0.41, CI 0.18-0.91 and aOR 0.36, CI 0.14-0.89, respectively). Conclusion(s): An intervention aimed at increasing LARC provision among adolescents successfully increased overall use of LARC but did not increase same-day insertions. Same-day LARC insertions may be increased by targeting interventions in pediatric clinics (e.g. increasing LARC providers and reinforcing quick-start protocols) and placing special focus on racial equity.
Authors/Institutions: Kelly H. Bruce, Kaiser Permanente Northern California, Santa Clara, California, United States; Maqdooda A. Merchant, Kaiser Permanente Northern California, Oakland, California, United States; Alexa P. Kaskowitz, Kaiser Permanente Northern California, Santa Clara, California, United States; Josephine S. Lau, Kaiser Permanente Northern California, San Leandro, California, United States