A 2016 Kaiser Permanente Northern California initiative improved adolescent access to a long-acting reversible contraceptive (LARC) through patient education resources, protocols, and insertion training for pediatric, family medicine, and gynecology providers.
Researchers studied outcomes among a cohort of youth, ages 15 to 18 years, who used contraception before and after implementation. They found the intervention was associated with a 90% increase in LARC use and a 36% decrease in teen pregnancy rates. Researchers concluded the increase in LARC use was mostly due to a shift away from short-acting contraception and toward contraceptive arm implant.1
Q&A
Contraceptive Technology Update asked senior study author Josephine Lau, MD, MPH, an adolescent medicine specialist with The Permanente Medical Group of Kaiser Permanente Northern California, a few questions about the study and its results. This transcript has been lightly edited for length and clarity.
CTU: Which finding was the most surprising?
Lau: It was a pleasant surprise to see the 90% increase in LARC uptake among teens. As part of a large health system, we engage in numerous quality improvement initiatives, and studies like this help us to know whether our efforts are working. This study demonstrates that a multifaceted approach involving all primary care services, including pediatrics, family medicine, and gynecology, can significantly impact pregnancy prevention.
CTU: What are the concerns about adolescent LARC use from the perspective of providers and reproductive healthcare? For instance, is LARC use among adolescents lower than would make sense from a public health perspective?
Lau: Implants and IUDs, in general, are very acceptable contraception options among adolescents. Many adolescents like the low-maintenance aspect of these methods. From the provider side, I think there are still a lot of primary care providers offering birth control pills as the first line because they are familiar with them. Many primary care providers may not feel 100% equipped to counsel teens on LARC because they are unfamiliar with the procedure or the side effects. In addition, there are still many misconceptions about same-day LARC among providers, including when it is clinically appropriate. What we know about LARC is that it is very safe to be placed on the same day for the majority of patients.
CTU: Your findings showed a quality intervention using same-day LARC increased LARC use and led to a 36% decrease in teen pregnancy rates. With such positive results, why is same-day LARC not offered more widely, especially in states that protect women’s autonomy and reproductive healthcare?
Lau: Orchestrating a same-day LARC procedure can be challenging in a busy primary care clinic. These are typically procedures that have to be worked into a provider schedule. Depending on how busy the day is, patients may have to wait until all the scheduled patients are cared for. Some of our clinics do this by having designated providers to work in the patients. These may be on-call providers, or providers with other duties where they do not have a full panel of patients they need to see on the day.
CTU: What would it take to offer same-day LARC in states where reproductive healthcare has been harmed by anti-abortion laws and the closure of reproductive health clinics? Is there a way that individual OB/GYNs and other providers could employ this tactic without extra funding? Are you hopeful that this could be employed more widely in the United States?
Lau: Most — if not all — of OB/GYNs and family planning clinics are already offering LARC to adolescents as routine care. An area to make LARC more accessible is to ensure primary care providers have the knowledge and skills to provide LARC, including more training on LARC counseling, LARC insertion training, and practice support strategies to facilitate same-day LARC insertions.
REFERENCE
- Bruce KH, Merchant MA, Kaskowitz AP, et al. Adolescent long-acting reversible contraceptive use, same-day insertions, and pregnancies following a quality initiative. J Adolesc Health 2023;S1054-139X(23)00311-7.
A 2016 Kaiser Permanente Northern California initiative improved adolescent access to a long-acting reversible contraceptive through patient education resources, protocols, and insertion training for pediatric, family medicine, and gynecology providers.
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