Advertisement

Telemedicine for Adolescent and Young Adult Long-Acting Reversible Contraception Follow-Up Care amidst a Global Pandemic

Published:August 07, 2022DOI:https://doi.org/10.1016/j.jpag.2022.08.002

      ABSTRACT

      Study Objective

      To describe adolescent and young adult (AYA) long-acting reversible contraception (LARC) follow-up care via telemedicine in the year following the COVID-19 pandemic onset

      Design

      Longitudinal cohort study

      Setting

      Three academic adolescent medicine clinics in the United States

      Participants

      AYAs using LARC

      Interventions

      None

      Main Outcome Measures

      The main outcome measures were patient characteristics, visit information (frequency, timing, and modality), patient-reported symptoms, and outcomes for those presenting for LARC follow-up care between April 1, 2020, and March 31, 2021. Descriptive statistics were used to describe the sample. χ2 tests and t tests were used to compare groups. Adjusted logistic regression models using general estimating equations were applied to assess factors associated with telemedicine visits and to examine visit outcomes.

      Results

      Of the 319 AYAs (ages 13.6-25.7 years), 40.1% attended at least one LARC telemedicine visit. Patients attending any telemedicine encounter vs only in-person visits had similar demographic and clinical characteristics. Of the 426 follow-up visits, 270 (63.4%) were conducted in person and 156 (36.6%) were performed via telemedicine. Most visits (62.7%) occurred within 12 months of device insertion. Reports of bothersome uterine bleeding beyond patient expectations (OR = 1.26; 95% CI, 0.80-1.96), any symptom (OR = 1.40; 95% CI, 0.94-2.10), or 2 or more symptoms (OR = 1.22; 95% CI, 0.67-2.22) at follow-up was not associated, positively or negatively, with mode of follow-up. Management of bleeding (OR = 1.27; 95% CI, 0.56-2.89), management of acne (P = .46), and need for rapid follow-up (P = .33) were similar between follow-up modalities.

      Conclusions

      Patient demographic/clinical characteristics and visit outcomes were similar between telemedicine and in-person LARC follow-up. Telemedicine could play an important role in AYA LARC care.

      Key Words

      Abbreviations:

      LARC (Long-acting reversible contraception), IUD (Intrauterine device), AYA (Adolescent and Young Adult)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric and Adolescent Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Centers for Disease Control and Prevention: Telehealth and telemedicine: a research anthology of law and policy resources. 2019. Available: https://www.cdc.gov/phlp/publications/topic/anthologies/anthologies-telehealth.html. Accessed January 3, 2022

      2. Health Resources & Services Administration: Policy changes during COVID-19. Available: https://telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/. Accessed January 3, 2022

        • Tyson N
        • Berlan E
        • Hewitt G
        • et al.
        Provision of reproductive health for teens during a pandemic.
        J Pediatr Adolesc Gynecol. 2020; 33: 331
        • American College of Obstetricians and Gynecologists
        COVID-19 FAQs for Obstetrician–Gynecologists, Gynecology.
        ACOG, Washington, DC2020 (Available:) (Accessed October 20, 2021)
        • Benson LS
        • Madden T
        • Tartelon J
        • et al.
        Society of Family Planning interim clinical recommendations: contraceptive provision when healthcare access is restricted due to pandemic response - 2021 update.
        Soc Fam Plann. 2021; : 1-10
        • Wood SM
        • White K
        • Peebles R
        • et al.
        Outcomes of a rapid adolescent telehealth scale-up during the COVID-19 pandemic.
        J Adolesc Health. 2020; 67: 172-178
        • Gilkey MB
        • Kong WY
        • Huang Q
        • et al.
        Using telehealth to deliver primary care to adolescents during and after the COVID-19 pandemic: national survey study of US primary care professionals.
        J Med Internet Res. 2021; 23: e31240
        • Barney A
        • Buckelew S
        • Mesheriakova V
        • et al.
        The COVID-19 pandemic and rapid implementation of adolescent and young adult telemedicine: challenges and opportunities for innovation.
        J Adolesc Health. 2020; 67: 164-171
        • Shim JY
        • Kaur R
        • Laufer MR
        • et al.
        The use of telemedicine in pediatric and adolescent gynecology.
        J Pediatr Adolesc Gynecol. 2022; 35: 133-137
        • Hill BJ
        • Lock L
        • Anderson B
        Racial and ethnic differences in family planning telehealth use during the onset of the COVID-19 response in Arkansas, Kansas, Missouri, and Oklahoma.
        Contraception. 2021; 104: 262-264
        • Pitts S
        • Milliren CE
        • Borzutzky C
        • et al.
        Adolescent/young adult long-acting reversible contraception: experience from a multisite adolescent medicine collaborative.
        J Pediatr. 2022; 243: 158-166
        • Curfman AL
        • Hackell JM
        • Herendeen NE
        • et al.
        Telehealth: improving access to and quality of pediatric health care.
        Pediatrics. 2021; 148: 1-6
        • Gilliam ML
        • Neustadt A
        • Gordon R:
        A call to incorporate a reproductive justice agenda into reproductive health clinical practice and policy.
        Contraception. 2009; 79: 243-246
        • Ravi A
        • Prine L
        • Waltermaurer E
        • et al.
        Intrauterine devices at six months: does patient age matter? Results from an urban family medicine Federally Qualified Health Center (FQHC) network.
        J Am Board Fam Med. 2014; 27: 822-830
        • Stifani BM
        • Avila K
        • Levi EE
        Telemedicine for contraceptive counseling: an exploratory survey of US family planning providers following rapid adoption of services during the COVID-19 pandemic.
        Contraception. 2021; 103: 157-162
        • Stifani BM
        • Smith A
        • Avila K
        • et al.
        Telemedicine for contraceptive counseling: patient experiences during the early phase of the COVID-19 pandemic in New York City.
        Contraception. 2021; 104: 254-261
        • Wilkinson TA
        • Kottke MJ
        • Berlan ED
        Providing contraception for young people during a pandemic is essential health care.
        JAMA Pediatr. 2020; 174: 823-824
        • Cohen MA
        • Powell AM
        • Coleman JS
        • et al.
        Special ambulatory gynecologic considerations in the era of coronavirus disease 2019 (COVID-19) and implications for future practice.
        Am J Obstet Gynecol. 2020; 223: 372-378
        • Curfman A
        • McSwain SD
        • Chuo J
        • et al.
        Pediatric telehealth in the COVID-19 pandemic era and beyond.
        Pediatrics. 2021; 148: 1-11