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 accessOne-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 GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
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
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
- Provision of reproductive health for teens during a pandemic.J Pediatr Adolesc Gynecol. 2020; 33: 331
- COVID-19 FAQs for Obstetrician–Gynecologists, Gynecology.ACOG, Washington, DC2020 (Available:) (Accessed October 20, 2021)
- 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
- Outcomes of a rapid adolescent telehealth scale-up during the COVID-19 pandemic.J Adolesc Health. 2020; 67: 172-178
- 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
- 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
- The use of telemedicine in pediatric and adolescent gynecology.J Pediatr Adolesc Gynecol. 2022; 35: 133-137
- 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
- Adolescent/young adult long-acting reversible contraception: experience from a multisite adolescent medicine collaborative.J Pediatr. 2022; 243: 158-166
- Telehealth: improving access to and quality of pediatric health care.Pediatrics. 2021; 148: 1-6
- A call to incorporate a reproductive justice agenda into reproductive health clinical practice and policy.Contraception. 2009; 79: 243-246
- 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
- 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
- Telemedicine for contraceptive counseling: patient experiences during the early phase of the COVID-19 pandemic in New York City.Contraception. 2021; 104: 254-261
- Providing contraception for young people during a pandemic is essential health care.JAMA Pediatr. 2020; 174: 823-824
- 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
- Pediatric telehealth in the COVID-19 pandemic era and beyond.Pediatrics. 2021; 148: 1-11
Article info
Publication history
Published online: August 07, 2022
Accepted:
August 4,
2022
Received in revised form:
July 11,
2022
Received:
May 19,
2022
Footnotes
Conflicts of interest: SP and AD are the co-PIs for a grant through the Investigator-Initiated Studies Program of Organon that was received in August 2020 (when data analysis was underway) to support data management and analysis. CM receives funding through this grant to support their involvement in the project. CB and SG are the directors of the Collaborative at their respective sites and received funding for data management through this grant.
Prior Presentation: This work was presented as an oral platform presentation on April 7, 2022, at the North American Society for Pediatric and Adolescent Gynecology 2022 Annual Clinical & Research Meeting.
✰Boston, Massachusetts; Los Angeles, California; Seattle, Washington
Identification
Copyright
© 2022 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
