Missed Opportunities for Discussing Contraception in Adolescent Primary Care

Area of Science:

• Adolescent Medicine
• Public Health
• Contraception Research

Background:

• Over half of adolescents are sexually active by age 18, accounting for half of all sexually transmitted infections (STIs).
• Adolescents frequently lack routine medical care, making contraception discussions during primary care visits essential.
• Previous research highlights the need to understand patterns in primary care contraception provision for this demographic.

Purpose of the Study:

• To determine the frequency of primary care visits before contraception was discussed or initiated among adolescents.
• To assess patient and provider factors influencing the provision of contraception in primary care settings.

Main Methods:

• A retrospective chart review of 12,619 adolescent primary care visits (excluding Title X visits) from January 2009 to June 2019.
• Data collected included patient demographics, visit type, provider characteristics, and whether contraception was discussed or initiated.
• Statistical analyses used nonparametric median tests and chi-squared tests to compare groups.

Main Results:

• Contraception was discussed in 82% of visits, with an average of 3 visits preceding the discussion.
• Among patients asked about contraception, 60% were using a method, and 15% initiated a new method (24.9% LARC).
• Factors associated with contraception discussions included female sex, older age, Hispanic ethnicity, public insurance, and female providers (P < .001).

Conclusions:

• Multiple primary care visits are often required before adolescents receive contraception counseling.
• Patient age, race, and gender, along with provider gender, significantly impact the timing and likelihood of contraception discussions.
• Implementing strategies to ensure contraception is discussed at all adolescent visits is crucial, given their inconsistent attendance for annual check-ups.