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Attendance of an Initial Follow-up Visit after Long-Acting Reversible Contraception Insertion and Method Continuation
Amanda E Bryson1, Howard J Cabral2, Mandy S Coles3
1Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
Study Objective:
To assess attendance of an initial follow-up visit after long-acting reversible contraception (LARC) insertion and whether follow-up was associated with a higher likelihood of method continuation in adolescents and young adults (AYAs).
Design:
Retrospective chart review including patients receiving LARC (etonogestrel 68 mg implant, levonorgestrel 52 mg intrauterine device, or copper intrauterine device) between January 1, 2014, and August 1, 2017.
Setting:
An urban adolescent center providing primary care and reproductive health services.
Participants:
A total of 331 patients 13-28 years of age.
Interventions:
Attendance of a follow-up visit 4-8 weeks after LARC insertion.
Main Outcome Measures:
Follow-up was defined as visits addressing LARC method or routine physical examinations in the adolescent center or affiliated school-based health clinics. Continuation and discontinuation were defined as documented presence or removal, respectively, of device at various time points. Descriptive analyses, χ2 test, Fisher exact test, t test, and survival analysis were used.
Results:
Approximately one-third (29.3%) of the patients attended a follow-up visit. Follow-up was associated with a higher likelihood of LARC removal in the first year (hazard ratio [HR] = 2.10, 95% confidence interval [CI] 1.33-3.32). At 500 days post-insertion and beyond, there was no difference in LARC continuation between AYAs who followed-up and those who did not (HR = 1.07, 95% CI 0.67-1.71).
Conclusion:
Few AYAs attended an initial follow-up visit after LARC placement. These visits were associated with an increased likelihood of LARC removal in the first year; however, this association was not observed long term. More information is needed to determine how to approach follow-up this population.
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