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Healthcare Burden of Trial-and-Error Contraceptive Prescribing in Adolescents
Gianina M Monestime1, Anna C Norman1, Margaret Cua1
1Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
Study Objective:
The current approach to contraception care is largely trial-and-error based. Approximately 40% of patients discontinue their chosen contraceptive method within the first year of use due to unfavorable side effects. We aimed to: 1) describe healthcare burden experienced by adolescents during contraceptive trials ("trial burden"), and 2) identify sociodemographic factors that modify trial burden experienced by adolescents and clinicians.
Methods:
We conducted a retrospective chart review of 100 adolescents initiating contraception at a tertiary care pediatric and adolescent gynecology clinic from 2021 to 2023. Sociodemographic data were collected. The primary outcome was contraceptive trial burden, defined as number of contraceptive trials, number of contraception-related outpatient visits, and duration of each trial. Secondary outcomes included prescription of secondary medication for side effect management, emergency room (ER) utilization, and unintended pregnancy. Pearson correlation and ANOVA tests were performed.
Results:
Mean age at contraception initiation was 15.4 ± 1.7 years. Adolescents required 2.2 ± 1.3 contraceptive trials over 19.3 ± 21.3 months, spanning over 6.3 ± 4.1 outpatient clinic visits prior to initiation of a final contraceptive method. Thirty-one percent required secondary medication for side effect management. Five adolescents presented to the ER for contraception-related complications. Four adolescents experienced unintended pregnancy during their contraceptive trials. Spanish-speaking adolescents attended more contraception-related outpatient visits and were more likely to require ER care.
Conclusion:
Trial-and-error contraceptive prescribing in adolescents is associated with significant and avoidable healthcare utilization. Study findings highlight inefficiencies in current contraceptive prescribing practices and the need for clinical tools that will assist with contraception selection, thereby streamlining contraception care and reducing healthcare burden for patients and providers.
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