Using ED visits to provide counsel on contraceptives

Pregnancy in adolescence can have a multigenerational impact on a family’s education and income and can lead to costs of $ 8.4 billion a year. The adolescent pregnancy rate in the United States has dropped significantly in recent years, but remains one of the highest among developed countries. Giving birth control counseling can be an important way to address the problem, but some children may not have a doctor who they visit regularly to provide such counseling. Cynthia Mollen, MD, MSCE, division chief of the emergency medicine department at the Children’s Hospital of Philadelphia in Pennsylvania, spoke about a study conducted in her hospital’s emergency department and Children’s Mercy in Kansas City, Missouri, that included contraceptive counseling. offered to teens at the Virtual Meeting of Pediatric Academic Societies in 2021.

The study used advanced practice providers such as nurses and physician assistants because they are a consistent workforce in the emergency department. The selected providers were trained via a webinar or personal training. Caregivers had access to emergency department support materials to assist with patient encounters. They also received booster sessions during the study period. The patient participants were any adolescent patient who was female; from 15 to 18 years old; had a main complaint; was not currently pregnant; and was considered a high risk of becoming pregnant. The counseling session took place at a time during the visit when it would not interfere with the medical care required for the main complaint.

A total of 27 experienced practitioners and 100 adolescent patients were enrolled in the study. The mean age of the patient was 16.7 years and 64% of the patients were black. A majority of patients (73%) reported a history of sexual activity and in this subgroup 4% reported a history of pregnancy. Previous use of contraception was common and 19% of patients reported using emergency contraception in the past. Sixty percent of patients reported high intent to start contraception. Older participants, participants with a history or previous sexual activity, and participants who had previously used birth control were more likely to report high intent to start birth control.

Advanced practice providers reported that the average counseling time was 12 minutes. They felt that the sessions were easy to deliver and that they felt competent to provide the counseling. Most caregivers indicated that their confidence in providing guidance has increased over the course of the study period. When asked about their satisfaction with the counseling provided, 90% of the patients said they were happy with it. Five percent of patients received contraception on the first visit and 22% had a follow-up visit specifically to start contraception.

Reference

Moles C. Contraception counseling of adolescents seeking care in pediatric emergency departments. Pediatric Academic Associations Meeting 2021; May 3, 2021; virtual. Access until May 3, 2021.

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