Linda Prine

Intrauterine Devices at Six Months: Does Patient Age Matter? Results from an Urban Family Medicine Federally Qualified Health Center (FQHC) Network

Background: Federally qualified health centers (FQHCs) can address high rates of unintended pregnancy among adolescents in the United States by increasing access to intrauterine devices (IUDs) in underserved settings. Despite national guidelines endorsing adolescent use of IUDs, some physicians remain concerned about IUD tolerance and safety in adolescents. Therefore we compared adolescents and adults in a family physician staffed FQHC network with regard to (1) IUD postinsertion experience, (2) device discontinuation, and (3) sexually transmitted infection (STI) rates. Methods: We conducted a retrospective cohort study among women <36 years old who had an IUD inserted in 2011 at a New York City FQHC staffed by family physicians. Results: We included 684 women (27% adolescents, 73% adults). During the 6-month postinsertion period, 59% of adolescents and 43% of adults initiated IUD-related clinical contact after insertion, most commonly for bleeding changes and pelvic or abdominal pain. There were no significant differences between groups in IUD expulsion or removal or STI rates. Conclusions: Urban FQHC providers may anticipate that, compared with their adult IUD users, adolescents will initiate more clinical follow-up visits after insertion. Both groups will, however, have similar clinical concerns about, reasons for, and rate of device discontinuation and low STI rates.

Establishing and Conducting a Regional, Hands-on Long-Acting Reversible Contraception Training Center in Primary Care

Although safe and effective (Stoddard, McNicholas, & Peipert, 2011; Winner et al., 2012), there are many barriers to increasing intrauterine and implantable contraception (collectively known as long-acting reversible contraception [LARC]) access. These barriers include systems issues (National Institute for Reproductive Health, 2016; Pace, Dolan, Tishler, Gooding, & Bartz, 2016; Rubin, Davis, & McKee, 2013), as well as a shortage of clinicians trained to insert and remove the devices (Nisen, Peterson, Cochrane, & Rubin, 2016). In particular, there is a national need to train more primary care clinicians in LARC insertion and removal (Gilmore et al., 2015; Harper et al., 2013; Nisen et al., 2016). Initiatives such as Upstream, Get LARC, LARC First, and Beyond the Pill offer critical systems and educational support for sites to increase LARC provision. In these programs, as in the majority of U.S. LARC training programs for clinicians in practice, the insertion and removal training occurs on simulators only (American College of Obstetricians and Gynecologists, 2018; “Beyond The Pill site-training,” n.d.; Harper et al., 2015; Lewis, Darney, & Thiel de Bocanegra, 2013). Although simulators are a well-established training modality (Bartz, Paris, Maurer, Gardner, & Johnson, 2016; Scalese, Obeso, & Issenberg, 2008) and can meet some learning needs (Nippita et al., 2018; Nitschmann, Bartz, & Johnson, 2014), supervised training with live patients is critical for training to competence in new procedural skills, including LARC (Nippita et al., 2018; Potter, Koyama, & Coles, 2015). Unless a practice site has clinicians who can train others, there are few opportunities for

Beyond the Surface: Care Seeking Among Patients Initiating Contraceptive Implant in an Urban Federally Qualified Health Center Network.

Purpose: To describe rates of and reasons for follow-up among adolescents and adults receiving contraceptive implants in a Federally Qualified Health Center (FQHC). Methods: Retrospective comparison of patient-initiated implant-related contacts during the 6 months postinsertion among adolescents (110) and adults (154) who had implants placed at a FQHC network. Results: Forty percent of adolescents and 26% of adults initiated follow-up (P = .016). Bleeding changes and discussing removal were the most common reasons for follow-up for both groups. Adolescents (5.5%) and adults (9.0%) had similar removal rates (P = .348). However, among patients who discussed implant removal, adults were more likely to have removals compared with adolescents (P = .002). Conclusions: Other FQHCs may anticipate a similar experience to ours, where adolescents may be more likely than adults to initiate implant-related follow up, with removal rates of less than 10% at 6 months. Further study of physician decision making and patient autonomy regarding implantable contraception removal requests is warranted.