Study Objective

To assess how the addition of a pediatric and adolescent gynecologist (PAG) in an area where one has not previously been available affects the use of long-acting reversible contraception (LARC) among adolescent and adult women 13-24 years of age.

Design

Retrospective chart review.

Setting

Academic practice including 12 general practice obstetric/gynecologists (GP) and 1 PAG, and Title X clinics in 3 neighboring counties in West Virginia.

Participants

Patients receiving an intrauterine device (IUD) or implant during 2010-2016.

Interventions

Subject charts were reviewed for age and date at insertion, provider (GP, PAG, and Title X), device type, parity, discontinuation, and sequential LARC placement.

Main Outcome Measures

Frequencies of LARC and relative risks (RR) with 95% confidence intervals were calculated for the 13- to 17-year and 18- to 24-year age groups and compared between provider type.

Results

The frequency of LARC increased over time for all providers for participants age 13-24; the PAG had the highest frequency of LARC among participants aged 13-17 years. The RR for IUD provision for the PAG provider among those aged 13-17 years was 3.1 and 32.5 times greater compared to GP and Title X (P < .001). Title X providers were 2.9 (2.27, 3.79) and 2.8 (2.06, 3.81) times more likely to provide implants to patients aged 13-17 years compared to PAG and GP, respectively (P < .001).

Conclusions

A PAG provider can have a positive impact on LARC uptake among adolescents in a community where this specialist has not previously been available. This is most noted among 13- to 17-year-old patients receiving IUDs.

中文翻译：

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青春期妇科医师对青少年患者宫内节育器和皮下避孕药使用的影响。

研究目标

评估在以前没有人的地区增加儿科和青春期妇科医生（PAG）会如何影响13-24岁的青春期和成年女性对长效可逆避孕（LARC）的使用。

设计

回顾性图表审查。

设置

学术实践包括西弗吉尼亚州3个邻近县的12位普通妇产科医生（GP）和1位PAG，以及Title X诊所。

参加者

在2010-2016年期间接受宫内节育器（IUD）或植入的患者。

干预措施

检查主题图的年龄和插入日期，提供者（GP，PAG和标题X），设备类型，奇偶校验，停产和连续LARC放置的日期。

主要观察指标

计算13至17岁和18至24岁年龄组的LARC频率和相对风险（RR），置信区间为95％，并比较提供者类型。

结果

所有提供商的13-24岁参与者的LARC频率随着时间的推移而增加；在13-17岁的参与者中，PAG发生LARC的频率最高。与GP和Title X相比，年龄在13-17岁之间的PAG提供者的宫内节育器提供的RR分别高3.1和32.5倍（P  <.001）。与PAG和GP相比，Title X提供者向13-17岁患者提供植入物的可能性分别高2.9倍（2.27，3.79）和2.8（2.06，3.81）倍（P  <.001）。

结论

PAG提供商可能会对以前没有该专家的社区中的青少年LARC吸收产生积极影响。在接受宫内节育器的13至17岁患者中，这一点最为明显。