Background

Over half of adolescents are sexually active by age 18 years and represent half of sexually transmitted infections (STI). These individuals often do not obtain routine medical care, so discussing contraception at each visit becomes imperative. Our study objectives were to determine the frequency of visits before contraception was discussed/initiated, and to assess factors affecting primary care contraception provision.

Methods

A retrospective chart review (January 2009-June 2019) was conducted for preventive, follow-up, and sick visits; Title X confidential visits were excluded. Questions were asked about method at start and end of the visit. Nonparametric median tests for continuous variables and chi-squared tests for categorical variables assessed for differences for patient age, race, gender, insurance type, visit type, and provider gender. The institutional review board approved the study as exempt.

Results

Patients (n = 12,619; median = 15 years; 58% female) were seen in primary care clinic. Providers asked about contraception for 82% of visits, and averaged 3 visits before contraception was discussed. For patients asked about contraception, 60% were using a contraceptive method, 15% left the visit on a new method (24.9% long-acting reversible contraception [LARC]). For patients not using contraception, 39.9% left the visit on a method. Patients asked about contraception were female, older, Hispanic, had public insurance, and were seen by female providers (P < .001). Follow-up/sick visits represented <20% of patients asked about contraception.

Conclusions

Multiple visits occur before contraception is discussed in adolescent primary care, and factors including age, race, and gender affect these discussions. Strategies to increase contraception discussions at all visits is essential, as adolescents do not always present for yearly visits.

中文翻译：

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讨论青春期初级保健避孕的机会错失。

背景

到18岁时，超过一半的青少年具有性活动能力，占性传播感染的一半，但他们无法获得常规医疗服务，因此必须在每次就诊时讨论避孕方法。我们的研究目标是确定在讨论/开始避孕之前就诊的频率，并评估影响提供初级保健避孕措施的因素。

方法

进行了回顾性图表审查（2009年1月至2019年6月），以进行预防，随访和患病就诊；标题X的秘密访问被排除在外。询问了关于开始，结束访问的方法的问题。针对年龄，种族，患者性别，患者性别，保险类型，就诊类型，提供者性别的差异，评估了非参数中位数检验（用于连续变量）和卡方检验（用于分类变量）。IRB批准此项研究为免税项目。

结果

在初级保健门诊就诊的患者（n = 12,619；中位数= 15岁；女性为58％），提供者询问了82％的就诊者的避孕情况，并在讨论避孕方法之前平均进行了3次就诊。对于被问及避孕的患者，有60％的人使用避孕方法。还剩下15％的新方法（24.9％LARC）。对于未使用避孕方法的患者，尚需39.9％的方法。被问及避孕的患者是女性，年龄较大，西班牙裔，有公共保险并且由女性提供者看过（p <.001）。随访/患病访视的患者中，＜20％询问避孕的患者。

结论

在青少年初级保健中讨论避孕措施之前，需要进行多次探访，包括年龄，种族，性别在内的因素会影响这些讨论。由于青少年并不总是参加每年的探视活动，因此在所有探视活动中增加避孕讨论的策略至关重要。