Attendance at an initial LARC follow-up visit

A retrospective chart review has concluded that less than one-third of adolescents and young adults (AYAs) attended an initial follow-up visit after long-acting reversible contraception (LARC) insertion.

The study in the Journal of Pediatric and Adolescent Gynecology also found that attendees were twice as likely to have LARC removal in the first year compared to those who did not have follow-up.

However, at 500 days post-insertion and beyond, there was no difference in LARC continuation rates between the two groups.

The chart review was conducted at the Adolescent Center at Boston Medical Center in Boston, Massachusetts, which provides primary care and reproductive health services.

All 331 patients, aged 13 to 28, received one of three LARCs -- etonogestrel 68 mg implant, levonorgestrel 52 mg intrauterine device, or copper intrauterine device -- between January 2014 and August 2017.

The intervention was attendance at a follow-up visit 4 to 8 weeks after LARC insertion, which was defined as a visit addressing LARC method or routine physicals in the Adolescent Center or affiliated school-based health clinics.

Only 29.3% of patients attended a follow-up visit.

Those who attended had a higher likelihood of LARC removal in the first year: hazard ratio (HR) = 2.10; 95% confidence interval (CI): 1.33 to 3.32.

But at 500 days post-insertion and beyond, LARC continuation rates were comparable between the two groups: HR = 1.07; 95% CI: 0.67 to 1.71.

“Our hypothesis was that attending follow-up visits would support AYAs choosing LARC, and therefore we expected to see a higher continuation rate in those who followed-up compared to those who did not,” said first author Amanda Bryson, MD, a medical fellow in the Division of Adolescent/Young Adult Medicine at Boston Children’s Hospital. “What we observed, though, is that those who followed-up were more likely to have their method removed within the first year after placement and that attending a follow-up visit did not affect continuation longer term.”

Bryson believes the next step is to better understand why a patient follows up or not. “Is it convenience? Desire for removal? Side effects? Or something else?” she said. “This will help us understand how to best support our patients who choose LARC.”

Bryson is especially curious to know more about those AYAs who did not follow-up. “Were they happy with the method and had no concerns, as opposed to experiencing side effects but had barriers to presenting to care?” she said.

Offering various options for follow-up, such as a phone call, a patient portal message, a telemedicine visit or an in-person visit “could be useful to increase post-insertion communication with patients and facilitate in-person appointments for those who need them,” Bryson said.

Because of the COVID-19 pandemic, “we have a unique opportunity to examine the role of telemedicine in reproductive healthcare for AYAs, including LARC-related care,” Bryson said. “I think telemedicine services may be particularly useful for this population, as well as help ameliorate potential barriers to presenting for LARC follow-up care.”

No current evidence-based guidelines exist for follow-up after LARC placement among AYAs, according to Bryson. “Although our study adds to the literature about LARC follow-up in this population, more research is needed to make formal recommendations about post-insertion LARC follow-up for AYAs,” she said.

__

Bryson reports no relevant financial disclosures.

Bryson AE, Cabral HJ, Coles MS. Attendance of an initial follow-up visit after long-acting reversible contraception insertion and method continuation among adolescents and young adults: a retrospective study. J Pediatr Adolesc Gynecol. Printed online January 21, 2021. doi:10.1016/j.jpag.2021.01.004