LARC ‘Quick Start’ in adolescents embraced by many providers

March 13, 2019

Most physicians consider the practice safe for adolescents, but a recent survey indicates there is still a training and education gap that must be filled. 

A survey of healthcare providers found that the majority consider “Quick Start” initiation of long-acting reversible contraception (LARC) safe for adolescents.

Overall, 70.9% of providers considered “Quick Start’ initiation of implants for adolescents to be safe, and 64.5% deemed initiation of intrauterine devices (IUDs) for young adults to be safe.

“‘Quick Start’ initiation of contraception means starting the chosen contraceptive method on the same day of the healthcare visit,” said co-author Lauren Zapata, PhD, MSPH, an epidemiologist in the CDC’s Division of Reproductive Health in Atlanta. “ ‘Quick Start’ eliminates unnecessary repeat visits by allowing same-day initiation of contraception, if the provider is reasonably certain that the patient is not pregnant.”

The cross-sectional survey consisted of a 33-item questionnaire mailed during 2013 and 2014 to a random sample of US healthcare providers, of whom 2,056 responded (a 51.2% response rate). Providers included physicians working in office-based settings and providers (including physicians, advanced clinical practitioners and nurses) working in health centers that receive some public funding for family planning services.

The findings in the Journal of Pediatric and Adolescent Gynecology found differences among provider characteristics.

For instance, public-sector providers who were not trained in implant or IUD insertion were less likely to perceive the practice safe for implants (adjusted OR 0.32; 95% CI: 0.25 – 0.41) and IUDs (adjusted OR 0.42; 95% CI: 0.32 – 0.55) compared to trained providers.

Those practicing at health centers that did not receive Title X funding were also less likely to perceive the practice safe for IUDs (adjusted OR 0.77; 95% CI: 0.61 – 0.98).

In addition, among office-based physicians, lack of training in LARC insertion correlated with a lower perception rate about “Quick Start” being safe for IUDs (adjusted OR 0.31; 95% CI: 0.12 – 0.77).

In contrast, providers specializing in adolescent medicine were more likely to report that “Quick Start” was safe compared to ob/gyns (implants: adjusted OR 2.21; 95% CI: 1.23 – 3.98; IUDs: adjusted OR 3.37; 95% CI: 1.39 – 8.21).

“Although the practice of ‘Quick Start’ of LARC for those who are medically eligible and the safety of LARC for adolescents is recommended by US family planning guidance and professional organizations, only about two-thirds of providers reported considering it safe for adolescents,” Dr. Zapata told Contemporary OB/GYN. “This finding suggest there may be a significant and important training and education gap to fill.”

Dr. Zapata, the lead author for a series of surveys of healthcare providers assessing attitudes and practices related to contraception, said targeted education and training on LARC insertion and removal, as well as dissemination of evidence-based US family planning guidance, could increase access to “Quick Start” initiation.

Specifically, training during medical residencies and via continuing education for practicing clinicians may improve LARC insertion proficiency. However, providers may be reluctant to counsel adolescents about LARC as a contraceptive option if they are restricted by practice policies.

Nonetheless, “Quick Start” initiation of contraception, including LARC, “is an important strategy to reduce barriers to contraception access, particularly because it eliminates unnecessary repeat visits,” Dr. Zapata said. “It is important for providers to know this is a recommended option for many patients and to consider it as they are counseling patients about contraception.”

Disclosures:

Dr. Zapata reports no relevant financial disclosures.