Telemedicine for Adolescent and Young Adult Long-acting Reversible Contraception Follow-up Care amidst a Global Pandemic

J Pediatr Adolesc Gynecol. 2022 Aug 7:S1083-3188(22)00263-7. doi: 10.1016/j.jpag.2022.08.002. Online ahead of print.

ABSTRACT

STUDY OBJECTIVE: Describe adolescent and young adult (AYA) long-acting reversible contraception (LARC) follow-up care via telemedicine in the year following the COVID-19 pandemic onset.

DESIGN: Longitudinal cohort study SETTING: : Three academic Adolescent Medicine clinics in the US PARTICIPANTS: : AYAs using LARC INTERVENTIONS: : None MAIN OUTCOME MEASURES: : Patient characteristics, visit information (frequency, timing, and modality), patient-reported symptoms, and outcomes for those presenting for LARC follow-up care between 4/1/20-3/31/21. Descriptive statistics described the sample. χ² tests and t-tests compared groups. Adjusted logistic regression models using general estimating equations assessed factors associated with telemedicine visits and examined visit outcomes.

RESULTS: Of the 319 AYAs (ages 13.6 - 25.7 years), 40.1% attended at least one LARC telemedicine visit. Patients attending any telemedicine encounter vs. only in-person visits had similar demographics and clinical characteristics. Of the 426 follow-up visits, 270 (63.4%) were conducted in-person and 156 (36.6%) were performed via telemedicine. The majority of visits (62.7%) occurred within 12 months of device insertion. Neither report of bothersome uterine bleeding beyond patient expectation (OR 1.26, CI = 0.80-1.96), any symptom (OR 1.40, CI = 0.94-2.10), or ≥2 symptoms (OR 1.22, CI = 0.67-2.22) at follow-up was associated, positively or negatively, with mode of follow-up. Management of bleeding (OR 1.27, CI 0.56-2.89), management of acne (p = .46), and need for rapid follow-up (p = .33) were similar between follow-up modalities.

CONCLUSIONS: Patient demographic/clinical characteristics and visit outcomes were similar between telemedicine vs. in-person LARC follow-up. Telemedicine may play an important role in AYA LARC care.

PMID:35948207 | DOI:10.1016/j.jpag.2022.08.002