Abstract
BACKGROUND: Same-day long-acting reversible contraception (LARC) is cost-effective and convenient . There have been no studies on how the COVID-19 pandemic impacted same-day LARC for adolescents. We aimed to determine the patient- and provider-level factors associated with same-day LARC placement for adolescents 12 months before and after COVID-19 protocols started on 3/15/2020. METHODS: This retrospective cohort study analyzed existing electronic health records from a large healthcare system in the Southeastern U.S. Adolescents included (N=954) were 10-19 years old and received outpatient LARC from 3/15/2019 to 3/14/2021. A logistic regression model determined the relationship of multiple variables on receipt of same day LARC before and during COVID-19. An interrupted time series examined changes in same-day LARC initiation during the 12 months before and after 3/15/2020. Our institutional IRB approved the study. RESULTS: While more adolescents initiated same-day LARC (61%) compared to those who did not (39%), fewer adolescents received same-day LARC during the pandemic (58%) compared to before (64%). Only county concordance was associated with same-day LARC both before and during the pandemic (aOR=2.31 and 1.83 respectively, both p< 0.05) (Table 1). During the pandemic, a few factors reduced the odds of same-day LARC:1) public insurance (aOR=0.52, p< 0.01, vs. private insurance), 2) non-OBGYN providers (pediatrics [aOR=0.34, p< 0.01], family medicine [aOR=0.53, p< 0.01] or internal medicine [aOR=0.13, p< 0.05], vs. OBGYN), and 3) advanced practice practitioners (aOR=0.46, p< 0.001, vs. physicians). There was no significant change in average monthly same-day LARC insertions before and after 3/15/2020 (p>0.05) (Figure 1). CONCLUSIONS: We identified differences in adolescent same-day LARC initiation during the pandemic by county concordance, insurance status, provider specialty, and provider type. Some potential explanations include barriers to accessing clinical care, such as fewer in-person appointments, reduced public transportation, or limited parental ability to transport their adolescent due to difficulties in childcare for other children. Additionally, fewer same-day LARC by providers in general pediatrics and medicine during the pandemic may suggest that non-LARC concerns took priority during in-person visits. Findings from this study may guide policy and programmatic interventions to improve access to same-day LARC for all adolescent populations. Supporting Figures or Tables: https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1373188-1-ANY(1).docx https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1373188-2-ANY(2).docx