Using ED visits to provide counsel on contraceptives

May 3, 2021
Miranda Hester

Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

Not every adolescent female patient has a doctor to turn to for contraceptive counseling. An investigation reported at the virtual 2021 Pediatric Academic Societies meeting offered insight into whether addressing the concern at emergency department (ED) visits could work.

Pregnancy during adolescence can have a multigenerational impact on a family’s educational and income and can lead to costs of $8.4 billion each year. The adolescent pregnancy rate in the United States has declined significantly over the past several years, but remains one of the highest among developed countries. Providing contraceptive counseling can be an important way to tackle the issue, but a number of children may not have a doctor that they regularly visit to provide such counseling. Cynthia Mollen, MD, MSCE, division chief in the division of emergency medicine at the Children’s Hospital of Philadelphia in Pennsylvania, spoke about a study performed in the emergency department at her hospital and Children’s Mercy in Kansas City, Missouri, that provided contraception counseling to teenagers at the virtual 2021 Pediatric Academic Societies meeting.

The study utilized advanced practice providers like nurse practitioners and physician assistants because they are a consistent workforce in the emergency department. The selected providers were trained either through a webinar or in-person training. The providers had access to support materials in the emergency department that could help with the patient encounters. They also received booster sessions throughout the study period. The patient participants were any adolescent patient who was female; aged 15 to 18 years; had any chief complaint; was not currently pregnant; and was considered high risk for becoming pregnant. The counseling session occurred at a time in the visit when it would not interfere with the medical care required by the chief complaint.

A total of 27 advanced practice providers and 100 adolescent patients were included in the study. The average age of the patient was 16.7 years and 64% of the patients were Black. A majority of the patients (73%) reported a history of sexual activity and in this subset, 4% reported a history of pregnancy. Previous contraception utilization was common and 19% of the patients indicated using emergency contraception in the past. Sixty percent of the patients reported a high intention of initiating contraception. Older participants, participants with a history or prior sexual activity, and participants with prior contraception use were more likely to report a high intention of beginning contraception use.

Advanced practice providers reported that the average counseling time was 12 minutes. They felt that the sessions were easy to deliver and that they felt competent to give the counseling. Most of the providers indicated that their confidence in providing the counseling increased over the course of the study period. When asked about satisfaction with the provided counseling, 90% of the patients said that they were happy with it. Five percent of the patients received contraception at the initial visit and 22% had a follow-up visit specifically to initiate contraception.

Reference

1. Mollen C. Contraception counseling of adolescents seeking care in pediatric emergency departments. Pediatric Academic Societies Meeting 2021; May 3, 2021; virtual. Accessed May 3, 2021.