391 - Feasibility of contraception counseling and prescribing among adolescents in the pediatric emergency department

Poster Number: 391
Publication Number: 391.406

Melissa K. Miller, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Amber N. Adams, Children's Mercy Hospitals and Clinics, Kansas City, KS, United States; Stephani Stancil, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Vincent Staggs, Children's Mercy KC / University of Missouri-Kansas City, Kansas City, MO, United States; Tara Ketterer, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Kathy Goggin, Children's Mercy Hospital Kansas City / University of Missouri Kansas City, Kansas City, MO, United States; Jacqueline Kopaygorodsky, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Elizabeth .. Miller, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States; Cynthia Mollen, Children's Hospital of Philadelphia, Philadelphia, PA, United States

Background: Following the Dobbs decision limiting reproductive care, adolescents urgently need increased contraceptive access. Offering contraception in non-traditional settings can increase access, but little is known about contraceptive care feasibility in the pediatric emergency department (ED). 

Objective: To assess feasibility of contraceptive care provided by trained ED clinicians.

Design/Methods: Randomized trial in two pediatric EDs enrolling patients aged 15-18 years with a uterus, not pregnant/desiring pregnancy, and not using hormonal contraception. We trained ED clinicians (i.e., advance practice providers and pediatricians) in contraceptive counseling and prescribing. Adolescents were randomized to enhanced usual care [EUC] or same day initiation [SDI] using block randomization to balance allocation of those with previous contraception use. All received counseling from trained clinicians and clinic referral opportunity; SDI participants could also receive contraception at the ED visit. After counseling, adolescents and clinicians reported feasibility with closed- (5 items using 5-point Likert scale: 0 [“strongly disagree”] to 4 [“strongly agree”]) and open-ended responses. We hypothesized care would be feasible (defined as average score across Likert items ≥3). We identified themes from open-ended responses and assessed contraception use at 30 days via survey.

Results: We enrolled 37 adolescents: 12 in EUC [two withdrew] and 25 in SDI; mean age was 16.6 years; Most (73%) were Black; 19% were Hispanic. Most (65%) reported previous sexual activity and nearly half (49%) reported previous hormonal contraception use. We trained 27 ED clinicians. Average feasibility scores were 4.1 (clinicians, range 1-5) and 4.6 (adolescents, range 3.6-5). Eleven (44%) SDI participants received contraception at the ED visit. Adolescents valued learning about different contraceptive options, which facilitated “figuring out what's best for me.” Clinicians described adolescents as “open” and “engaged” during counseling. Clinicians noted that contraception misconceptions were common and parental presence could influence contraceptive care, either positively or negatively. Among 17 participants reached at 30 days, SDI participants were more likely to report use of hormonal contraception (78% vs. 13%; p=0.007), compared to EUC.

Conclusion(s): Patient-centered contraception counseling and prescribing in pediatric EDs was deemed feasible by clinicians and adolescents during a pediatric ED visit. Offering same day initiation in the ED could improve adolescent contraceptive access as barriers to reproductive care increase.