Examining quality of contraceptive services for adolescents in Oregon's family planning program. 2015

Maria Isabel Rodriguez, and Blair G Darney, and Emily Elman, and Rachel Linz, and Aaron B Caughey, and K John McConnell
Oregon Health & Science University, Portland, OR, USA. Electronic address: rodrigma@ohsu.edu.

OBJECTIVE To assess the quality of care provided to adolescents (10-19 years old) compared to women (aged 20-25 years) who accessed services in Oregon's Contraceptive Care (CCare) program. METHODS We analyzed data routinely collected using the Clinic Visit Record form from women aged 25 years and younger who visited CCare clinics between January 1, 2004, and October 31, 2010. Modern methods were characterized into three tiers: Tier 1 is the intrauterine device, implant and sterilization; Tier 2, hormonal methods; and Tier 3, all barrier methods. Nonmodern methods included no method, withdrawal and natural family planning. We used multivariable logistic regression models to examine the effect of age on three indicators of quality of contraceptive care: transitioning from a nonmodern to a modern method, transitioning from Tier 3 methods to Tier 1 or Tier 2 methods, and initiation of long-acting reversible contraception (LARC). We then produced predicted probabilities to facilitate data interpretation. RESULTS Adolescents accounted for 344,856 (41%) of the 848,221 clinic visits occurring in CCare among women under age 25. Compared with women (ages 20-25 years), young and older adolescents had decreased odds of LARC initiation [odds ratio (OR) 0.24 (95% confidence interval [CI] 0.16-0.35) and OR 0.44 (95% CI 0.38-0.52), respectively]. However, compared with women, both young and older adolescents had increased odds of leaving with any contraceptive method [OR 1.8 95% (CI 1.26-2.59) and OR 1.42 (95% CI 1.21-1.66)]. Among clients presenting with no method of contraception at the beginning of the visit, 78.7% of young adolescents (95% CI 73.84-83.03) compared with 81.44% (95% CI 77.02-85.52) of older adolescents, and 76.63% (95% CI 69.90-80.75) of young women left with a modern method, controlling for other covariates. CONCLUSIONS Although adolescents served by CCare are more likely to initiate contraception, they are less likely to receive LARC than women aged 20-25 years. CONCLUSIONS Efforts are needed to ensure that adolescents have access to highly effective reversible contraception.

UI MeSH Term Description Entries
D007434 Intrauterine Devices Contraceptive devices placed high in the uterine fundus. Contraceptive Devices, Intrauterine,Contraceptive IUD,Contraceptive IUDs,IUD, Unmedicated,Unmedicated IUDs,Contraceptive Device, Intrauterine,Device, Intrauterine,Device, Intrauterine Contraceptive,Devices, Intrauterine,Devices, Intrauterine Contraceptive,IUD, Contraceptive,IUDs, Contraceptive,Intrauterine Contraceptive Device,Intrauterine Contraceptive Devices,Intrauterine Device,Unmedicated IUD
D008484 Medicaid Federal program, created by Public Law 89-97, Title XIX, a 1965 amendment to the Social Security Act, administered by the states, that provides health care benefits to indigent and medically indigent persons. Dental Medicaid Program,Medical Assistance, Title 19,Dental Medicaid Programs,Medicaid Program, Dental,Medicaid Programs, Dental,Program, Dental Medicaid,Programs, Dental Medicaid
D009922 Oregon State bounded on the north by Washington, on the east by Idaho, on the south by California and Nevada, and on the west by the Pacific Ocean.
D011787 Quality of Health Care The levels of excellence which characterize the health service or health care provided based on accepted standards of quality. Pharmacy Audit,Quality of Care,Quality of Healthcare,Audit, Pharmacy,Care Quality,Health Care Quality,Healthcare Quality,Pharmacy Audits
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D003076 Coitus Interruptus A contraceptive method whereby coitus is purposely interrupted in order to prevent EJACULATION of SEMEN into the VAGINA. Interruptus, Coitus
D003267 Contraception Prevention of CONCEPTION by blocking fertility temporarily, or permanently (STERILIZATION, REPRODUCTIVE). Common means of reversible contraception include NATURAL FAMILY PLANNING METHODS; CONTRACEPTIVE AGENTS; or CONTRACEPTIVE DEVICES. Birth Control,Contraceptive Methods,Female Contraception,Fertility Control,Inhibition of Fertilization,Male Contraception,Contraception, Female,Contraception, Male,Contraceptions, Female,Contraceptions, Male,Contraceptive Method,Female Contraceptions,Fertilization Inhibition,Male Contraceptions
D003278 Contraceptives, Oral, Hormonal Oral contraceptives which owe their effectiveness to hormonal preparations. Hormonal Oral Contraceptive,Hormonal Oral Contraceptive Agent,Contraceptive Agents, Estrogen,Contraceptive Agents, Oral, Hormonal,Hormonal Oral Contraceptive Agents,Oral Contraceptive Agents, Hormonal,Oral Contraceptives, Hormonal,Contraceptive, Hormonal Oral,Contraceptives, Hormonal Oral,Estrogen Contraceptive Agents,Hormonal Oral Contraceptives,Oral Contraceptive, Hormonal
D004343 Drug Implants Small containers or pellets of a solid drug implanted in the body to achieve sustained release of the drug. Drug Implant,Drug Pellet,Pellets, Drug,Drug Pellets,Implant, Drug,Implants, Drug,Pellet, Drug
D005193 Family Planning Services Health care programs or services designed to assist individuals in the planning of family size. Various methods of CONTRACEPTION can be used to control the number and timing of childbirths. Family Planning,Family Planning Programs,Planned Pregnancy,Pregnancy, Planned,Family Planning Program,Family Planning Service,Planned Pregnancies,Planning Service, Family,Planning Services, Family,Pregnancies, Planned,Program, Family Planning,Programs, Family Planning,Service, Family Planning,Services, Family Planning

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