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Background: Efforts to increase contraceptive use among adolescents are urgently needed. One approach is to use clinical settings that do not routinely provide contraception services, such as the emergency department (ED). Though many are amenable to ED-based contraceptive care, best practices for providing this care are largely unexplored.

Objective: To assess intention to initiate contraception among adolescent females immediately after receiving ED-based contraceptive counseling, and to assess counseling feasibility, contraception initiation and completion of a follow-up visit for contraceptive care.

Design/Methods: Prospective cohort study in two urban pediatric EDs. Using webinar modules and in-person sessions, advanced practice providers (APPs) were trained to deliver brief contraception counseling. Through a patient-centered approach APPs discussed contraception type, same-day initiation and follow-up needs. Patients aged 15-18 years with any chief complaint were included if they were not currently pregnant and identified as high-risk for pregnancy (reported heterosexual sex within the last 6 months or likely future sexual activity, did not desire pregnancy, were not currently using hormonal contraception/copper intrauterine device). At the index visit we assessed demographics, feasibility of the counseling session (by both participant and APP) and intention to initiate contraception (5-point Likert scales), and contraception initiation/follow-up completion (assessed via medical record review and participant phone interview at 8 weeks post-index visit).

Results: We trained 27 APPs. 62 adolescents have completed study procedures; mean age was 16.6 years, and 26% were White, 55% Black, 16% Hispanic. Counseling lasted a mean of 12 minutes. APPs reported: counseling was easy to deliver (97%); sufficient time to complete the counseling (89%); and feeling competent to provide the counseling (89%). Most adolescents (94%) reported satisfaction with the counseling session. Half (53%) reported high intention to initiate contraception; 13 (21%) were prescribed contraception during the index visit. Seven (11%) completed a follow-up visit.

Conclusion(s): A brief contraception counseling session was feasible during a pediatric ED visit. The majority of those counseled expressed intention to initiate contraception, including some who initiated during the ED visit, but few followed-up after the ED visit. Further efforts to increase contraception access among sexually-active ED patients should include contraception initiation during ED visits.

Presented at the 2021 PAS Virtual Conference

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Emergency Medicine | Pediatrics

When and Where Presented

Presented at the 2021 PAS Virtual Conference

Contraception counseling of adolescents seeking care in pediatric emergency departments