Providing contraceptive care in the pediatric emergency department
A new study found that two-thirds of female adolescents ages 16-21 seen in a pediatric Emergency Department (ED) were interested in discussing contraception, despite having a high rate of recent visits to a primary care provider. More than 22% indicated that they would be likely to start or change contraception during the ED visit. Is the ED a "Golden Opportunity" for contraceptive education and initiation, ask the authors of this study in Journal of Women's Health.
The article entitled "Identifying a Golden Opportunity: Adolescent Interest in Contraceptive Initiation in a Pediatric Emergency Department" was coauthored by Colleen Gutman, MD and Atsuko Koyama, MD, MPH, Emory University, David Dorfman, MD and Patricia Kavanagh, MD, Boston University School of Medicine, and Halea Meese, University of Colorado School of Medicine.
Among the 381 women surveyed, 80.5% had been sexually active with a male partner and 28.2% had previously been pregnant. Thirty-nine percent of the women were currently using hormonal contraception, and 57.2 % were satisfied with their current method of contraception. Based on their findings, the researchers concluded that the ED provides an important opportunity to discuss and initiate effective contraception for young women.
The accompanying Editorial entitled "Contraception Provision in the Emergency Department: Are We Ready to Overcome the Obstacles?" details the challenges to providing contraceptive care in the ED, but concludes: "Despite these barriers, the benefits to providing contraception are undeniable." Obstacles include the variation in provider comfort with discussing contraceptive options, the training required for placing long-acting reversible contraception, such as implants, billing and insurance issues, and concerns related to parental and provider acceptance.
Editorial coauthors Kayleigh Fischer, MD, Washington University in Saint Louis School of Medicine, and Lauren Chernnick, MD, Columbia University Medical. Center, conclude, "If we can design novel ways to weave contraceptive provision in to the ED workflow, such as using technology or outside assistance such as health educators, we may be closer to finding the middle ground in which our female patients are receiving the evidence-based, patient-centered reproductive counseling they not only need but deserve."