160 - Provider Attitudes Toward Providing Long-Acting Reversible Contraception in a Pediatric Emergency Department

Publication Number: 160.6165

Lauren Coffey, Medical College of Wisconsin, Milwaukee, WI, United States; Vanessa McFadden, Medical College of Wisconsin, MIlwaukee, WI, United States; Rachel Segal, Medical College of Wisconsin, Milwaukee, WI, United States; Elizabeth Hovel, Medical College of Wisconsin, Milwaukee, WI, United States; Kelli Corrao, Medical College of Wisconsin, Milwaukee, WI, United States; Michelle Pickett, Medical College of Wisconsin, Milwaukee, WI, United States

Background: The pediatric emergency department (ED) is a unique location to potentially provide long-acting reversible contraceptives (LARCs) such as subdermal hormonal implants and intra-uterine devices (IUDs) to adolescents. Teens have demonstrated interest in initiating contraception in the ED. Same-day ED LARC insertion has been piloted with success in adults.

Objective: Evaluate pediatric provider attitudes towards the concept of ED LARC placement to assess the feasibility of providing this service.

Design/Methods: Cross-sectional single-center survey distributed to providers in pediatric emergency medicine (PEM), pediatric hospital medicine, child advocacy pediatrics, and adolescent medicine in July 2024. Survey was informed by current literature and content experts. Questions addressed provider support for LARC provision in the ED as well as perceived benefits and barriers. Likert responses were dichotomized; neutral and disagreeing responses were combined. Data was analyzed with descriptive statistics and Fisher exact test.

Results: 56 providers responded (43% response rate). Most agree the ED is an appropriate place to insert subdermal implants (63%) and that PEM providers are appropriate providers to insert them (71%), although PEM agreement was less, there was no significant difference by specialty, Table 1. However only 46% agree the ED is an appropriate place to insert IUDs; only 22% of PEM providers agree which is significantly less than other specialties (p=0.01), Table 1. 55% agree with PEM providers inserting IUDs, with no significant difference by specialty. Top benefits of ED LARC placement include preventing unintended pregnancy (88%) and accessing a population with low utilization of primary or gynecologic care (80%), Table 2. Top barriers include time involved in counseling patients (89%) and lack of follow-up (82%), Table 3.
PEM providers varied in their personal level of comfort of ED LARC provision: 41% would be agreeable to performing insertion, 23% preferred consulting specialties inserting LARCs in the ED, 14% were comfortable with other PEM providers but not personally. Only one provider was not comfortable with any provision of this service in the ED.

Conclusion(s): Most participants agree with subdermal implant insertion in the ED, and nearly all PEM providers are comfortable with either themselves or another provider inserting a LARC in the ED. Future LARC provision in the ED must consider time and workflow constraints to increase PEM providers buy-in, but will be beneficial for accessing patient populations unique to the ED.

Table 1: Provider attitudes towards LARC placement in the pediatric ED, by specialty
LARC = long-acting reversible contraception; ED = emergency department; IUD = intrauterine device; PEM = pediatric emergency medicine; PHM = pediatric hospital medicine; CAP = child abuse pediatrics; AM = adolescent medicine

Table 2: Perceived benefits of LARC insertion in the pediatric ED, by specialty*
LARC = long-acting reversible contraception; ED = emergency department; IUD = intrauterine device; PEM = pediatric emergency medicine; PHM = pediatric hospital medicine; CAP = child abuse pediatrics; AM = adolescent medicine
* survey responders able to select multiple responses
+ signifies p-value <0.05

Table 3: Perceived barriers to LARC insertion in the pediatric ED, by specialty*
LARC = long-acting reversible contraception; ED = emergency department; PEM = pediatric emergency medicine; PHM = pediatric hospital medicine; CAP = child abuse pediatrics; AM = adolescent medicine
* survey responders able to select multiple responses
+ signifies p-value <0.05

Table 1: Provider attitudes towards LARC placement in the pediatric ED, by specialty
LARC = long-acting reversible contraception; ED = emergency department; IUD = intrauterine device; PEM = pediatric emergency medicine; PHM = pediatric hospital medicine; CAP = child abuse pediatrics; AM = adolescent medicine

Table 2: Perceived benefits of LARC insertion in the pediatric ED, by specialty*
LARC = long-acting reversible contraception; ED = emergency department; IUD = intrauterine device; PEM = pediatric emergency medicine; PHM = pediatric hospital medicine; CAP = child abuse pediatrics; AM = adolescent medicine
* survey responders able to select multiple responses
+ signifies p-value <0.05

Table 3: Perceived barriers to LARC insertion in the pediatric ED, by specialty*
LARC = long-acting reversible contraception; ED = emergency department; PEM = pediatric emergency medicine; PHM = pediatric hospital medicine; CAP = child abuse pediatrics; AM = adolescent medicine
* survey responders able to select multiple responses
+ signifies p-value <0.05