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

Research output: Contribution to journalArticle

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Abstract

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. Study Design 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. Conclusion Although adolescents served by CCare are more likely to initiate contraception, they are less likely to receive LARC than women aged 20-25 years. Implication Efforts are needed to ensure that adolescents have access to highly effective reversible contraception.

Original languageEnglish (US)
Pages (from-to)328-335
Number of pages8
JournalContraception
Volume91
Issue number4
DOIs
StatePublished - Apr 1 2015

Fingerprint

Family Planning Services
Contraceptive Agents
Contraception
Confidence Intervals
Odds Ratio
Quality of Health Care
Ambulatory Care
Natural Family Planning Methods
Logistic Models
Intrauterine Devices

Keywords

  • Adolescents
  • Contraception
  • LARC
  • Medicaid
  • Quality of care
  • Title X

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

Cite this

Examining quality of contraceptive services for adolescents in Oregon's family planning program. / Rodriguez, Maria; Darney, Blair; Elman, Emily; Linz, Rachel; Caughey, Aaron; McConnell, Kenneth (John).

In: Contraception, Vol. 91, No. 4, 01.04.2015, p. 328-335.

Research output: Contribution to journalArticle

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abstract = "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. Study Design 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. Conclusion Although adolescents served by CCare are more likely to initiate contraception, they are less likely to receive LARC than women aged 20-25 years. Implication Efforts are needed to ensure that adolescents have access to highly effective reversible contraception.",
keywords = "Adolescents, Contraception, LARC, Medicaid, Quality of care, Title X",
author = "Maria Rodriguez and Blair Darney and Emily Elman and Rachel Linz and Aaron Caughey and McConnell, {Kenneth (John)}",
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AU - McConnell, Kenneth (John)

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N2 - 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. Study Design 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. Conclusion Although adolescents served by CCare are more likely to initiate contraception, they are less likely to receive LARC than women aged 20-25 years. Implication Efforts are needed to ensure that adolescents have access to highly effective reversible contraception.

AB - 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. Study Design 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. Conclusion Although adolescents served by CCare are more likely to initiate contraception, they are less likely to receive LARC than women aged 20-25 years. Implication Efforts are needed to ensure that adolescents have access to highly effective reversible contraception.

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