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Hartheimer JS, Allison BA, Perry MF. Increasing access to LARC removal in pediatrics to support adolescent reproductive justice in the United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2024. [PMID: 38837867 DOI: 10.1111/psrh.12270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND In the United States (U.S.), adolescents and young adults are increasingly using contraception, including long-acting reversible contraception (LARC) [e.g., subdermal implants (e.g., Nexplanon®) and intrauterine devices (IUDs)]; however, access to LARC device removal may be difficult for adolescents and young adults. Reproductive justice is the right to bodily autonomy, have children, not have children, and safely parent the children we have. METHODS In this commentary, we discuss that while the specialties of family medicine and obstetrics and gynecology have incorporated the principles of reproductive justice into their contraceptive care, further work is needed to ingrain this philosophy into pediatrics training. Since LARC devices are historically only removable by health care providers, pediatricians may act as gatekeepers to removing LARC, obstructing the reproductive justice of adolescents and young adults. RESULTS We describe that adolescents and young adults in the U.S. face unique barriers to LARC removal including limited access to the health care system, potential breaches in confidentiality, and provider bias. These barriers may lead adolescents and young adults to remove their own LARC device when experiencing unwanted side effects or desiring pregnancy. While IUD self-removal is a safe and accessible option, safety and efficacy data on subdermal implant self-removal is currently limited. CONCLUSION In order to promote reproductive justice in adolescents and young adults, we recommend that (1) pediatricians should address potential barriers to LARC removal prior to insertion, (2) pediatricians must offer unbiased LARC removal, (3) pediatricians who place LARC must be knowledgeable about complicated LARC removal, and (4) pediatricians should discuss LARC self-removal options with adolescents and young adults.
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Affiliation(s)
- Joline S Hartheimer
- The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Bianca A Allison
- Division of General Pediatrics and Adolescent Medicine, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Martha F Perry
- Division of General Pediatrics and Adolescent Medicine, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Yarger J, Hopkins K, Elmes S, Rossetto I, Van Liefde D, De La Melena S, Harper CC. Use of telemedicine to obtain contraception among young adults: Inequities by health insurance. Contraception 2024; 134:110419. [PMID: 38467325 DOI: 10.1016/j.contraception.2024.110419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/19/2023] [Accepted: 03/06/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVES The objective of this study was to describe the use of telemedicine for contraception in a sample of young adults and examine differences by health insurance coverage. STUDY DESIGN We analyzed survey data collected from May 2020 to July 2022 from individuals at risk of pregnancy aged 18 to 29 recruited at 29 community colleges in California and Texas. We used multivariable mixed-effects logistic regression models with random effects for site and individual to compare the use of telemedicine to obtain contraception by insurance status, sociodemographic characteristics, and state. RESULTS Our analytic sample included 6465 observations from 1630 individuals. Participants reported using a contraceptive method obtained through telemedicine in just 6% of observations. Uninsured participants were significantly less likely than those privately insured to use contraception obtained through telemedicine (adjusted odds ratio [aOR], 0.54; 95% confidence interval [CI], 0.31-0.97), as were participants who did not know their insurance status (aOR, 0.54; 95% CI, 0.29-0.99). Texas participants were less likely to use contraception obtained via telemedicine than those in California (aOR, 0.42; CI: 0.25-0.69). CONCLUSIONS Few young people in this study obtained contraception through telemedicine, and insurance was crucial for access in both states. IMPLICATIONS Although telemedicine holds promise for increasing contraceptive access, we found that few young adults were using it, particularly among the uninsured. Efforts are needed to improve young adults' access to telemedicine for contraception and address insurance disparities.
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Affiliation(s)
- Jennifer Yarger
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, United States; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States; Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, United States.
| | - Kristine Hopkins
- Population Research Center, University of Texas at Austin, Austin, TX, United States
| | - Sarah Elmes
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Irene Rossetto
- Population Research Center, University of Texas at Austin, Austin, TX, United States
| | - Danielle Van Liefde
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Stephanie De La Melena
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Cynthia C Harper
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, United States; Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, United States
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Meurice ME, Mody SK, Nodora J, Marengo A, Averbach S. Social determinants of choosing telemedicine for contraceptive care: A retrospective cohort study. Contraception 2024; 134:110414. [PMID: 38431258 DOI: 10.1016/j.contraception.2024.110414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES Compare demographic characteristics and contraception choices among individuals seeking contraception care via telemedicine versus in-person. STUDY DESIGN Retrospective cohort study of contraception visits from June-September 2021 at Planned Parenthood of the Pacific Southwest. We assessed demographics and contraception choices. We used multivariable logistic regression to evaluate effect of language, age, income, having children, and insurance type on choosing telemedicine. RESULTS We included 16,855 patients: 2383 (14.1%) telemedicine visits and 14,472 (85.9%) in-person visits; 149/2383 (6.3%) non-English speakers used telemedicine compared to 1194/14,472 (8.3%) who used in-person care. A higher proportion of the telemedicine cohort had public insurance compared to the in-person cohort (2312/2383 [97.0%] telemedicine vs 11,646/14,472 [80.5%] in-person). Among the telemedicine cohort, a higher proportion of patients chose a barrier method (691/2363 [29.2%] telemedicine vs 1564/14,215 [11.0%] in-person) and short-acting method (1248/2363 [52.8%] telemedicine vs 5834/14,215 [41.0%] in-person) compared to in-person. A higher proportion of in-person patients chose long-acting reversible contraception (2681/14,215 [18.9%] in-person vs 179/2363 [7.6%] telemedicine) and injection (3779/14,215 [26.6%] in-person vs 115/2363 [4.9%] telemedicine) compared to telemedicine. Speaking Spanish was associated with decreased odds of choosing telemedicine after adjusting for covariates (aOR 0.53 [95% CI 0.44-0.64], p < 0.001). Older age, having children, lower income, and public insurance were associated with increased odds of choosing telemedicine. CONCLUSIONS Telemedicine for contraception visits was associated with language, age, parity, income, and insurance. Despite small absolute difference in the proportion of patients that speak Spanish, in adjusted multivariate analysis speaking Spanish was associated with lower odds of choosing telemedicine. IMPLICATIONS Increasing access for people with limited technology as well as those who prefer non-English languages is essential to promote equitable reproductive care. Prospective research that focuses on patient experience and preferences is needed to better guide access to equitable, person-centered contraception care.
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Affiliation(s)
- Marielle E Meurice
- Division of Complex Family Planning, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, La Jolla, CA, United States.
| | - Sheila K Mody
- Division of Complex Family Planning, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Jesse Nodora
- Radiation Medicine and Applied Sciences, Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States
| | - Antoinette Marengo
- Planned Parenthood of the Pacific Southwest, San Diego, CA, United States
| | - Sarah Averbach
- Division of Complex Family Planning, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, La Jolla, CA, United States
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Bryson AE, Milliren CE, Golub SA, Maslyanskaya S, Escovedo M, Borzutzky C, Pitts SAB, DiVasta AD. Telemedicine for Adolescent and Young Adult Long-Acting Reversible Contraception Post-insertion Visits: Outcomes over 1 Year. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00223-7. [PMID: 38679156 DOI: 10.1016/j.jpag.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
STUDY OBJECTIVE Telemedicine for long-acting reversible contraception (LARC) care is understudied given the rapid implementation of these services in response to the COVID-19 pandemic. We compared outcomes over 1 year of adolescents and young adults (AYAs) attending a LARC post-insertion visit via telemedicine vs in person. DESIGN Longitudinal cohort study. SETTING Four academic adolescent medicine clinics in the United States. PARTICIPANTS AYAs (ages 13-26 years) who received LARC between 4/1/20 and 3/1/21 and attended a post-insertion visit within 12 weeks. INTERVENTIONS none. MAIN OUTCOME MEASURES Outcomes over 1 year were compared between AYAs who completed this visit via telemedicine vs in person. We analyzed the data using descriptive statistics, bivariate analyses, and regression models. RESULTS Of 194 AYAs (ages 13.9-25.7 years) attending a post-insertion visit, 40.2% utilized telemedicine. Menstrual management (odds ratio (OR) = 1.02; confidence interval (CI): 0.40-2.60), acne management (P = .28), number of visits attended (relative risk (RR) = 1.08; CI: 0.99-1.19), and LARC removal (P = .95) were similar between groups. AYAs attending via telemedicine were less likely than those attending in person to have STI testing (P = .001). Intrauterine device expulsion or malposition and arm symptoms with implant in situ were rare outcomes in both groups. CONCLUSION Roughly 40% of AYAs attended a post-insertion visit via telemedicine during the first year of the COVID-19 pandemic and had similar 1-year outcomes as those attending in person. The decreased likelihood of STI testing for those using telemedicine highlights the need to provide alternative options, when indicated, such as asynchronous or home testing. Our results support the use of telemedicine for AYA LARC post-insertion care and identify potential gaps in telemedicine care which can help improve clinic protocols.
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Affiliation(s)
- Amanda E Bryson
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.
| | - Carly E Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts
| | - Sarah A Golub
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Sofya Maslyanskaya
- Division of Adolescent Medicine, Children's Hospital at Montefiore, New York, New York
| | - Michelle Escovedo
- Division of Adolescent/Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Claudia Borzutzky
- Division of Adolescent/Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Sarah A B Pitts
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Amy D DiVasta
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
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Eliason EL, Bellerose M. Changes in postpartum insurance and care use by disability status during the COVID-19 pandemic. Disabil Health J 2024; 17:101581. [PMID: 38233252 DOI: 10.1016/j.dhjo.2024.101581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND People with disabilities face unique health needs and barriers to perinatal care. The pandemic may have worsened health care access disparities, while pandemic-era Medicaid provisions potentially improved access via increased insurance coverage. OBJECTIVE We assessed changes in postpartum insurance, visits, and reproductive health care during the COVID-19 public health emergency (PHE) and PHE Medicaid provisions among individuals with disabilities versus individuals without disabilities. METHODS We used the 2019-2020 Pregnancy Risk Assessment Monitoring System survey and Disability Supplement to compare changes in postpartum outcomes by disability status during COVID-19. Adjusted regression models included an interaction term between disability status and postpartum exposure to the PHE. Comparative differences were examined overall, among low-income respondents, and among respondents with Medicaid-paid deliveries. RESULTS During the PHE, there was a significant increase in postpartum Medicaid by 7.1% points (95 % CI: 0.6, 13.6) and a decrease in uninsurance by 5.2% points (95 % CI: -9.0, -1.4) among respondents with disabilities relative to those without. There was a significant increase in postpartum contraception during the PHE among respondents with disabilities relative to those without by 6.3% points (95 % CI: -0.1, 12.5). The PHE was associated with larger increases in postpartum Medicaid and larger decreases in postpartum uninsurance among low-income respondents, with similar estimates among respondents with Medicaid-insured deliveries. CONCLUSIONS During the COVID-19 PHE, individuals with disabilities saw increased postpartum insurance and improved contraceptive use. As PHE Medicaid provisions are rolled back, these differential improvements should be factored into decisions about postpartum Medicaid eligibility.
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Affiliation(s)
- Erica L Eliason
- Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main St, Providence, RI, 02903, USA.
| | - Meghan Bellerose
- Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main St, Providence, RI, 02903, USA
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Bryson AE, Milliren CE, Borzutzky C, Golub SA, Pitts SAB, DiVasta AD. Adolescent and young adult long-acting reversible contraception post-insertion visit attendance before and after COVID-19. Int J Adolesc Med Health 2024; 36:55-60. [PMID: 37982676 DOI: 10.1515/ijamh-2023-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/07/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES Widespread use of telemedicine for contraceptive care, including long-acting reversible contraception (LARC), was adopted in the United States in response to the COVID-19 pandemic. Given the rapid implementation of these services, little is known about the use of telemedicine for adolescent and young adult (AYA) contraceptive care. This study examined the routine use of telemedicine for LARC post-insertion care by comparing visit attendance between AYAs receiving LARC before and after the COVID-19 pandemic onset. METHODS This analysis included LARC insertions 3/1/19-11/30/19 (pre-pandemic onset cohort) and 4/1/20-12/31/20 (post-pandemic onset cohort) from three Adolescent Medicine subspecialty clinics in the United States. De-identified data were collected via review of the electronic health record. Descriptive statistics, χ2 tests, and t-tests described and compared groups. Adjusted logistic regression models examined factors associated with attending a post-insertion visit and attending this visit via telemedicine. RESULTS This analysis included 525 LARC insertions (279 pre- and 246 post-pandemic onset). The proportion of AYAs attending a post-insertion visit increased after the COVID-19 pandemic onset (pre 30 % vs. post 46 %; p≤0.001). Adjusted models revealed that the post-pandemic onset cohort was nearly twice as likely to attend a post-insertion visit as the pre-pandemic onset cohort (OR=1.90; 95 % CI=1.68-2.15). Of those attending this visit in the post-pandemic onset cohort (n=112), 42 % utilized telemedicine. CONCLUSIONS AYAs were more likely to attend post-insertion visits after the COVID-19 pandemic onset than before. Telemedicine may have influenced this change in visit attendance.
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Affiliation(s)
- Amanda E Bryson
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Carly E Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - Claudia Borzutzky
- Division of Adolescent/Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Sarah A Golub
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Sarah A B Pitts
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Amy D DiVasta
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
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Xiao X, Mehta HB, Curran J, Garibaldi BT, Alexander GC. Potential drug-drug interactions among U.S. adults treated with nirmatrelvir/ritonavir: A cross-sectional study of the National Covid Cohort Collaborative (N3C). Pharmacotherapy 2023; 43:1251-1261. [PMID: 37539477 PMCID: PMC10838345 DOI: 10.1002/phar.2860] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 08/05/2023]
Abstract
STUDY OBJECTIVE To estimate the prevalence of potential moderate to severe drug-drug interactions (DDIs) involving nirmatrelvir/ritonavir, identify interacting medications, and evaluate risk factors associated with potential DDIs. DESIGN Cross-sectional study. DATA SOURCE Electronic health records from the National COVID Cohort Collaborative Enclave, one of the largest COVID-19 data resources in the United States. PATIENTS Outpatients aged ≥18 years and started nirmatrelvir/ritonavir between December 23, 2021 and March 31, 2022. INTERVENTION Nirmatrelvir/ritonavir. MEASUREMENTS The outcome is potential moderate to severe DDIs, defined as starting interacting medications reported by National Institutes of Health 30 days before or 10 days after starting nirmatrelvir/ritonavir. MAIN RESULTS Of 3214 outpatients who started nirmatrelvir/ritonavir, the mean age was 56.8 ± 17.1 years, 39.5% were male, and 65.8% were non-Hispanic white. Overall, 521 (16.2%) were potentially exposed to at least one moderate to severe DDI, most commonly to atorvastatin (19.2% of all DDIs), hydrocodone (14.0%), or oxycodone (14.0%). After adjustment for covariates, potential DDIs were more likely among individuals who were older (odds ratio [OR] 1.16 per 10-year increase, 95% confidence interval [CI] 1.08-1.25), male (OR 1.36, CI 1.09-1.71), smokers (OR 1.38, CI 1.10-1.73), on more co-medications (OR 1.35, CI 1.31-1.39), and with a history of solid organ transplant (OR 3.63, CI 2.05-6.45). CONCLUSIONS One in six of individuals receiving nirmatrelvir/ritonavir were at risk of a potential moderate or severe DDI, underscoring the importance of clinical and pharmacy systems to mitigate such risks.
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Affiliation(s)
- Xuya Xiao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hemalkumar B. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jill Curran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Brian T. Garibaldi
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - G. Caleb Alexander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
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Merz-Herrala AA, Kerns JL, Logan R, Gutierrez S, Marshall C, Diamond-Smith N. Contraceptive care in the United States during the COVID-19 pandemic: A social media survey of contraceptive access, telehealth use and telehealth quality. Contraception 2023; 123:110000. [PMID: 36871620 PMCID: PMC9985539 DOI: 10.1016/j.contraception.2023.110000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVES To examine demographic, socioeconomic, and regional differences in contraceptive access, differences between telehealth and in-person contraception visits, and telehealth quality in the United States during the COVID-19 pandemic. STUDY DESIGN We surveyed reproductive-age women about contraception visits during the COVID-19 pandemic via social media in July 2020 and January 2021. We used multivariable regression to examine relationships between age, racial/ethnic identity, educational attainment, income, insurance type, region, and COVID-19 related hardship, and ability to obtain a contraceptive appointment, telehealth vs in-person visits, and telehealth quality scores. RESULTS Among 2031 respondents seeking a contraception visit, 1490 (73.4%) reported any visit, of which 530 (35.6%) were telehealth. In adjusted analyses, lower odds of any visit was associated with Hispanic/Latinx and Mixed race/Other identity (aOR 0.59 [0.37-0.94], aOR 0.36 [0.22-0.59], respectively), the South, Midwest, Northeast (aOR 0.63 [0.47-0.85], aOR 0.64 [0.46-0.90], aOR 0.52 [CI 0.36-0.75], respectively), no insurance (aOR 0.63 [0.43-0.91]), greater COVID-19 hardship (aOR 0.52 [0.31-0.87]), and earlier pandemic timing (January 2021 vs July 2020 aOR 2.14 [1.69-2.70]). Respondents from the Midwest and South had lower odds of telehealth vs in-person care (aOR 0.63 [0.44-0.88], aOR 0.54 [0.40-0.72], respectively). Hispanic/Latinx respondents and those in the Midwest had lower odds of high telehealth quality (aOR 0.37 [0.17-0.80], aOR 0.58 [0.35-0.95], respectively). CONCLUSIONS We found inequities in contraceptive care access, less telehealth use for contraception visits in the South and Midwest, and lower telehealth quality among Hispanic/Latinx people during the COVID-19 pandemic. Future research should focus on telehealth access, quality, and patients' preferences. IMPLICATIONS Historically marginalized groups have faced disproportionate barriers to contraceptive care, and telehealth for contraceptive care has not been employed equitably during the COVID-19 pandemic. Though telehealth has the potential to improve access to care, inequitable implementation could exacerbate existing disparities.
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Affiliation(s)
- Allison A Merz-Herrala
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA, United States.
| | - Jennifer L Kerns
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA, United States
| | - Rachel Logan
- University of California, San Francisco, Department of Family and Community Medicine, San Francisco, CA, United States
| | - Sirena Gutierrez
- University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, United States
| | - Cassondra Marshall
- School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Nadia Diamond-Smith
- University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, United States
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Hansen K, Cohen MA, Ramanadhan S, Paynter R, Edelman A, Henderson JT. Risk of thromboembolism in patients with COVID-19 who are using hormonal contraception: a Cochrane systematic review. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:201-209. [PMID: 36882324 PMCID: PMC10359512 DOI: 10.1136/bmjsrh-2023-201792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The coronavirus disease COVID-19 is associated with an increased risk of thrombotic events. Individuals with COVID-19 using hormonal contraception could be at additional risk for thromboembolism, but evidence is sparse. METHODS We conducted a systematic review on the risk of thromboembolism with hormonal contraception use in women aged 15-51 years with COVID-19. We searched multiple databases through March 2022, including all studies comparing outcomes of patients with COVID-19 using or not using hormonal contraception. We applied standard risk of bias tools to evaluate studies and GRADE methodology to assess certainty of evidence. Our primary outcomes were venous and arterial thromboembolism. Secondary outcomes included hospitalisation, acute respiratory distress syndrome, intubation, and mortality. RESULTS Of 2119 studies screened, three comparative non-randomised studies of interventions (NRSIs) and two case series met the inclusion criteria. All studies had serious to critical risk of bias and low study quality. Overall, there may be little to no effect of combined hormonal contraception (CHC) use on odds of mortality for COVID-19-positive patients (OR 1.0, 95% CI 0.41 to 2.4). The odds of hospitalisation for COVID-19-positive CHC users may be slightly decreased compared with non-users for patients with body mass index <35 kg/m2 (OR 0.79, 95% CI 0.64 to 0.97). Use of any type of hormonal contraception may have little to no effect on hospitalisation rates for COVID-19-positive individuals (OR 0.99, 95% CI 0.68 to 1.44). CONCLUSIONS Not enough evidence exists to draw conclusions regarding risk of thromboembolism in patients with COVID-19 using hormonal contraception. Evidence suggests there may be little to no or slightly decreased odds of hospitalisation, and little to no effect on odds of mortality for hormonal contraception users versus non-users with COVID-19.
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Affiliation(s)
- Katie Hansen
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Megan A Cohen
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Shaalini Ramanadhan
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Robin Paynter
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Alison Edelman
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jillian T Henderson
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
- Evidence-based Practice Center, Kaiser Permanente, Portland, Oregon, USA
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Vernon V, Patel J, Cieri-Hutcherson NE, Arellano R, Elmore H, Griffin BL, Mitzel K, Moyeno WM, O'Connell MB, Pelaccio K, Lodise NM. The impact of COVID-19 on select considerations in patients of reproductive age: Brief talking points for pharmacists. J Am Pharm Assoc (2003) 2023; 63:720-724. [PMID: 36775738 PMCID: PMC9831663 DOI: 10.1016/j.japh.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 01/12/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has elicited many health concerns, including the impact of the infection and vaccine on reproductive health. Although robust evidence demonstrates the safety of all available COVID-19 vaccines, misinformation and disinformation related to the vaccine continue to circulate. As accessible and essential health care workers, it is crucial that pharmacists are informed of the evidence related to effects of the COVID-19 infection and vaccinations on reproductive health care. Menstrual cycle changes have been noted owing to COVID-19 infection, pandemic stress, and COVID-19 vaccination. COVID-19 infection and vaccination have not been shown to influence female fertility, pregnancy rates, and lactation. The use of exogenous estrogen may further contribute to an increased risk of thromboembolism with COVID-19 infection, and differences in the risk of cerebral venous sinus thrombosis appear to exist between the types of vaccines. The benefits of COVID-19 vaccination outweigh any risks. Shared decision-making is necessary when discussing vaccination with patients. Pharmacists play a vital role in dispelling misinformation and disinformation related to the impact of COVID-19 illness and vaccination on reproductive health care.
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Pearlman Shapiro M, Myo M, Chen T, Nathan A, Raidoo S. Remote Provision of Medication Abortion and Contraception Through Telemedicine. Obstet Gynecol 2023:00006250-990000000-00746. [PMID: 37054393 DOI: 10.1097/aog.0000000000005205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/23/2023] [Indexed: 04/15/2023]
Abstract
This Narrative Review describes the remote provision of family planning services, including medication abortion and contraception, through telemedicine. The coronavirus disease 2019 (COVID-19) pandemic was a catalyst to shift toward telemedicine to maintain and expand access to crucial reproductive health services when public health measures necessitated social distancing. There are legal and political considerations when providing medication abortion through telemedicine, along with unique challenges, even more so after the Dobbs decision starkly limited options for much of the country. This review includes the literature describing the logistics of telemedicine and modes of delivery for medication abortion and details special considerations for contraceptive counseling. Health care professionals should feel empowered to adopt telemedicine practices to provide family planning services to their patients.
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Affiliation(s)
- Marit Pearlman Shapiro
- University of Southern California, Los Angeles, and the University of California, San Diego, La Jolla, California; and the University of Hawaii, Honolulu, Hawaii
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12
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Fay KE, Traore F, Amico JR. Intrauterine device self-removal practices during the COVID-19 pandemic among family planning clinics. Contraception 2023; 118:109889. [PMID: 36243126 PMCID: PMC9554323 DOI: 10.1016/j.contraception.2022.09.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To explore the prevalence of intrauterine device self-removal practices before and during the COVID-19 pandemic among family planning clinics. STUDY DESIGN This is a secondary analysis of data from a descriptive, longitudinal study using a clinic-based convenience sample from the Abortion Clinical Research Network assessing baseline and pandemic-adaptive family planning practices. RESULTS Of the 63 sites that provided contraception, 5 (7.9%) reported providing guidance on intrauterine device self-removal at baseline. Sixteen sites (25.4%) provided guidance on self-removal by the end of the study period. Self-removal counseling was associated with being an academic center and reporting a median lower number of monthly contraceptive encounters. CONCLUSIONS Endorsement of IUD self-removal increased to one-quarter of sites by the final timepoint. IMPLICATIONS Twenty-five percent of family planning clinics reported provision of intrauterine device self-removal guidance by eight months into the COVID-19 pandemic, a three-fold increase from baseline; these findings suggest clinician support for patient autonomy in contraceptive self-management and limited concern for safety issues with self-removal during a public health emergency.
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Affiliation(s)
- Kathryn E. Fay
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, United States,Corresponding author
| | - Fadila Traore
- The Cambridge School of Weston, Weston, MA, United States
| | - Jennifer R. Amico
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
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Salcedo J, Cleland K, Bartz D, Thompson I. Society of Family Planning Clinical Recommendation: Emergency contraception. Contraception 2023; 121:109958. [PMID: 36693445 DOI: 10.1016/j.contraception.2023.109958] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/30/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
Emergency contraception (EC) refers to several contraceptive options that can be used within a few days after unprotected or under protected intercourse or sexual assault to reduce the risk of pregnancy. Current EC options available in the United States include the copper intrauterine device (IUD), levonorgestrel (LNG) 52 mg IUD, oral LNG (such as Plan B One-Step, My Way, Take Action), and oral ulipristal acetate (UPA) (ella). These clinical recommendations review the indications, effectiveness, safety, and side effects of emergency contraceptive methods; considerations for the use of EC by specific patient populations and in specific clinical circumstances and current barriers to emergency contraceptive access. Further research is needed to evaluate the effectiveness of LNG IUDs for emergency contraceptive use; address the effects of repeated use of UPA at different times in the same menstrual cycle; assess the impact on ovulation of initiating or reinitiating different regimens of regular hormonal contraception following UPA use; and elucidate effective emergency contraceptive pill options by body mass indices or weight.
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Affiliation(s)
- Jennifer Salcedo
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, United States.
| | - Kelly Cleland
- American Society for Emergency Contraception, Lawrenceville, NJ, United States
| | - Deborah Bartz
- Department of Obstetrics and Gynecology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Ivana Thompson
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
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VandeVusse A, Castillo PW, Kirstein M, Mueller J, Kavanaugh M. Disruptions and opportunities in sexual and reproductive health care: How COVID-19 impacted service provision in three US states. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2022; 54:188-197. [PMID: 36351551 PMCID: PMC9878085 DOI: 10.1363/psrh.12213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CONTEXT The COVID-19 pandemic abruptly disrupted the provision of sexual and reproductive health care in the United States. METHODS We conducted interviews with family planning clinic staff at 55 health care facilities in Arizona, Iowa, and Wisconsin in late 2020 and early 2021. We asked respondents about the challenges they faced and ways they adapted their service provision as a result of the pandemic. We conducted content and thematic analyses of the interview transcripts using an inductively developed qualitative coding scheme. RESULTS Family planning clinics and providers made a variety of changes to their clinic operations and service delivery. The three major areas of change for these facilities were implementation of COVID-19 safety procedures, shifting service delivery and staffing to meet patient needs, and the rapid uptake and expansion of telehealth. CONCLUSION While providers faced many challenges, they also described opportunities to innovate and rethink standard of care protocols that may continue to shape sexual and reproductive health care even after the pandemic abates.
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