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Abstract：
OBJECTIVE: Despite increasing use of long-acting reversible contraception (LARC) among U.S. adolescents, there is limited literature on factors affecting intrauterine device (IUD) or subdermal implant use. This study aimed to describe statewide rates, and associated patient and provider factors of adolescent IUD or implant initiation and continuation.
METHODS: This retrospective cohort study used N.C. Medicaid claims data. 10,408 adolescents were eligible (i.e., 13-19 years, female sex, continuous Medicaid enrollment, had an IUD or implant insertion or removal code from January 1, 2013, to October 1, 2015). Bivariate analyses assessed differences in adolescents using IUD versus implant. Kaplan-Meier curves were created to assess IUD or implant discontinuation through December 31, 2018.
RESULTS: Adolescents initiated 8,592 implants and 3,369 IUDs (N = 11,961). There were significant differences in nearly all provider and patient factors for those who initiated implants versus IUDs. 16% of implants and 53% of IUDs were removed in the first year. Younger (i.e., age <18 years old), Hispanic, and Black adolescents had higher adjusted continuation of implants compared with older and White adolescents, respectively (both p < .001). Those whose IUD was inserted by an obstetrician/gynecologist provider had lower continuation of IUDs compared with non-obstetrician/gynecologist providers (p < .001).
CONCLUSIONS: We found that age-related, racial, and ethnic disparities exist in both implant and IUD continuation. Practice changes to support positive adolescent experiences with implant and IUD insertion and removals are needed, including patient-centered health care provider training in contraception counseling, LARC initiation and removal training for adolescent-facing providers, and broader clinic capacity for LARC services.
METHODS: This retrospective cohort study used N.C. Medicaid claims data. 10,408 adolescents were eligible (i.e., 13-19 years, female sex, continuous Medicaid enrollment, had an IUD or implant insertion or removal code from January 1, 2013, to October 1, 2015). Bivariate analyses assessed differences in adolescents using IUD versus implant. Kaplan-Meier curves were created to assess IUD or implant discontinuation through December 31, 2018.
RESULTS: Adolescents initiated 8,592 implants and 3,369 IUDs (N = 11,961). There were significant differences in nearly all provider and patient factors for those who initiated implants versus IUDs. 16% of implants and 53% of IUDs were removed in the first year. Younger (i.e., age <18 years old), Hispanic, and Black adolescents had higher adjusted continuation of implants compared with older and White adolescents, respectively (both p < .001). Those whose IUD was inserted by an obstetrician/gynecologist provider had lower continuation of IUDs compared with non-obstetrician/gynecologist providers (p < .001).
CONCLUSIONS: We found that age-related, racial, and ethnic disparities exist in both implant and IUD continuation. Practice changes to support positive adolescent experiences with implant and IUD insertion and removals are needed, including patient-centered health care provider training in contraception counseling, LARC initiation and removal training for adolescent-facing providers, and broader clinic capacity for LARC services.
摘要：
目标：尽管在美国青少年中使用长效可逆避孕（LARC），关于影响宫内节育器(IUD)或皮下植入物使用的因素的文献有限.这项研究旨在描述全州的利率，青少年宫内节育器或植入和继续植入的相关患者和提供者因素。
方法：本回顾性队列研究使用N.C.Medicaid索赔数据。10,408名青少年符合资格(即，13-19年,女性性别,持续的医疗补助登记，从2013年1月1日至2015年10月1日，有宫内节育器或植入物插入或取出代码)。双变量分析评估青少年使用宫内节育器与植入物的差异。创建Kaplan-Meier曲线以评估到2018年12月31日IUD或植入物停药。
结果：青少年开始植入8,592枚植入物和3,369枚宫内节育器（N=11,961）。对于那些开始植入宫内节育器的人，几乎所有提供者和患者因素都存在显着差异。第一年移除16％的植入物和53％的宫内节育器。更年轻(即，年龄<18岁)，西班牙裔,与年长和白人青少年相比，黑人青少年的植入物调整后的连续性更高，分别(两者p<.001)。与非产科医生/妇科医生提供者相比，那些由产科医生/妇科医生提供者插入宫内节育器的持续宫内节育器较低（p<.001）。
结论：我们发现年龄相关，种族,植入和宫内节育器延续存在种族差异。需要进行实践更改，以支持青少年在植入和IUD插入和移除方面的积极经验，包括以患者为中心的医疗服务提供者避孕咨询培训，面向青少年提供者的LARC启动和移除培训，以及更广泛的LARC服务诊所能力。
方法：本回顾性队列研究使用N.C.Medicaid索赔数据。10,408名青少年符合资格(即，13-19年,女性性别,持续的医疗补助登记，从2013年1月1日至2015年10月1日，有宫内节育器或植入物插入或取出代码)。双变量分析评估青少年使用宫内节育器与植入物的差异。创建Kaplan-Meier曲线以评估到2018年12月31日IUD或植入物停药。
结果：青少年开始植入8,592枚植入物和3,369枚宫内节育器（N=11,961）。对于那些开始植入宫内节育器的人，几乎所有提供者和患者因素都存在显着差异。第一年移除16％的植入物和53％的宫内节育器。更年轻(即，年龄<18岁)，西班牙裔,与年长和白人青少年相比，黑人青少年的植入物调整后的连续性更高，分别(两者p<.001)。与非产科医生/妇科医生提供者相比，那些由产科医生/妇科医生提供者插入宫内节育器的持续宫内节育器较低（p<.001）。
结论：我们发现年龄相关，种族,植入和宫内节育器延续存在种族差异。需要进行实践更改，以支持青少年在植入和IUD插入和移除方面的积极经验，包括以患者为中心的医疗服务提供者避孕咨询培训，面向青少年提供者的LARC启动和移除培训，以及更广泛的LARC服务诊所能力。
