National Practices, Attitudes, and Training Surrounding Long-Acting Reversible Contraception Procedures for Adolescents

BACKGROUND: Primary care for adolescents in the United States is predominantly provided by pediatricians. For these patients, sexual health and contraception are important parts of primary care. Despite this, pediatricians are often less comfortable providing contraceptive counseling and lack training to administer long-acting reversible contraception (LARC), a highly effective form of contraception. Medically- and socially- complex patients access to contraception is additionally limited, as they often receive much of their medical care in the hospital setting. Training pediatricians and pediatric hospitalists to effectively administer LARC in both outpatient and inpatient settings would increase adolescent access to sexual health care, including LARC. OBJECTIVE: This mixed-methods study aims (1) to quantitatively describe national practices and training for providing sexual health services, including LARC, in the inpatient setting and (2) to qualitatively characterize the attitudes of clinicians about the appropriateness of and training surrounding LARC procedures for adolescents in the inpatient setting to generate strategies to improve training for pediatricians. METHODS: For aim 1, pediatric providers across the nation were invited to complete an online REDCap survey to assess current LARC services at their institution, attitudes about desiring LARC services, and interest in LARC training. Descriptive frequencies were reported. For aim 2, focus group interviews of a subsample of survey participants were facilitated on Zoom to assess barriers and facilitators to sexual health services and training for these sexual health services in pediatric hospitals. Interviews were transcribed and coded using Nvivo. Discordance was resolved by consensus and thematic analysis was performed. RESULTS: Survey data (n = 610) indicated that inpatient LARC services are currently limited (12% and 19% of participants reporting IUDs and implants, respectively, administered inpatient at their hospital site). Among those at hospitals not currently placing LARC, many wished this service was available (43% for IUD and 37% for implant) and over half were willing to learn how to place LARC (49% for IUD and 56% for implant). From the interview data (n = 32), beliefs in the appropriateness of administering LARC to adolescents varied, but many believed it was appropriate in all settings, including inpatient as "every hospitalization is an opportunity to review healthcare maintenance, and contraception- that's healthcare maintenance for a teenager." Regarding training, lack of willingness to learn how to place LARC centered around lack of knowledge, skills, and resources for pediatricians and pediatric hospitalists. Although training opportunities are often available, they are usually elective and at inopportune times. Those who have successfully received training reported it occurring during scheduled training blocks and including instructions on confidentiality and billing. CONCLUSION: Some of the limited availability of LARC for adolescent patients can be attributed to limited contraceptive training for pediatricians and pediatric hospitalists. To expand access, training opportunities for pediatric trainees should be scheduled as part of mandatory didactics and include didactic, simulation, and clinical practice components that touch on logistic aspects including acquiring equipment, confidential counseling, and billing and documentation.