Attendance of an Initial Follow-up Visit after Long-Acting Reversible Contraception Insertion and Method Continuation Among Adolescents and Young Adults: A Retrospective Study.

Abstract

To assess attendance of an initial follow-up visit after long-acting reversible contraception (LARC) insertion and whether follow-up was associated with a higher likelihood of method continuation in adolescents and young adults (AYAs). Retrospective chart review including patients receiving LARC (etonogestrel 68mg implant, levonorgestrel 52mg intrauterine device, or copper intrauterine device) between January 1, 2014, and August 1,2017. An urban adolescent center providing primary care and reproductive health services. A total of 331 patients 13-28years of age. Attendance of a follow-up visit 4-8weeks after LARC insertion. Follow-up was defined as visits addressing LARC method or routine physical examinations in the adolescent center or affiliated school-based health clinics. Continuation and discontinuation were defined as documented presence or removal, respectively, of device at various time points. Descriptive analyses, χ2 test, Fisher exact test, t test, and survival analysis were used. Approximately one-third (29.3%) of the patients attended a follow-up visit. Follow-up was associated with a higher likelihood of LARC removal in the first year (hazard ratio [HR]=2.10, 95% confidence interval [CI] 1.33-3.32). At 500days post-insertion and beyond, there was no difference in LARC continuation between AYAs who followed-up and those who did not (HR=1.07, 95% CI 0.67-1.71). Few AYAs attended an initial follow-up visit after LARC placement. These visits were associated with an increased likelihood of LARC removal in the first year; however, this association was not observed long term. More information is needed to determine how to approach follow-up this population.