P084The role of pediatric subspecialists in adolescent and young adult contraceptive care

Abstract

<h3>Objectives</h3> To evaluate pediatric subspecialists' contraceptive attitudes and care practices for their adolescent and young adult (AYA) patients with chronic medical illnesses and/or medications that put them at risk for adverse pregnancy outcomes. <h3>Methods</h3> We used listservs to recruit pediatric subspecialists that care for AYAs (aged 12–24) at risk for pregnancy who have complex medical conditions that pose significant pregnancy health risk, as defined by the WHO (World Health Organization) or who use teratogenic medications. Participants completed an online survey about their contraceptive attitudes and care behaviors. <h3>Results</h3> 510 pediatric subspecialists completed the survey (24% renal, 18% pulmonology, 18% gastroenterology, 9% rheumatology and; the remaining 31% included endocrinology, hematology/oncology, and neurology). Most (73%) felt their role included discussing contraception with patients, but only 38% felt it was important to discuss with all their adolescent patients and only 5% felt "totally comfortable" doing so. Only 18% had a clinic policy or note template regarding contraception78% felt their role included making a referral for contraception: 60% referred to adolescent medicine and only 37% referred to gynecology specialists. 11% felt that their role included contraceptive provision. Most (78%) said having referral resources, and training on taking a sexual history and on local laws would make it easier for them to discuss sexual and reproductive health with their patients. <h3>Conclusions</h3> Our findings demonstrate a clear and important need for complex family planning specialists to develop collaborative training and referral relationships with pediatric subspecialists to improve access to reproductive healthcare for their patients.