Single-visit insertion of long-acting reversible contraception in a single health system

Abstract

ObjectiveTo identify patient and practice characteristics associated with single-visit placement of long-acting reversible contraception (LARC) across the University of North Carolina Health system. Study designWe conducted a retrospective observational study using existing electronic health records. We abstracted data from charts of individuals ages 15–50 years who received a LARC device between March 15, 2019, and March 14, 2021. Our primary outcome was whether a patient received LARC at one, or after multiple, outpatient visits. We used descriptive statistics to examine patient, clinician, and practice characteristics. We used bivariate analysis and generalized estimating equation to examine relationships between characteristics and single-visit LARC receipt. ResultsMost of the 4599 individuals received care at obstetrics and gynecology clinics (3411/4599; 74%), and received their LARC device in a single visit (3163/4599; 69%). More intrauterine devices (3151) were placed than implants (1448). The adjusted odds of receiving a LARC in a single visit was highest for those who self-paid (aOR (adjusted odds ratio) 1.83, 1.19–2.82) and those who received an implant (aOR 1.25, 1.07–1.46). Patients seen by advanced practice practitioners (aOR 0.67, 0.56–0.80) or by an internal medicine specialty clinician (aOR 0.13, 0.00–0.35) had lower odds of receiving a single-visit LARC compared to those seen by a specialist obstetrician-gynecologist physician. ConclusionMost single-visit LARC placements were performed by clinicians in obstetrician-gynecologist specialty practices. ImplicationsAmong individuals seeking long-acting reversible contraceptives from clinics in a single health system in North Carolina, most received a device at a single visit and most single-visit insertions were done by an obstetrician-gynecologist.