Study of the Implementation of Telehealth-Supported LARC Provision in School-Based Health Centers

Columbia University75 enrolled

Overview

This is a prospective observational cohort study that will include SBHC patients at the 6 participating SBHCs who receive a reproductive health visit as part of their care in a setting where telehealth-supported care is available. Information will be collected during patient interviews in the follow-up observation period regarding LARC initiation, satisfaction and continuation. Aim 1. Quantify uptake of LARC (contraceptive implant, IUD) within the SBHC network following implementation of telehealth-supported LARC provision. Aim 2: Describe the implementation of telehealth-supported long-acting reversible contraception (LARC) service provision in school-based health centers (SBHCs) using mixed methods. Aim 3: Quantify LARC continuation, as in absolute continuation rate 12 months post-initiation, with analyses also examining continuation at 6 months follow-up period, among LARC initiators within the SBHC network following implementation of telehealth-supported LARC provision. Aim 4: Compare continuation rates across dimensions of telehealth experience.

Long acting reversible contraceptives (LARCs) are safe and effective for adolescents, but low rates of use among this population and early discontinuation due to method dissatisfaction limits their potential to reduce unintended pregnancy. Reducing barriers for obtaining LARCs by adolescents who want to use them is key in reducing risk of unintended pregnancy. Data will be collected from patients who are receiving same-day LARC as a part of their normal care via telehealth services in school-based health centers (SBHCs). This implementation model, therefore, has the potential for replication and scale-up with wide reach. The findings from this study, given the SBHC setting, have the potential to inform and improve LARC service delivery for adolescents far beyond New York City and the SBHC setting.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Long Acting Reversible Contraception

Eligibility

Sex: FEMALEMin age: 13 YearsMax age: 22 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * an enrolled patient at the participating SBHC * age 13-22 years * female * had a visit at the SBHC during the study period that is coded as a "reproductive health visit" including contraceptive counseling, contraceptive management, and contraceptive method initiation Exclusion Criteria (specifically for Aims 2 and 3): * are younger than age 13 years * are older than age 22 * are not an enrolled patient of the participating SBHCs * did not initiate a LARC method * are a person without a uterus * are unable to read, speak, and understand either English or Spanish

Outcomes

Primary Outcomes

Number of Telehealth and Non-Telehealth LARC Device Initiations Within the SBHC Network

Among all patients who had a visit for contraceptive counseling, quantify the number of telehealth LARC consultations and LARC initiations overall, and compare by LARC type (contraceptive implant vs. IUD) using data collected from patient interviews.

Time frame: Up to 20 months

Percentage of Patients Reported Being Satisfied With Telehealth-supported Care

A qualitative interview and a quantitative survey will be used to assess LARC patients' experience and satisfaction with telehealth-supported care. Patients will be assessed by investigator as satisfied or not satisfied based on their responses.

Time frame: Up to 20 months

LARC Continuation Rate Over a Follow-up Period Among LARC Initiators Within the SBHC Network Following Implementation of Telehealth-supported LARC Provision

Using EHR data for all patients who initiated LARC, investigator will use Kaplan-Meier survival curves to assess LARC discontinuation overall. Continuation rate will be expressed as a percentage at 6 months post-initiation, and using Kaplan-Meier curves to model discontinuation.

Time frame: At 6 months post LARC initiation