Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.
Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts.
J Pediatr Adolesc Gynecol. 2024 Aug;37(4):438-443. doi: 10.1016/j.jpag.2024.04.004. Epub 2024 Apr 26.
Telemedicine for long-acting reversible contraception (LARC) care is understudied given the rapid implementation of these services in response to the COVID-19 pandemic. We compared outcomes over 1 year of adolescents and young adults (AYAs) attending a LARC post-insertion visit via telemedicine vs in person.
Longitudinal cohort study.
Four academic adolescent medicine clinics in the United States.
AYAs (ages 13-26 years) who received LARC between 4/1/20 and 3/1/21 and attended a post-insertion visit within 12 weeks.
none.
Outcomes over 1 year were compared between AYAs who completed this visit via telemedicine vs in person. We analyzed the data using descriptive statistics, bivariate analyses, and regression models.
Of 194 AYAs (ages 13.9-25.7 years) attending a post-insertion visit, 40.2% utilized telemedicine. Menstrual management (odds ratio (OR) = 1.02; confidence interval (CI): 0.40-2.60), acne management (P = .28), number of visits attended (relative risk (RR) = 1.08; CI: 0.99-1.19), and LARC removal (P = .95) were similar between groups. AYAs attending via telemedicine were less likely than those attending in person to have STI testing (P = .001). Intrauterine device expulsion or malposition and arm symptoms with implant in situ were rare outcomes in both groups.
Roughly 40% of AYAs attended a post-insertion visit via telemedicine during the first year of the COVID-19 pandemic and had similar 1-year outcomes as those attending in person. The decreased likelihood of STI testing for those using telemedicine highlights the need to provide alternative options, when indicated, such as asynchronous or home testing. Our results support the use of telemedicine for AYA LARC post-insertion care and identify potential gaps in telemedicine care which can help improve clinic protocols.
鉴于在 COVID-19 大流行期间迅速实施这些服务，长效可逆避孕（LARC）的远程医疗服务研究较少。我们比较了通过远程医疗和面对面就诊接受 LARC 后插植就诊的青少年和年轻成年人（AYA）的 1 年结局。
纵向队列研究。
美国的四个学术青少年医学诊所。
2020 年 4 月 1 日至 2021 年 3 月 1 日期间接受 LARC 并在 12 周内接受后插植就诊的 AYA（年龄 13-26 岁）。
无。
比较通过远程医疗和面对面就诊完成该就诊的 AYA 在 1 年内的结局。我们使用描述性统计、双变量分析和回归模型分析数据。
在 194 名接受后插植就诊的 AYA（年龄 13.9-25.7 岁）中，40.2%的人使用了远程医疗。月经管理（比值比（OR）=1.02；置信区间（CI）：0.40-2.60）、痤疮管理（P=.28）、就诊次数（相对风险（RR）=1.08；CI：0.99-1.19）和 LARC 取出（P=.95）在两组间相似。与面对面就诊的 AYA 相比，通过远程医疗就诊的 AYA 进行性传播感染（STI）检测的可能性更小（P=.001）。两组均罕见出现宫内节育器排出或放置不当以及皮下埋植剂部位手臂症状。
在 COVID-19 大流行的第一年，大约 40%的 AYA 通过远程医疗就诊，并且与面对面就诊的 AYA 有相似的 1 年结局。对于使用远程医疗的患者，STI 检测的可能性降低突出了需要在需要时提供替代方案，例如异步或家庭检测。我们的结果支持将远程医疗用于 AYA LARC 后插植护理，并确定了远程医疗护理中的潜在差距，这有助于改进诊所方案。
