Contraceptive Method Switching and Long-Acting Reversible Contraception Removal in U.S. Safety Net Clinics, 2016-2021.
Journal
Obstetrics and gynecology
ISSN: 1873-233X
Titre abrégé: Obstet Gynecol
Pays: United States
ID NLM: 0401101
Informations de publication
Date de publication:
01 09 2023
01 09 2023
Historique:
received:
09
03
2023
accepted:
11
05
2023
medline:
21
8
2023
pubmed:
3
8
2023
entrez:
3
8
2023
Statut:
ppublish
Résumé
To describe patterns of contraceptive method switching and long-acting reversible contraception (LARC) removal in a large network of community health centers. We conducted a retrospective cohort study using individual-level electronic health record data from 489 clinics in 20 states from 2016 to 2021. We used logistic regression models, including individual-, clinic-, and state-level covariates, to calculate adjusted odds ratios and predicted probabilities of any observed contraceptive method switching and LARC removal among those with baseline incident LARC, both over 4-year time periods. Among 151,786 patients with 513,753 contraceptive encounters, 22.1% switched to another method at least once over the 4-year observation period, and switching patterns were varied. In patients with baseline LARC, the adjusted predicted probability of switching was 19.0% (95% CI 18.0-20.0%) compared with patients with baseline moderately effective methods (16.2%, 95% CI 15.1-17.3%). The adjusted predicted probability of switching was highest among the youngest group (28.6%, 95% CI 25.8-31.6% in patients aged 12-14 years) and decreased in a dose-response relationship by age to 8.4% (95% CI 7.4-9.4%) among patients aged 45-49 years. Latina and Black race and ethnicity, public or no insurance, and baseline Title X clinic status were all associated with higher odds of switching at least once. Among baseline LARC users, 19.4% had a removal (to switch or discontinue) within 1 year and 30.1% within 4 years; 97.6% of clinics that provided LARC also had evidence of a removal. Community health centers provide access to method switching and LARC removal. Contraceptive switching and LARC removal are common, and clinicians should normalize switching and LARC removal among patients.
Identifiants
pubmed: 37535965
doi: 10.1097/AOG.0000000000005277
pii: 00006250-990000000-00843
pmc: PMC10424816
mid: NIHMS1906380
doi:
Substances chimiques
Contraceptive Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
669-678Subventions
Organisme : AHRQ HHS
ID : R01 HS025155
Pays : United States
Informations de copyright
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
Financial Disclosure Blair G. Darney's institution receives research support from Merck/Organon. Dr. Darney serves on the Board of Directors of the Society of Family Planning. Kate Coleman-Minahan was a consultant for The Lawyering Project. The other authors did not report any potential conflicts of interest.
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