Date: Monday, October 22, 2018
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Many states allow pharmacists to prescribe combined hormonal contraception (HC), eliminating the barrier of a provider visit. For adolescent rheumatology patients, however, a clinician visit can be an opportunity to discuss specific hormonal contraindications. We examine adolescent rheumatology patients’ HC experience, ability to self-screen for HC contraindications, and acceptability of pharmacist prescribing HC.
After IRB approval, females ages 14-21 were recruited from pediatric rheumatology (RC), primary care (PC), and other subspecialty (OS) clinics. Participants completed a demographic and behavioral survey, including Child with Special Health Care Needs (CSHCN) screener, perceived severity of pregnancy (1 item, range 1-5) and acceptability of pharmacist prescribing HC (2 items). Adolescents and physicians separately completed checklists for potential contraindications to HC per the CDC Medical Eligibility Criteria (MEC). The checklist was a screener, capturing broad categories rather than specific high-risk diagnoses (e.g. lupus in general, vs. + antiphospholipid antibodies). Discordance was any difference between adolescent and physician for a potential level 3/4 MEC contraindications. Unsafe discordance was Adol No/Physician Yes for a level 3/4 MEC contraindication (under-report) while safe discordance was Adol Yes/Physician No (over-report). We used Chi Square, ANOVA and logistic regression.
We recruited 47 (16%) RC adolescent/physician pairs, 175 (58%) PC pairs, and 77 (26%) OS pairs. In RC, 71% identified as white, 11% African American, 2% Latino, and 16% multiracial or other. PC were more likely to be African American or Latino, and OS White. The mean age for RC was 16.3 +/- 1.3 years, similar to PC and OS (p=NS). 94% of RC were CSHCN, compared to PC 45% and OS 88% (p<.001). 19% of RC were sexually active, compared to 45% PC and 13% OS (p<.001).
In RC, 13 (28%) had ever used HC (combined pills, injection, ring, patch), and 2 (4%) LARC (implant, IUD), lower than PC (45% HC, 9% LARC) or OS (35% HC, 6.5% LARC) (p=.05 for HC). Thirty-two (68%) of RC patients had at least 1 potential MEC level 3/4 contraindication, higher than PC (14%) or OS (26%) (p<.001). The most common for RC were lupus, migraines, and hypertension. RC reported a higher perceived severity of pregnancy (RC 4.1 +/- 1.1 vs PC 3.2 +/- 1.6 and OS 3.6 +/- 1.4, p<.05). Although the rate of overall discordance between adolescent and providers for RC was high (RC 36% vs. PC 17% and OS 25%, p<.05), the rate of unsafe discordance was low (RC 11%, PC 6%, OS 9%, P=NS). Adolescents in RC were equally interested in pharmacist prescribing HC (RC 45%, PC 43% and OS 51%). Logistic regression among RC patients, controlling for age, only sexual experience was associated with (lower) unsafe discord.
Despite Despite adolescent rheumatology patients’ high rates of potential contraindications and low rates of HC use, they are interested in pharmacist access. When discordant, they are more likely to over-report (safe) rather than under-report (unsafe) potential contraindications. Clinicians caring for these adolescents should proactively address HC and associated risks.
To cite this abstract in AMA style:Tarvin S, Wilkinson T, Vielott T, Meredith A, Meagher C, Ott M. Hormonal Contraception Use and Capacity to Self-Screen for Contraindications Among Adolescents in a Pediatric Rheumatology Clinic [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/hormonal-contraception-use-and-capacity-to-self-screen-for-contraindications-among-adolescents-in-a-pediatric-rheumatology-clinic/. Accessed January 24, 2022.
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