Background/Purpose:

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.

Methods:

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.

Results:

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.

Conclusion:

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.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/hormonal-contraception-use-and-capacity-to-self-screen-for-contraindications-among-adolescents-in-a-pediatric-rheumatology-clinic/