Providing adolescent contraception in the emergency room
Awarded 2015
Complex Family Planning Fellowship Research
Emily Schneider, MD
University of New Mexico Health Sciences Center

Purpose: Adolescent girls who use emergency departments for non-emergent complaints have risk factors for unintended pregnancy and are difficult to reach in outpatient settings. This pilot study examined the feasibility of comprehensive contraceptive counseling in a novel outreach setting, a pediatric emergency department (PED). 
Methods: This prospective cohort pilot study enrolled girls ages 13-18 presenting to the PED for non-emergent complaints during a 12-week period. Participants watched a contraceptive counseling DVD, reviewed handouts, and were offered counseling by a PED physician. The primary outcome was feasibility of the counseling intervention, measured by length of stay (LOS). Secondary outcomes included participant and physician satisfaction, assessed by follow-up surveys.
Results: Thirteen girls were enrolled; 62% were sexually active and 46% were currently using contraception. Recruitment was impeded for over half of the study period by PED staff concerns about conducting confidential adolescent research. The median intervention time was 13 minutes (range 8 – 21). LOS of participant encounters was no different than LOS for all PED encounters of Medicaid adolescents during the study period (median 287 minutes (range 103 – 895) vs. 233 (10 – 3264), p=0.13). Follow-up surveys were completed by 62% of participants and 86% of physicians. Seven participants (88%) and five physicians (83%) thought it was a good idea to discuss contraception during a PED encounter.
Conclusions: Comprehensive contraceptive counseling during a PED encounter was acceptable to adolescents and did not impact patient throughput. Unanticipated barriers to confidential adolescent research in the PED environment merit further investigation.
Implication and Contribution: Emergency departments could fill a gap in contraceptive services for adolescents at risk of pregnancy. Contraceptive counseling in a pediatric emergency department was acceptable to adolescents and did not impact throughput, but was impeded by unanticipated barriers to confidential adolescent research. Future studies should consider strategies to overcome these barriers.