127. The Impact of COVID-19 on Same-Day LARC Initiation Among Adolescents in a Large Statewide Health System

Same-day long-acting reversible contraception (LARC) is a cost-effective and convenient way to provide interested adolescents with highly effective pregnancy prevention. There have been no studies on how the COVID-19 pandemic impacted the frequency of same-day LARC placement for adolescents. We aimed to determine the patient- and provider-level factors associated with same-day LARC placement for adolescents 12 months before and after COVID-19 protocols went into effect on 3/15/2020. This retrospective cohort study analyzed existing electronic health records from a single large healthcare system in the Southeastern U.S. Adolescents included (N=954) were aged 10-19 years old and received a new LARC at an outpatient visit from 3/15/2019 to 3/14/2021. A logistic regression model determined the joint relationship of multiple exposure variables on receipt of a LARC in a single visit (yes/no) before and during the COVID-19 shift. We used an interrupted time series design to examine changes in same-day LARC initiation during the 12 months before and after 3/15/2020. More adolescents initiated LARC in single-visit (61%) compared to those who did not (39%), though fewer adolescents received same-day LARC during the pandemic (58%) compared to before (64%). Only zip code concordance was associated with same-day LARC use both before and during the pandemic (aOR=2.31 and 1.83 respectively, both p<0.05). During the pandemic, a few factors reduced the odds of same-day initiation including 1) public insurance (aOR=0.52, p<0.01, compared to private insurance), 2) non-OBGYN providers (specifically, pediatrics [aOR=0.34, p<0.01], family medicine [aOR=0.53, p<0.01] or internal medicine [aOR=0.13, p<0.05]), and 3) advanced practice practitioners (aOR=0.46, p<0.001, compared to physicians). Throughout the study period, the average monthly rates of same-day LARC insertions were similar, with no significant change before or after 3/15/2020 (p>0.05). We identified differences in receiving same-day LARC during the pandemic by zip code concordance, insurance status, provider specialty, and provider type. Some potential explanations include an exacerbation of systematic barriers to accessing clinical care, such as fewer in-person appointments, reduced public transportation, or limited parental ability to transport their adolescent due to difficulties accessing childcare for other children during remote learning. Additionally, lower same-day LARC by providers in pediatrics, family medicine, and internal medicine during the pandemic may suggest that non-LARC concerns took priority during in-person visits with general healthcare providers, many of whom may already have lower comfort with LARC placement. Given that access to all forms of contraception remains essential for adolescent health and well-being, findings from this study may guide policy and programmatic interventions to improve access to same-day LARC for all adolescent populations.