Adolescent pregnancy prevention in a staff-model HMO

February 1998

POSTERPRESENTATIONS

LISTENINGTOYOUTH:TEENPERSPECTIVES ONPREGNANCY PREVENTION. KarenHacker,MD,YaredAmare,Ph.D., NancyStrunk,RN., CarmenTorres,FM.D.BostonPublicHealth CommissionandBostonPublicSchools,Boston,MA. Objective : Wehypthesizedthatstudentsatvsryinglevelsofriskforpregnsncyhsddifferingviewsonwhat coufdbe doneto preveotteenpregnancy.Thesevaryinglevelsofriskincluded:studentswhoare abstinen~students whoarcconsistentcontrsceptors,andstudentswhoareinconsistentccmtrsceptors. DESIGN: A 75 questionsurveywasdesignedbymernbersofa brosd-basedtcerrpregnsncyprcvention edition. Thesurveywasadministeredin sixBostonhighschoolsinrandomizedtenthandeleventhgradeclasses. Surveys werebothanonymousandoptional.Allstudentsintlwscclasseswereinvitedto participate.1000surveyswere receivedandanalyzed.Chi-squaretestswasusedto testforststiaticallysignificantdit%renceain studentresponses. RESULTS:Sixty-thrcepercentofatudentsrcpmtedhavinghadsexualintercourse.Ofthcse, 35~0 reported using birthcontroleverytimewhereas65%wereinconsistentcontraceptors.Whileonfy11%ofrespondentssaidthey wanteda babyrightnow,61°Aoffcmslessaidthatif they becamepregnanttheywoufdkeepthebaby.Studentssaid thatmoreinformationonpregnancyandbirthcontrol(52%),educationshoutrelationships(33%),psrentsf communication (32%),improvedaccessto bhtbcontrol(310A),andeducationaboutthererditiesofparcnting(30??) wouldpreventthemhrn gettingpregnant.Abstinentteensweremorelikely(5S0/o) thaneitherconsistent contraceptors(49%)or inconsistentcontraceptors(49??)to ssythst moreinformationonpregnancysndbirth contiolwoufdpreventpregnancy(IX.05.) Consistently contrme@ing teensweremorelikely(40??)thanabstinent (26%)or inconsistentcontrsceptors(33%)to thinkthstgreatersccesstobirthcontrolwoufdpreventpregnancy (p.01)andto thinkthatached heslthcentersshoulddistributecondoms(68%ofconsistentusersvs 49%of abstinentteensand58°Aofirxmnsistcnt users)@@Ol). Theyweresfsomorelikelyto be havingtleqwcrrt conversationswiththeirparents(49?!)thaneitherabstinent(31VO) or inconsistentcontraceptors(38°A)@<.001). Femsfes( 43%)wercmorelikelytlummsles(22%)to reportthattheheakhcsrc arenawastheirpreferredsourceof intbrmation(p<.001)whereasmsfesweremoreIikelythanf-es toreportparents(23%vs. 18%)andhealth educationchases (16%vs. 8%)astheirs(p<.001).when askedwhatfactorspreventedthemhrnusing contraceptioninthep@ inconsistentcontrsceptorsweremorelikelyto saythattheyhadnotexpcctd tohavesex (13%)or thattheynevcrthoughtofit (15%)comparedto consistentusers(9%and6%respectively)(p<.001). CONCLUSIONS:Afthougfrmsny tecnsdonotactivelywsntapregmmcy,theirbehaviorsndtfretkctthatthey wouldkeepa pregnancyif theybecamepregnantplacesthemathighrisk. Teensreportthatmoreinformationftmn psren@school,mdheslthcare providerscanhelppreventpregnancy.Thisstudysuggeststhatsdolescentswith diffmingpregnsncyris krequire novelstrategiesto assisttheminpregnancyprevention.Parentaldiscussionis of utmostimportanceandprovidersshouldplayanactiverolein supporting this. Jnschool,hesftheducationcurricula shouldprovideteachingpointsforallyouthwhileschoolbasedhealthcenterscanexpandaccessfw thoseinneed.

ADOLESCENTPREGNANCYPREVENTIONIN A STAFF-MODELHMO. Joan Fine, M.D., MedicalWestAssociates,Chicopee,Massachusetts OBJECTIVE:A comprehensiveadolescentpregnancypreventionprograminvolvingall enrolledadolescentmembersin a staff-modelHMOwas undertakenin 1996,to try to lowerpregnancy ratesanddeviseinterventionstrategies. DESIGN: A QuafityImprovementteamreviewedchartsof pregnantteensfrom 1994and 1995for preinterventiondata. 23%of74 pregnantteensunderage 18hadbeenseenin the healthcenterswithin oneyear priorto conceptionfor a well visit,and 880/0for a sick visit. Pregnancyrates were calculated as the numberof pregnanciesincludingmiscarriages,terminationsand deliveriescompletedthrough age 18per enrolledfemaleadolescentage 13through18. In 1994,there were 126pregnancieswitha rate of 42.1pregnancies11000and in 1995therewere 113pregnanciesanda rate of 43.6I 1000. Theteam changedPediatricdepartmentpoliciesto endorseannualphysicalsfor teens withthe use of a confidentialreproductivehealthquestionnaireat all such visits. The questionnaireincluded10high risk questions,which,if answeredpositively,indicateda needfor discussionwitha trainedbirthcontrol counselor at the time of the visit. Compliancewas monitoredthrough chart review and 80Y0 compliancewas achieved. Obstetricdepartmentpolicieswerechangedto includechart documentation of birth control selectionat the 28-weekprenatal visit and immediateprovisionof birth control at delivery. RESULTS:Resultsfor 1996showeda loweringof the pregnancyrateto 36.4/ 1000. Althoughthere is no controlgroupwithinthe HMO,localbirthratesfor the nearestcity in 15to 19yesr-oldscompiled by the stateHealthDepartmentshoweda rate of96.61 1000in 1994and 77.2f 1000in 1995. Datafor 1996will be availablein January,1998. The20%localdropin birthrate in slightlyolderteenswasnot reflected in any drop in total pregnancyrate in youngerHMOteens in the same time period. This makes the subsequent14°/0drop in HMO total pregnancyrate since the program’sinceptionmore mermingfid. CONCLUSIONS:Adolescentpregnancypreventionin a staffmodelHMOcan be achievedthrough an interdisciplinaryteam’s efforts. Success~l reductionof pregnancyrates requiresa recognitionby managedcare leadershipthat adolescentpregnancyis a costly, avoidablecondition. Administrative supportis essentialin endorsingpolicychangesto complywith recommendednationalstandardsfor improvingadolescentheakhcare.

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