title: Examining quality of contraceptive services for adolescents in Oregon's family planning program.
abstract: OBJECTIVE
  To assess the quality of care provided to adolescents (10-19 years old) compared to women (aged 20-25 years) who accessed services in Oregon's Contraceptive Care (CCare) program.
  
  
  METHODS
  We analyzed data routinely collected using the Clinic Visit Record form from women aged 25 years and younger who visited CCare clinics between January 1, 2004, and October 31, 2010. Modern methods were characterized into three tiers: Tier 1 is the intrauterine device, implant and sterilization; Tier 2, hormonal methods; and Tier 3, all barrier methods. Nonmodern methods included no method, withdrawal and natural family planning. We used multivariable logistic regression models to examine the effect of age on three indicators of quality of contraceptive care: transitioning from a nonmodern to a modern method, transitioning from Tier 3 methods to Tier 1 or Tier 2 methods, and initiation of long-acting reversible contraception (LARC). We then produced predicted probabilities to facilitate data interpretation.
  
  
  RESULTS
  Adolescents accounted for 344,856 (41%) of the 848,221 clinic visits occurring in CCare among women under age 25. Compared with women (ages 20-25 years), young and older adolescents had decreased odds of LARC initiation [odds ratio (OR) 0.24 (95% confidence interval [CI] 0.16-0.35) and OR 0.44 (95% CI 0.38-0.52), respectively]. However, compared with women, both young and older adolescents had increased odds of leaving with any contraceptive method [OR 1.8 95% (CI 1.26-2.59) and OR 1.42 (95% CI 1.21-1.66)]. Among clients presenting with no method of contraception at the beginning of the visit, 78.7% of young adolescents (95% CI 73.84-83.03) compared with 81.44% (95% CI 77.02-85.52) of older adolescents, and 76.63% (95% CI 69.90-80.75) of young women left with a modern method, controlling for other covariates.
  
  
  CONCLUSIONS
  Although adolescents served by CCare are more likely to initiate contraception, they are less likely to receive LARC than women aged 20-25 years.
  
  
  CONCLUSIONS
  Efforts are needed to ensure that adolescents have access to highly effective reversible contraception.
authors.affiliation: Oregon Health & Science University, Portland, OR, USA. Electronic address: rodrigma@ohsu.edu.
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Rodriguez
authors.affiliation: Oregon Health & Science University, Portland, OR, USA; Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico.
authors.forename: Blair G
authors.initials: BG
authors.lastname: Darney
authors.affiliation: Reproductive Health Program, Oregon Health Authority, Portland, OR 97211, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Elman
authors.affiliation: Reproductive Health Program, Oregon Health Authority, Portland, OR 97211, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Linz
authors.affiliation: Oregon Health & Science University, Portland, OR, USA.
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
authors.affiliation: Oregon Health & Science University, Portland, OR, USA.
authors.forename: K John
authors.initials: KJ
authors.lastname: McConnell
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D015331:Cohort Studies; D003076:Coitus Interruptus; D017280:Condoms / Q000706:statistics & numerical data; D003267:Contraception / Q000379:methods*; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use; D004343:Drug Implants / Q000627:therapeutic use; D005193:Family Planning Services / Q000592:standards*; D005260:Female; D006801:Humans; D007434:Intrauterine Devices / Q000706:statistics & numerical data; D016015:Logistic Models; D008484:Medicaid; D015999:Multivariate Analysis; D012252:Natural Family Planning Methods / Q000706:statistics & numerical data; D016017:Odds Ratio; D009922:Oregon; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
chemical_list: D003278:Contraceptives, Oral, Hormonal; D004343:Drug Implants
keywords: Adolescents; Contraception; LARC; Medicaid; Quality of care; Title X