P2.A006: Increasing Utilization of Emergency Contraception in Pediatric Primary Care Post-Dobbs: A QI Venture

Purpose/Objectives: Adolescent pregnancy in the US continues to outpace other high-resource countries, with 75% remaining unplanned (1-3). Teens’ options changed drastically with the US Supreme Court’s 2022 Dobbs decision. Reversing Roe v Wade left many states with tenuous access to abortion. Emergency contraception (EC) serves as a safe, reliable, non-abortive means to prevent pregnancy and is tied to lower teen birth rates (4). The AAP recommends reactive and advanced prescription of EC (5). We designed a needs assessment survey to lay the foundation for a quality improvement (QI) project in primary care pediatrics, with the goal of increasing (advanced) prescription of EC.

Design/Methods: This was a web-based survey sent to pediatric primary care providers at three academic centers in Wisconsin in November-December 2023. The survey was adapted from previous work (6-9) and evaluated EC knowledge, changes in attitudes and practices regarding EC since Dobbs, along with barriers and potential QI opportunities. Data was summarized with descriptive and comparative (Chi-squared or t-tests) statistics.

Results: Fifty-one of 214 (24%) completed the survey. Most respondents were cisgender (100%), female (76%) physicians (85%), >10 years post-training (72%). Over half (64%) served a suburban population (24% urban, 12% rural). Only 12% of respondents correctly identified all five types of EC used in the US, and 40% identified all correct indications. Most knew oral EC (90%) and IUDs (16%) are not abortifacients. About 75% knew long-term contraception can be initiated same-day with EC. Greater than two-thirds of respondents undershot the time window for each oral EC option. Most respondents (81%) felt EC is more important now than prior to the Dobbs decision, but few (7%) report increased prescription of EC (Figure 1). Only 31% had prescribed EC at all over the past year. Barriers to provision and desired supports were explored (Table 1). Lastly, demographics were compared with knowledge and practices, with two significant trends: providers < 10 years post-training had higher knowledge rates (77% correct vs 68%, p = 0.02) and providers in urban (54%) or rural (40%) areas were more likely to have prescribed EC in the past year than suburban (16%) counterparts (p = 0.039).

Conclusion/Discussion: Most respondents feel EC is more important following the Dobbs decision, though few have increased prescribing practices. This needs assessment identified potential reasons for this discrepancy including gaps in provider knowledge, low self-efficacy, and attitudes that may be receptive to further education. As in Table 1, many respondents indicated they’d be more likely to prescribe EC with our posited QI interventions. This study highlights a strong need to bolster EC education in pediatrics and address systems factors that will facilitate easier, more confident EC prescription. This data will be used to implement QI projects aimed at improving EC prescribing practices.