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Thursday, April 2, 2009 Dial-in Phone Number : 1-866-551-3680 Access Code : 7136382#

“Fast Track”: Increasing Access to Reproductive Health Care Services for Adolescents by Implementing Evidenced-based Protocols. Thursday, April 2, 2009 Dial-in Phone Number : 1-866-551-3680 Access Code : 7136382#. Disclosure.

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Thursday, April 2, 2009 Dial-in Phone Number : 1-866-551-3680 Access Code : 7136382#

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  1. “Fast Track”: Increasing Access to Reproductive Health Care Services for Adolescents by Implementing Evidenced-based Protocols Thursday, April 2, 2009 Dial-in Phone Number: 1-866-551-3680 Access Code: 7136382#

  2. Disclosure • I have no real or perceived vested interests that relate to this presentation nor do I have any relationships with pharmaceutical companies, biomedical device manufacturers, and/or other corporations whose products or services are related to pertinent therapeutic areas.

  3. Course Objectives • Discuss current evidence-based screening criteria for cervical pathology and sexually transmitted infections. • Review procedures for utilizing the “Quick Start” method for initiation of hormonal birth control. • Consider the importance of integrating new ways of delivering clinical services to enhance patient access and outcomes to further public health goals to reduce unintended pregnancy

  4. U.S. teenagers have higher pregnancy, birth and abortion rates than adolescents in other developed countries.

  5. Teen contraception use

  6. Unintended pregnancy rate: by race/ethnicity/income Unintended pregnancies per 1,000 women Guttmacher, 2006

  7. Chlamydia — Age- and sex-specific rates: United States, 2007 CDC 2007 STD Surveillance Report

  8. Evidenced-Based Practice

  9. Thanks to: • Alan Guttmacher Institute • World Health Organization • Association of Reproductive Health Professionals • Contraceptive Technology • Physicians for Reproductive Choice and Health • Bridging the Gap Foundation • CDC

  10. Lucia 17-year-old High school senior Needs a check-up & a school form

  11. First priority: complete history On track team Sexually active x 2 years Uses condoms “sometimes” Eats lots of chips & pizza

  12. Does Lucia need a pelvic exam?

  13. Does Lucia need a Pap smear? Thin-prep or slide? With or without HPV test?

  14. Does Lucia need STI tests? Chlamydia, gonorrhea, HIV, syphilis

  15. Summary: what Lucia needs Height/weight Blood pressure Urine gonorrhea/chlamydia HIV test RPR Immunizations Contraception counseling

  16. Yolanda 16 years old Has UTI symptoms Requests a pregnancy test

  17. Emergency Contraception:Levonorgestrel 2 tabs at once, up to 5 days after unprotected sex

  18. “Quick Start” Take 1st birth control pill on day of office visit (or apply patch/insert ring)

  19. Oral contraceptives are NOT teratogenic

  20. Anna 17-year-old Asks you to call in new birth control pill prescription

  21. Hormonal ContraceptivesWhat is needed before prescribing? REQUIRED Medical history NOT REQUIRED Pap smear Pelvic/breast exam STI testing Hemoglobin RECOMMENDED Blood pressure

  22. Hormonal ContraceptivesWhich teens can’t use estrogen? Estrogen contraindications: Migraine with aura Uncontrolled hypertension Postpartum < 6 weeks History of DVT Smoking: NOT a contraindication for teens

  23. Systemic Barriers

  24. Minors’ Rights:Do parents need to know?

  25. Counseling to Enhance Adherence • LISTEN to her ideas about the best method • EXPLORE lifestyle issues that may impact adherence • ENCOURAGE her to call you with problems/concerns

  26. Solutions:Be Pro-active with Contraception! DE-LINK pap smears and pelvic exams from birth control prescriptions ROUTINELY prescribe 1-year supply

  27. Implementation Technical Support • Region II Title X Providers • Contact: • Dawn Middleton, Region II Title X TA Director • 212-594-7741 ext. 243 or dmiddleton@cicatelli.org • Community Health Centers and Family Practice Physicians • Contact: • Lisa Maldonado, Executive Director, Reproductive Health Access Project • 212-924-7747 ext. 1367 or lmm9@earthlink.net

  28. Resources • Region III Title X Family Planning Training Center: http://www.cicatelli.org/titlex/Webinars.htm • Reproductive Health Access Project (RHAP): http://www.reproductiveaccess.org • The Adolescent Health Care Communication Program (AHCCP) http://www.nirhealth.org/sections/ourprograms/ourprograms_adolescent_health.asp

  29. Questions?

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