Availability of Long Acting Reversible Contraceptives for Adolescents in Urban vs Rural West Virginia Counties

The study objective was to evaluate long acting reversible contraceptive (LARC) method availability and access for adolescents in rural and urban counties in West Virginia (WV). A cross-sectional survey of Title X family planning providers throughout WV was conducted from January 2016-July 2017. This survey was sent to 226 family planning providers in WV to assess patterns of LARC availability. The survey assessed provider training level, LARC services provided and frequency, clinical practice, referral patterns, and comfort level providing adolescent LARC services. Survey results were analyzed by providers’ rural vs urban status, based on US census county codes. Survey responses yielded 127 total responders, 65 (51.2%) were urban, and the remaining 62 (48.8%), were rural. Urban providers had a larger representation of medical doctors, while rural providers were primarily nurse practitioners (p This survey showed significant differences in practice between urban and rural settings, including training, experience, contraceptive options, barriers to care, and practice guidelines

Appalachian Parent and Provider Views on the Use of Pharmacies for Human Papillomavirus Vaccination in Adolescents

The uptake of the human papilloma virus (HPV) vaccine in West Virginia is lagging despite it being highly protective against HPV related diseases. The purpose of this study was to determine parent and provider perception on usingpharmacies for HPV vaccination in adolescents. This was done by surveying both parents and providers in a rural academic institution. Providers were surveyed before and six months after an educational intervention that instructed providers on local legislation and the logistics of prescribing the HPV vaccine through pharmacies. The provider survey assessed awareness of pharmacy vaccine access and prescribing practices. Parents of adolescents were surveyed to assess what patients might benefit most from pharmacy access for vaccination. A total of 71 providers completed the initial survey, and 45 completed the six-month assessment. Only 22.5% were aware of the pharmacy legislation at the initial survey, and 64.4% at six months (p

The National Hockey League and Salary Arbitration: Time for a Line Change

Published in cooperation with the American Bar Association Section of Dispute Resolutio

HPV Vaccination Among Females with Mental and Physical Limitation

Introduction Adolescent HPV vaccination rates lag behind other vaccinations, partly due to missed opportunities for vaccination and lack of provider recommendation. This study evaluated the rates of HPV vaccination among adolescents with physical and mental limitation and controls, and evaluated differences in parental knowledge and reasons for nonvaccination between groups. Materials and Methods A retrospective chart review was performed on female patients age 12-18 presenting to pediatric or gynecology clinics in 2012. Those subjects with a diagnosis of mental or physical limitation were classified as “affected”. HPV vaccination rates were compared between affected and control groups. Parents of affected subjects were contacted by phone and surveyed regarding HPV knowledge and reasons for nonvaccination. Parents of controls were contacted at a 2:1 ratio and administered the same survey. Results 1673 females were included in the study; 72 (4.3%) with mental/physical impairment (affected). Overall, 944 (56.4%) subjects had initiated HPV vaccination and 653 (39%) had completed the three dose series. When comparing affected subjects to controls, the control group was more likely to have received any HPV vaccination (RR 1.32, 95% CI 1.013, 1.73). Parents of 21 affected subjects and 44 control subjects were contacted by phone. No differences were found in parent knowledge of HPV or importance of vaccination to a child’s health. There were no differences in reasons for nonvaccination between groups, but for both groups “lack of provider recommendation” was in the top two choices. That the vaccine was “not needed” was the other main reason given for nonvaccination in the affected group, while the control group main reason for nonvaccination was “concerns for safety”. Discussion Adolescents with mental or physical limitation may be less likely to receive HPV vaccination. Lack of provider recommendation remains one of the primary reasons those in this population do not receive HPV vaccination

Contraception Choice and Compliance Among Mothers with Opioid Addiction: Identifying Barriers to Care

West Virginia leads the nation in substance abuse deaths per capita. This epidemic has given rise to a novel population of high risk, obstetrics patients with opiate abuse. Appropriate education, counseling, and implementation of contraception is of extreme importance among this population due to risks of unintended pregnancy. This study was a retrospective chart review to determine compliance and uptake of contraceptive methods by patients in a maternal buprenorphine maintenance program prior to and following implementation of standardized contraception education and Medicaid coverage of immediate postpartum long acting reversible contraceptives (LARC). Rates of planned contraception and rates of actual method initiation were compared between two groups representing two distinct time periods before and after intervention. Rates of high efficacy contraception options, especially LARC options, were noted to statistically significantly increase following dedicated education and Medicaid coverage. Patients receiving no contraception at all significantly decreased following these interventions. Patients desiring surgical sterilization continued to encounter barriers to care as the rate of actual sterilization to desired sterilization was still very low

Promoting Reproductive Health Using Telemedicine: A Prospective Study Among Rural Appalachian High School Teens

Introduction: Telemedicine allows rural underserved populations access to medical resources that may not be available in their communities. Following promising results with a telemedicine project aimed at educating female students in McDowell County, West Virginia on reproductive health (RH) in 2015, we conducted a follow-up study including both male and female high school students during the 2016 school year. Materials and Methods: Telemedicine sessions on RH were incorporated into existing afterschool programs at two rural high schools. Students’ knowledge on RH was assessed via pre-test, immediate post-test, and 6-month post-test evaluations. RH was taught by medical students and faculty at a distal university. Results: 77 students participated and 37 students completed a 6-month follow-up survey. Statistically significant increases in knowledge scores regarding both birth control and sexually transmitted disease prevention were noted at 6-month follow-up. A larger proportion of students reported “always” utilizing birth control (35.3% vs. 64.7%) as well as condom usage (46.2% vs. 58.8%) at six months compared to before the intervention, but was not statistically significant. The intervention was rated as “effective” or “very effective” by 91.9% of participants, and 75.6% stated they were “very likely” to participate the future. Discussion: Telemedicine is a promising and sustainable tool in teaching RH to rural underserved areas

Failure of effective contraception in opioid addicted mothers: a disparity in planned and actual usage

The ongoing opioid epidemic in West Virginia has given rise to a unique population of opioid-addicted obstetric patients. Appropriate education, counseling, and implementation of contraception is of extreme importance among this high risk patient population. This study was a retrospective chart review aimed at evaluating contraception choice and initiation rates among patients enrolled in a maternal buprenorphine maintenance program compared to non-opioid addicted patients. Rates of planned contraception initiation were compared between the two groups. Rates of actual contraception initiation were also compared. Contraceptive choices were then placed into one of three tiers based on efficacy, and rates of initiation of equivalent, less effective, or more effective methods of contraception were compared between the groups. Rates of compliance to planned contraceptive method were low for both groups and not statistically different between the two. Use of long acting reversible contraceptives was statistically higher among the control population. Compared to the control group, a significant number of women in the opioid group received less effective contraception than planned. This study shows that the high-risk population of opioid addicted patients did not receive high efficacy, long lasting contraception at the same rate as their non-opioid addicted peers

Complications and Hospital Admissions among Pregnant Women with Substance Abuse

In recent times, there has been an increase in drug abuse in not only the general population, but in women of reproductive age. Our objectives were to identify, classify, and describe the spectrum of complications, the average number of admissions, and length of hospital stay that occur among pregnant women with substance abuse. The aim was to obtain better understanding of complication prevalence to improve management in this ever-growing population. A retrospective chart review was conducted of pregnant women ages 18-45 with a history of substance abuse from 2013-2018 in the tri-state area of West Virginia, Ohio, and Kentucky. We collected the following data: demographics, medical history, specific substances abused, inpatient admission dates and diagnoses, and delivery information. A total of 411 patients met the inclusion criteria, with a total of 525 pregnancies. Out of 525 pregnancies, 71.6 % used buprenorphine (i.e., Subutex), 43.4% used opiates, excluding heroin, and 35% of patients used heroin. Out of the 525 pregnancies, there were 714 inpatient antepartum admissions. Of these, 376 were admissions due to withdrawal symptoms (52.7%). A total of 263 pregnancies had at least one admission for withdrawal, drug abuse, overdose, or buprenorphine/methadone conversion (50%). The average length of hospital stay for withdrawal admissions was 3.4 days (SD). There were 62 admissions for infectious causes, 24 of these being due to pyelonephritis (38.7%). The findings highlight multiple areas for future studies as well as areas for quality improvement in the management of this population