Photo Credit: Antonio_Diaz

Dr. Bianca Allison discusses the benefits of person-centered contraceptive care for teens and young adults, as well as barriers that limit its adoption.

“Person-centered contraceptive care (PCCC), defined as respectful contraceptive counseling and care that gives a central focus to a patient’s values and goals, is important for reproductive autonomy,” researchers wrote in the American Journal of Obstetrics and Gynecology. “In a contrasting change to 2012 recommendations to provide tiered-effectiveness counseling (ie, discussion of contraceptive options in order of efficacy), supporting adolescent and young adult reproductive autonomy by providing noncoercive PCCC is an explicit care goal endorsed by both the American College of Obstetricians and Gynecologists and American Academy of Pediatrics.”

Further, research has indicated that many clinicians, particularly those who treat adolescents, are not providing PCCC and instead use directive methods like tiered-effectiveness counseling, according to the study authors.

Bianca A. Allison, MD, MPH, and colleagues systematically reviewed 12 studies on PCCC for adolescents and young adults aged 24 years and younger. Their findings suggest this approach improves short- and medium-term adolescent and young adult outcomes and clinicians’ comfort and knowledge.

“One of the biggest things we need is to make sure systems are set up to support this kind of care,” Dr. Allison tells Physician’s Weekly. “That includes making sure teens and young adults can access the full range of birth control options—without unnecessary barriers—and that their privacy is protected to the maximum extent possible.”

Outcomes Improved by PCCC

The findings from Dr. Allison and colleagues showed that PCCC improved seven patient-centered outcomes, including:

• Quality of Care: When physicians used PCCC, patients reported a higher quality of care.
• Patient Knowledge: Patients who experience PCCC either had more knowledge than the control group or did before the intervention.
• Self-Efficacy: Two studies mentioned this outcome, with both reporting that self-efficacy improved for up to six months after PCCC.
• Perceived Benefits: One study discussed this outcome, with 95% of respondents in that study perceiving PCCC as beneficial.
  • Contraceptive Choices: An increased number of patients choose a contraceptive method after PCCC.
  • Continuation of Contraception: Three studies measured the outcome, and all reported higher continuation after PCCC.

The results also highlighted four clinician-focused outcomes:

• Comfort: Physicians often felt more comfortable with PCCC than other contraceptive care strategies.
• Quality of Care: Three studies measured on this outcome from the clinicians’ perspective, reporting that physicians feel PCCC improves overall care.
• Perceived Benefits: Clinicians view PCCC as beneficial to their overall practice.
• Quicker Decisions: Two studies reported that patients and clinicians who engaged in PCCC spent less time choosing the right contraceptive method.

Challenges to Implementation

Despite PCCC’s effectiveness, not all clinicians use this method. Some clinicians may not have the comfort or knowledge to effectively deliver PCCC, highlighting a need for ongoing education.

“Training is a great first step, but it’s not enough on its own,” Dr. Allison says. “What really helps is creating space for ongoing learning—whether that’s quick case discussions with colleagues, mentorship from folks who are really comfortable with person-centered care, or even just short check-ins where teams reflect on what’s working and what’s not.”

Clinics can integrate tools that keep this education top of mind, such as EHR prompts for PCCC, a self-assessment checklist for physicians, or a simplified way to collect patient feedback, she added.

The study results also highlight systemic barriers to PCCC, according to the researchers, including the traditional prioritization of tiered effective approaches—such as reducing the number of teen pregnancies without looking at an individual’s unique needs or reimbursement structures—that make it hard to reserve the time PCCC requires.

“We also need EHRs that make it easy to document patient preferences and prompt more person-centered conversations,” Dr. Allison added. “Reimbursement structures that allow for more time when needed, especially with younger patients who may have more questions or for same-day long-acting reversible contraception initiation, are key too.”

Including Patients in the Conversation

Finally, Dr. Allison notes that young people should be involved in determining how services are delivered. This can be accomplished through youth advisory councils or the inclusion of such patients in quality improvement initiatives to improve PICC.

“If we want care to be person-centered, we need to hear directly from the people receiving it,” she says.

One of the easiest ways to do this without increasing the burden for the clinician is to offer patient-facing support tools. “Clinics can make these part of their routine by sending links through the patient portal, offering a tablet or physical flipchart during the rooming process, or even posting a QR code on the wall,” Dr. Allison notes.

Once a patient meets with their clinician, the clinician can pull up their answers and use them as a starting point for conversations around contraception options.

“When a clinician takes a few minutes to review the patient’s answers together during the visit, it really helps make the conversation feel more tailored and collaborative,” Dr. Alison says.