Omar Hatim, Fowler Amy, D'Angelo Sandy
Section of Adolescent Medicine, Department of Pediatrics, Adolescent Medicine and Young Parent Programs, J422, Kentucky Clinic, University of Kentucky, Lexington, KY 40536-0284, USA.
Int J Adolesc Med Health. 2002 Apr-Jun;14(2):149-52. doi: 10.1515/ijamh.2002.14.2.149.
Poor compliance and high discontinuation rates of Depot-Medroxyprogesterone Acetate (DMPA) and other contraceptive methods are major factors in the continuing problem of adolescent pregnancy. In this study we attempted to determine if providing comprehensive health care for teen mothers and their babies would improve continuation rates of DMPA. Patients who started DMPA between 1/1/96 and 1/1/99 were included. Teen mothers and their babies received all their health care in this clinic, supported by State funding. Key elements regarding DMPA in this clinic were continuity of care, phone and mail reminders of appointments, free DMPA for patients without insurance, counseling at each visit and available evening clinic. In the study period a total of 299 (age 13-22 years) patients were started on DMPA. Fifty-one percent were white, 47% black and 2% others. Sixty-three percent were single, 20% married, 3% cohabitating and 14% undetermined (missing data). Seventy-eight percent had one baby and 22% more than one. A total of 189 patients (63.2%) continued to be compliant after one year of use and 101 patients (33.8% of total) continued beyond the second year. The most common side effect reported was bleeding or spotting (32%), However only seven patients (2.3%) discontinued use because of it. It is concluded that continuity of care (same staff and providers on each visit), regular counseling, flexible hours (evening appointments), financial ease (free DMPA and no visit charge for those without insurance), combined Teen-Tot health visits and regular reminders of appointments may help improve compliance and continuation rates in teen mothers leading to better success in preventing repeat teen pregnancy.
醋酸甲羟孕酮长效避孕针（DMPA）及其他避孕方法的依从性差和停药率高是青少年怀孕问题持续存在的主要因素。在本研究中，我们试图确定为青少年母亲及其婴儿提供全面的医疗保健是否会提高DMPA的持续使用率。纳入了在1996年1月1日至1999年1月1日期间开始使用DMPA的患者。青少年母亲及其婴儿在该诊所接受所有医疗保健，由州政府提供资金支持。该诊所关于DMPA的关键要素包括持续护理、通过电话和邮件提醒预约、为无保险患者免费提供DMPA、每次就诊时进行咨询以及设有晚间诊所。在研究期间，共有299名（年龄在13至22岁之间）患者开始使用DMPA。其中51%为白人，47%为黑人，2%为其他种族。63%为单身，20%已婚，3%同居，14%情况不明（数据缺失）。78%育有一个孩子，22%育有不止一个孩子。共有189名患者（63.2%）在使用一年后仍持续依从，101名患者（占总数的33.8%）持续使用超过两年。报告的最常见副作用是出血或点滴出血（32%），然而只有7名患者（2.3%）因此停药。研究得出结论，持续护理（每次就诊由相同的工作人员和提供者负责）、定期咨询、灵活的就诊时间（晚间预约）、经济便利（免费提供DMPA且为无保险者免除就诊费用）、青少年与婴儿联合健康检查以及定期预约提醒，可能有助于提高青少年母亲的依从性和持续使用率，从而在预防青少年再次怀孕方面取得更好的成效。
