Fairhurst Karen, Wyke Sally, Ziebland Sue, Seaman Peter, Glasier Anna
Division of Community Health Sciences (General Practice), University of Edinburgh, 20 West Richmond Street, Edinburgh EH8 9DX, UK.
Fam Pract. 2005 Jun;22(3):280-6. doi: 10.1093/fampra/cmh728. Epub 2005 Mar 15.
Advance supplies of emergency contraception (EC) were made available to women aged 16-29 through general practice and family planning services in Lothian, Scotland. Although this intervention was not associated with an overall reduction in abortion rates in Lothian, it was hypothesized that some general practices may have been more successful than others in promoting and delivering the intervention.
To investigate, using comparative case studies, whether, and why, some general practices were more successful in promoting and delivering advance supplies of EC than others.
Eleven purposively sampled general practices from the 97 participating in the intervention were studied. The number of packs of advance supplies distributed was recorded and distribution rates per 100 eligible women per practice calculated. 44 semi-structured interviews with staff were used to describe the mechanisms through which advance supplies were distributed and health professionals' views of the intervention.
Distribution rates varied from 0.9 to 32.0 per 100 eligible women. Respondents described three mechanisms through which advance supplies were distributed: passive, reactive and proactive. Views about EC, and the suitability of their patient population for advance supplies, varied and configured specific practice contexts that facilitated or hindered the delivery of advance supplies. Favourable views and pro-active mechanisms were associated with higher distribution rates, less favourable or ambivalent views and passive delivery mechanisms with lower distribution rates.
If primary care professionals are to actively engage with a sexual health promotion agenda they need to develop appropriate interpersonal skills and address their values, attitudes and cultural competences.
在苏格兰洛锡安地区，通过全科医疗和计划生育服务，向16至29岁的女性提供了紧急避孕（EC）的预存药物。尽管这一干预措施并未使洛锡安地区的堕胎率整体下降，但据推测，某些全科医疗在推广和提供该干预措施方面可能比其他机构更为成功。
通过比较案例研究，调查某些全科医疗在推广和提供紧急避孕预存药物方面是否比其他机构更成功以及原因。
从参与该干预措施的97家全科医疗中，有目的地抽取了11家进行研究。记录预存药物分发的包数，并计算每家诊所每100名符合条件的女性的分发率。对工作人员进行了44次半结构化访谈，以描述预存药物的分发机制以及卫生专业人员对该干预措施的看法。
每100名符合条件的女性的分发率在0.9至32.0之间。受访者描述了预存药物分发的三种机制：被动、反应性和主动性。对紧急避孕的看法以及其患者群体对预存药物的适用性各不相同，并构成了促进或阻碍预存药物提供的特定诊所环境。积极的看法和主动的机制与较高的分发率相关，不太积极或矛盾的看法以及被动的分发机制与较低的分发率相关。
如果初级保健专业人员要积极参与性健康促进议程，他们需要培养适当的人际沟通技巧，并解决自身的价值观、态度和文化能力问题。
