Grossman Daniel, Fernandez Leticia, Hopkins Kristine, Amastae Jon, Garcia Sandra G, Potter Joseph E
Ibis Reproductive Health, San Francisco, California, USA.
Obstet Gynecol. 2008 Sep;112(3):572-8. doi: 10.1097/AOG.0b013e31818345f0.
To estimate how well a convenience sample of women from the general population could self-screen for contraindications to combined oral contraceptives using a medical checklist.
Women 18-49 years old (N=1,271) were recruited at two shopping malls and a flea market in El Paso, Texas, and asked first whether they thought birth control pills were medically safe for them. They then used a checklist to determine the presence of level 3 or 4 contraindications to combined oral contraceptives according to the World Health Organization Medical Eligibility Criteria. The women then were interviewed by a blinded nurse practitioner, who also measured blood pressure.
The sensitivity of the unaided self-screen to detect true contraindications was 56.2% (95% confidence interval [CI] 51.7-60.6%), and specificity was 57.6% (95% CI 54.0-61.1%). The sensitivity of the checklist to detect true contraindications was 83.2% (95% CI 79.5-86.3%), and specificity was 88.8% (95% CI 86.3-90.9%). Using the checklist, 6.6% (95% CI 5.2-8.0%) of women incorrectly thought they were eligible for use when, in fact, they were contraindicated, largely because of unrecognized hypertension. Seven percent (95% CI 5.4-8.2%) of women incorrectly thought they were contraindicated when they truly were not, primarily because of misclassification of migraine headaches. In regression analysis, younger women, more educated women, and Spanish speakers were significantly more likely to correctly self-screen (P<.05).
Self-screening for contraindications to oral contraceptives using a medical checklist is relatively accurate. Unaided screening is inaccurate and reflects common misperceptions about the safety of oral contraceptives. Over-the-counter provision of this method likely would be safe, especially for younger women and if independent blood pressure screening were encouraged.
评估来自普通人群的便利样本女性使用医学检查表自我筛查复方口服避孕药禁忌证的效果。
在得克萨斯州埃尔帕索市的两个购物中心和一个跳蚤市场招募了18至49岁的女性（N = 1271），首先询问她们是否认为避孕药对自己在医学上是安全的。然后，她们根据世界卫生组织医学适用性标准，使用检查表来确定是否存在复方口服避孕药的3级或4级禁忌证。这些女性随后接受了一位不知情的执业护士的访谈，该护士还测量了血压。
无辅助自我筛查检测真正禁忌证的敏感性为56.2%（95%置信区间[CI] 51.7 - 60.6%），特异性为57.6%（95% CI 54.0 - 61.1%）。检查表检测真正禁忌证的敏感性为83.2%（95% CI 79.5 - 86.3%），特异性为88.8%（95% CI 86.3 - 90.9%）。使用检查表时，6.6%（95% CI 5.2 - 8.0%）的女性错误地认为自己适合使用避孕药，而实际上她们是禁忌的，主要原因是未识别出的高血压。7%（95% CI 5.4 - 8.2%）的女性错误地认为自己是禁忌的，而实际上并非如此，主要原因是偏头痛的错误分类。在回归分析中，年轻女性、受教育程度较高的女性和讲西班牙语的女性正确自我筛查的可能性显著更高（P <.05）。
使用医学检查表自我筛查口服避孕药禁忌证相对准确。无辅助筛查不准确，反映了对口服避孕药安全性的常见误解。非处方提供这种方法可能是安全的，特别是对于年轻女性，并且如果鼓励进行独立的血压筛查。
