University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
J Gen Intern Med. 2011 Jul;26(7):731-6. doi: 10.1007/s11606-011-1647-3.
Whether contraceptive counseling improves contraceptive use is unknown.
To evaluate the association between contraceptive counseling provided by primary care physicians and patients' contraceptive use.
DESIGN/PARTICIPANTS: All women aged 18-50 who visited one of four primary care clinics between October 2008 and April 2010 were invited to complete surveys about their visit. Seven to 30 days post visit, participants completed a survey assessing pregnancy intentions, receipt of contraceptive counseling, and use of contraception at last sexual intercourse. Survey data were linked to medical record data regarding contraceptive prescriptions prior to and during the clinic visit. Women were classified as in need of contraceptive counseling if they were sexually active, were not pregnant or trying to get pregnant, and had no evidence of contraceptive use prior to their index clinic visit.
Fifty percent (n = 386) of women were in need of contraceptive counseling at the time of their visit. Those who received contraceptive counseling from a primary care provider were more likely to report use of hormonal contraception when they last had sex (unadjusted OR: 3.83, CI: 2.25-6.52), even after adjusting for age, race, education, income, marital status, pregnancy intentions, and prior pregnancy (adjusted OR: 2.68, CI: 1.48-4.87). Counseling regarding specific types of contraception was associated with an increased use of those methods. For example, counseling regarding hormonal contraceptives was associated with a greater likelihood of use of hormonal methods (adjusted OR: 4.78, CI: 2.51-9.12) and counseling regarding highly effective reversible methods was highly associated with use of those methods (adjusted OR: 18.45, CI: 4.88-69.84). These same relationships were observed for women with prior evidence of contraceptive use.
Contraceptive counseling in primary care settings is associated with increased hormonal contraceptive use at last intercourse. Increasing provision of contraceptive counseling in primary care may reduce unintended pregnancy.
避孕咨询是否能提高避孕率尚不清楚。
评估初级保健医生提供的避孕咨询与患者避孕使用之间的关联。
设计/参与者：2008 年 10 月至 2010 年 4 月期间，邀请在四家初级保健诊所就诊的所有 18-50 岁女性完成有关就诊的调查。就诊后 7-30 天，参与者完成了一项关于妊娠意向、接受避孕咨询以及上次性行为中使用避孕措施的调查。调查数据与就诊前和就诊期间的医疗记录中关于避孕处方的数据相关联。如果女性有性行为、没有怀孕或试图怀孕，且在就诊前没有使用避孕措施，则认为她们需要避孕咨询。
50%（n=386）的女性在就诊时需要避孕咨询。那些从初级保健提供者那里获得避孕咨询的人，在上次性行为中更有可能报告使用激素避孕（未调整的 OR：3.83，95%CI：2.25-6.52），即使在调整了年龄、种族、教育程度、收入、婚姻状况、妊娠意向和既往妊娠后（调整后的 OR：2.68，95%CI：1.48-4.87）。关于具体避孕方法的咨询与增加这些方法的使用有关。例如，关于激素避孕的咨询与使用激素方法的可能性增加有关（调整后的 OR：4.78，95%CI：2.51-9.12），关于高效可逆方法的咨询与使用这些方法高度相关（调整后的 OR：18.45，95%CI：4.88-69.84）。对于有避孕措施使用既往证据的女性，也观察到了相同的关系。
初级保健环境中的避孕咨询与上次性行为中激素避孕措施的使用增加有关。增加初级保健中避孕咨询的提供可能会降低意外怀孕的风险。
