Pitts Sarah A B, Corliss Heather L, Kharasch Sigmund J, Gordon Catherine M
Division of Adolescent/Young Adult Medicine, Children's Hospital Boston, Boston, Massachusetts, USA.
J Pediatr Adolesc Gynecol. 2011 Dec;24(6):392-6. doi: 10.1016/j.jpag.2011.05.012.
To assess whether a policy and educational intervention in an urban, pediatric emergency department (ED) increases advance provision of emergency contraception (EC) to patients.
DESIGN/SETTING/PARTICIPANTS: A pre- and post-intervention, retrospective chart review was conducted in an urban, pediatric ED assessing provider care of sexually active female adolescents and young adults. INTERVENTION/MAIN OUTCOME MEASURES: A policy was instituted recommending that ED providers prescribe EC and provide an educational handout to all sexually active female adolescents and young adults. ED providers were educated about EC and this policy. Charts, subsequently reviewed, included sexually active female patients, age 13-21 years, presenting to the ED status post sexual assault, seeking EC, or with an abdominal, gynecologic, or urologic complaint. Student's t-tests, Pearson's chi-square and Fisher's Exact tests compared pre- and post-intervention provider and patient characteristics and outcomes.
The mean age of the patient sample was 18.8 years (SD=1.7), 83% were Black or Hispanic, 43% were previously pregnant, 25% reported not using birth control. Last unprotected sexual intercourse was not documented for 87% of patients presenting with medical complaints. There was no difference in the advance prescribing of EC or the provision of the educational handout to patients pre- (3.3%) or post- (5.6%) intervention (P = 0.73).
Despite a policy and an educational intervention for providers, little change occurred in advance EC prescribing in an urban, pediatric ED. Additionally, many providers were not documenting last unprotected sexual intercourse, potentially missing an opportunity to treat patients with EC at the time of their visit.
评估在城市儿科急诊科实施的一项政策和教育干预措施是否能增加向患者提前提供紧急避孕（EC）服务的情况。
设计/地点/参与者：在一家城市儿科急诊科进行了一项干预前后的回顾性病历审查，评估对性活跃的女性青少年和年轻成年人的医疗服务情况。干预措施/主要观察指标：制定了一项政策，建议急诊科医护人员为所有性活跃的女性青少年和年轻成年人开具紧急避孕药并提供一份教育手册。对急诊科医护人员进行了有关紧急避孕和该政策的培训。随后审查的病历包括年龄在13至21岁之间、因性侵犯后前来急诊科就诊、寻求紧急避孕或有腹部、妇科或泌尿科主诉的性活跃女性患者。采用学生t检验、Pearson卡方检验和Fisher精确检验对干预前后医护人员及患者的特征和结果进行比较。
患者样本的平均年龄为18.8岁（标准差=1.7），83%为黑人或西班牙裔，43%曾怀孕，25%报告未采取避孕措施。在因医疗主诉前来就诊的患者中，87%未记录最后一次无保护性行为的情况。干预前（3.3%）和干预后（5.6%）向患者提前开具紧急避孕药或提供教育手册的情况没有差异（P = 0.73）。
尽管对医护人员实施了一项政策和教育干预措施，但在城市儿科急诊科，提前开具紧急避孕药的情况几乎没有变化。此外，许多医护人员未记录最后一次无保护性行为，这可能导致在患者就诊时错失为其提供紧急避孕治疗的机会。
