Harper Cynthia C, Henderson Jillian T, Raine Tina R, Goodman Suzan, Darney Philip D, Thompson Kirsten M, Dehlendorf Christine, Speidel J Joseph
Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco 94118, USA.
Fam Med. 2012 Oct;44(9):637-45.
Family physicians and obstetrician-gynecologists provide much of contraceptive care in the United States and have a shared goal in preventing unintended pregnancy among patients. We assessed their competency to offer women contraceptives of the highest efficacy levels.
We conducted a national probability survey of family physicians and obstetrician-gynecologists (n=1,192). We measured counseling and provision practices of intrauterine contraception and used multivariable regression analysis to evaluate the importance of evidence-based knowledge to contraceptive care.
Family physicians reported seeing fewer contraceptive patients per week than did obstetrician-gynecologists and were less likely to report sufficient time for counseling. While 95% of family physicians believed patients were receptive to learning about intrauterine contraception, fewer than half offered counseling or the method. Only half were trained to competence to offer intrauterine contraception, while virtually all obstetrician-gynecologists were. Both family physicians and obstetrician-gynecologists were unlikely to have adequate knowledge of the women who would be good candidates for intrauterine contraception-as gauged by the Centers for Disease Control and Prevention Medical Eligibility Criteria for contraception-and consequently did not offer the method to a wide range of eligible patients.
Most family physicians providing contraceptive care were not offering methods with top-tier effectiveness, although they reported interest in updating contraceptive skills through training. Obstetrician-gynecologists had technical skills to offer intrauterine contraception but still required education on patient selection. Greater hands-on training opportunities for family physicians, and complementary education on eligible method candidates for obstetrician-gynecologists, can increase access to intrauterine contraception by women seeking contraceptive care.
在美国，家庭医生和妇产科医生提供了大部分避孕护理服务，并且在预防患者意外怀孕方面有着共同目标。我们评估了他们提供最高效避孕方法的能力。
我们对家庭医生和妇产科医生进行了一项全国性概率抽样调查（n = 1192）。我们衡量了宫内避孕的咨询和提供情况，并使用多变量回归分析来评估循证知识对避孕护理的重要性。
家庭医生报告称，他们每周接待的避孕患者比妇产科医生少，且不太可能有足够时间进行咨询。虽然95%的家庭医生认为患者愿意了解宫内避孕，但提供咨询或该方法的不到一半。只有一半的家庭医生接受过提供宫内避孕的能力培训，而几乎所有妇产科医生都接受过。家庭医生和妇产科医生都不太可能充分了解哪些女性适合使用宫内避孕——根据疾病控制与预防中心的避孕医学适用标准来衡量——因此没有向广泛的符合条件的患者提供该方法。
大多数提供避孕护理的家庭医生没有提供顶级有效的方法，尽管他们表示有兴趣通过培训更新避孕技能。妇产科医生具备提供宫内避孕的技术能力，但仍需要在患者选择方面接受教育。为家庭医生提供更多实践培训机会，以及为妇产科医生提供关于合适方法适用对象的补充教育，可以增加寻求避孕护理的女性获得宫内避孕的机会。
