the Departments of Obstetrics and Gynecology and Family Medicine and the Departments of Epidemiology and Department of Health Services, School of Public Health, University of Washington, Seattle; the Departments of Medical Informatics and Clinical Epidemiology and Obstetrics and Gynecology, Oregon Health & Science University, Portland.
J Am Board Fam Med. 2014 Jan-Feb;27(1):26-33. doi: 10.3122/jabfm.2014.01.130142.
Recent evidence-based guidelines expanded the definition of appropriate candidates for the levonorgestrel-releasing intrauterine system (LNG-IUS). We investigated correlates of evidence-based selection of candidates for the LNG-IUS by physicians who offer insertion.
We conducted a mixed-mode (online and mail) survey of practicing family physicians and obstetrician-gynecologists in Seattle.
A total of 269 physicians responded to the survey (44% response rate). Of the 217 respondents who inserted intrauterine devices, half or fewer routinely recommended the LNG-IUS to women who are nulliparous, younger than 20 years old, or have a history of sexually transmitted infections (STIs). In multivariable analyses, training/resident status was positively associated with recommending the LNG-IUS to women <20 years old (adjusted odds ratio [aOR], 3.6; 95% confidence interval [CI], 1.6-8.0) and women with history of STI (aOR, 3.7; 95% CI, 1.6-8.4). Perceived risk of infection or infertility was negatively associated with recommending the LNG-IUS to nulliparous women (aOR, 0.2; 95% CI, 0.1-0.5) and women with a history of STI (aOR, 0.3; 95% CI, 0.1-0.8).
Many family physicians and obstetrician-gynecologists who insert the LNG-IUS are overly restrictive in selecting candidates, although those who train residents are more likely to follow evidence-based guidelines. Interventions that address negative bias and perceptions of risks, in addition to improving knowledge, are needed to promote wider use of the LNG-IUS.
最近的循证指南扩大了左炔诺孕酮宫内节育系统（LNG-IUS）适用候选者的定义。我们调查了提供宫内节育器插入服务的医生在选择 LNG-IUS 候选者时与循证相关的因素。
我们对西雅图的执业家庭医生和妇产科医生进行了混合模式（在线和邮件）调查。
共有 269 名医生对调查做出了回应（回应率为 44%）。在 217 名插入宫内节育器的受访者中，有一半或更少的医生常规向未生育、年龄小于 20 岁或有性传播感染史的女性推荐 LNG-IUS。在多变量分析中，培训/住院医师身份与向年龄小于 20 岁的女性（调整后的优势比[aOR]，3.6；95%置信区间[CI]，1.6-8.0）和有性传播感染史的女性（aOR，3.7；95% CI，1.6-8.4）推荐 LNG-IUS 呈正相关。对感染或不孕风险的感知与向未生育的女性（aOR，0.2；95% CI，0.1-0.5）和有性传播感染史的女性（aOR，0.3；95% CI，0.1-0.8）推荐 LNG-IUS 呈负相关。
许多插入 LNG-IUS 的家庭医生和妇产科医生在选择候选者时过于严格，尽管接受住院医师培训的医生更有可能遵循循证指南。除了提高知识水平外，还需要采取干预措施来解决负面偏见和对风险的看法，以促进更广泛地使用 LNG-IUS。
