Schwarz E Bimla, Papic Melissa, Parisi Sara M, Baldauf Erin, Rapkin Rachel, Updike Glenn
University of Pittsburgh, Department of Medicine; University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology; University of Pittsburgh, Department of Obstetrics, Gynecology and Reproductive Sciences.
University of Pittsburgh, Department of Medicine.
Contraception. 2014 Jul;90(1):66-71. doi: 10.1016/j.contraception.2014.02.007. Epub 2014 Feb 26.
To compare contraceptive knowledge and use among women seeking emergency contraception (EC) before and after an inner-city clinic began providing structured counseling and offering same-day intrauterine device (IUD) or implant placement to all women seeking EC.
For 8 months before and 21 months after this change in clinic policy, women aged 15-45 who wanted to avoid pregnancy for at least 6 months were asked to complete surveys immediately, 3 and 12 months after their clinic visit. In addition, we abstracted electronic medical record (EMR) data on all women who sought EC (n=328) during this period. We used chi-squared tests to assess pre/post differences in survey and EMR data.
Surveys were completed by 186 women. After the clinic began offering structured counseling, more women had accurate knowledge of the effectiveness of IUDs, immediately and 3 months after their clinic visit. In addition, more women initiated IUD or implant use (survey: 40% vs. 17% preintervention, p=0.04; EMR: 22% vs. 10% preintervention, p=0.01), and fewer had no contraceptive use (survey: 3% vs. 17% preintervention, p<0.01; EMR: 32% vs. 68%, p<0.01) in the 3 months after seeking EC. EMR data indicate that when same-day placement was offered, 11.0% of women received a same-day IUD. Of those who received a same-day IUD, 88% (23/26) reported IUD use at 3-months and 80% (12/15) at 12 months.
Routine provision of structured counseling with the offer of same-day IUD placement increases knowledge and use of IUDs 3 months after women seek EC.
Women seeking EC from family planning clinics should be offered counseling about highly effective reversible contraceptives with the option of same-day contraceptive placement.
比较在一家市中心诊所开始提供结构化咨询并为所有寻求紧急避孕（EC）的女性提供当日宫内节育器（IUD）放置或植入服务前后，寻求紧急避孕的女性的避孕知识和使用情况。
在诊所政策发生这一变化之前的8个月和之后的21个月里，年龄在15 - 45岁、希望避免怀孕至少6个月的女性被要求在就诊后立即、3个月和12个月完成调查。此外，我们提取了在此期间所有寻求紧急避孕的女性（n = 328）的电子病历（EMR）数据。我们使用卡方检验来评估调查和EMR数据中的前后差异。
186名女性完成了调查。在诊所开始提供结构化咨询后，更多女性在就诊后立即和3个月时对宫内节育器的有效性有准确的了解。此外，更多女性开始使用宫内节育器或植入物（调查：干预后为40%，干预前为17%，p = 0.04；EMR：干预后为22%，干预前为10%，p = 0.01），并且在寻求紧急避孕后的3个月内没有采取避孕措施的女性更少（调查：干预后为3%，干预前为17%，p < 0.01；EMR：干预后为32%，干预前为68%，p < 0.01）。EMR数据表明，当提供当日放置服务时，11.0%的女性接受了当日宫内节育器放置。在接受当日宫内节育器放置的女性中，88%（23/26）报告在3个月时使用宫内节育器，80%（12/15）在12个月时使用。
常规提供结构化咨询并提供当日宫内节育器放置服务可增加女性寻求紧急避孕后3个月时对宫内节育器的知识和使用。
从计划生育诊所寻求紧急避孕的女性应接受关于高效可逆避孕方法的咨询，并可选择当日避孕措施放置。
