Rodriguez Maria Isabel, Darney Blair G, Elman Emily, Linz Rachel, Caughey Aaron B, McConnell K John
Oregon Health & Science University, Portland, OR, USA.
Oregon Health & Science University, Portland, OR, USA; Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico.
Contraception. 2015 Apr;91(4):328-35. doi: 10.1016/j.contraception.2014.12.008. Epub 2014 Dec 27.
To assess the quality of care provided to adolescents (10-19 years old) compared to women (aged 20-25 years) who accessed services in Oregon's Contraceptive Care (CCare) program.
We analyzed data routinely collected using the Clinic Visit Record form from women aged 25 years and younger who visited CCare clinics between January 1, 2004, and October 31, 2010. Modern methods were characterized into three tiers: Tier 1 is the intrauterine device, implant and sterilization; Tier 2, hormonal methods; and Tier 3, all barrier methods. Nonmodern methods included no method, withdrawal and natural family planning. We used multivariable logistic regression models to examine the effect of age on three indicators of quality of contraceptive care: transitioning from a nonmodern to a modern method, transitioning from Tier 3 methods to Tier 1 or Tier 2 methods, and initiation of long-acting reversible contraception (LARC). We then produced predicted probabilities to facilitate data interpretation.
Adolescents accounted for 344,856 (41%) of the 848,221 clinic visits occurring in CCare among women under age 25. Compared with women (ages 20-25 years), young and older adolescents had decreased odds of LARC initiation [odds ratio (OR) 0.24 (95% confidence interval [CI] 0.16-0.35) and OR 0.44 (95% CI 0.38-0.52), respectively]. However, compared with women, both young and older adolescents had increased odds of leaving with any contraceptive method [OR 1.8 95% (CI 1.26-2.59) and OR 1.42 (95% CI 1.21-1.66)]. Among clients presenting with no method of contraception at the beginning of the visit, 78.7% of young adolescents (95% CI 73.84-83.03) compared with 81.44% (95% CI 77.02-85.52) of older adolescents, and 76.63% (95% CI 69.90-80.75) of young women left with a modern method, controlling for other covariates.
Although adolescents served by CCare are more likely to initiate contraception, they are less likely to receive LARC than women aged 20-25 years.
Efforts are needed to ensure that adolescents have access to highly effective reversible contraception.
评估俄勒冈州避孕护理（CCare）项目中为青少年（10 - 19岁）提供的护理质量，并与20 - 25岁女性接受的护理质量进行比较。
我们分析了2004年1月1日至2010年10月31日期间，年龄在25岁及以下且前往CCare诊所就诊的女性，使用临床就诊记录表格常规收集的数据。现代避孕方法分为三个层级：第一层是宫内节育器、植入物和绝育；第二层是激素避孕方法；第三层是所有屏障避孕方法。非现代避孕方法包括不采取任何方法、体外排精和自然计划生育。我们使用多变量逻辑回归模型来检验年龄对避孕护理质量三个指标的影响：从不现代避孕方法转变为现代避孕方法、从第三层避孕方法转变为第一层或第二层避孕方法，以及开始使用长效可逆避孕方法（LARC）。然后我们生成预测概率以方便数据解读。
在25岁以下女性的CCare诊所就诊的848,221次就诊中，青少年占344,856次（41%）。与20 - 25岁女性相比，年轻青少年和年长青少年开始使用LARC的几率降低[优势比（OR）分别为0.24（95%置信区间[CI] 0.16 - 0.35）和OR 0.44（95% CI 0.38 - 0.52）]。然而，与20 - 25岁女性相比，年轻青少年和年长青少年离开诊所时采取任何避孕方法的几率都增加了[OR 1.8（95% CI 1.26 - 2.59）和OR 1.42（95% CI 1.21 - 1.66）]。在就诊开始时未采取任何避孕方法的患者中，控制其他协变量后，78.7%的年轻青少年（95% CI 73.84 - 83.03）、81.44%的年长青少年（95% CI 77.02 - 85.52）以及76.63%的年轻女性离开诊所时采取了现代避孕方法。
尽管接受CCare服务的青少年更有可能开始采取避孕措施，但与20 - 25岁女性相比，他们接受LARC的可能性较小。
需要做出努力以确保青少年能够获得高效的可逆避孕方法。
