Carvajal Diana N, Khanna Niharika, Williams Mozella, Gold Marji
Department of Family and Community Medicine, University of Maryland.
Fam Med. 2016 Sep;48(8):642-4.
Long-acting reversible contraceptives (LARCs) are very effective methods of pregnancy prevention. To ensure autonomy over childbearing, women need access to contraception and abortion services. Family physicians can improve access by increasing numbers and locations of trained providers. In 2014, the University of Maryland (UMD) Reproductive Health EDucation In family medicine (RHEDI) program sought to enhance LARC and abortion training by increasing: (1) resident participation in LARC services, (2) resident participation/interest in abortion care, (3) patient access to LARCs and medication abortions (MABs).
We used a pre-post framework comparing years 2013 and 2014 with respect to number of resident-provided LARC services, number of residents participating in abortion, and total number of LARCs and MABs provided practice-wide.
The setting is an urban residency practice.
(1) increased dedicated appointments for LARC and MABs, (2) dedicated appointment scheduler, (3) comprehensive family planning didactics and clinical workshops, (4) faculty-supported Residents for Choice group.
2014: Residents provided substantially more LARC services compared to 2013. Placement increased from 50 to 90, and removals tripled (25 to 73). 2014 site-wide LARC placement also increased (160 versus 98), removals increased (44 in 2013, 106 in 2014). Twelve residents per year are eligible to participate in abortion care. In 2013, two participated: in 2014, 10 participated. MABs provided in 2014 (18) did not change from 2013 (17).
The UMD RHEDI program demonstrated that attention to care-provision systems and education enhances resident training and increases patient access to family planning services. Programs with similar goals may find our methods helpful.
长效可逆避孕法（LARC）是非常有效的预防怀孕方法。为确保生育自主权，女性需要获得避孕和堕胎服务。家庭医生可以通过增加经过培训的服务提供者数量和地点来改善服务可及性。2014年，马里兰大学（UMD）家庭医学生殖健康教育（RHEDI）项目试图通过增加以下方面来加强长效可逆避孕法和堕胎培训：（1）住院医师参与长效可逆避孕法服务；（2）住院医师参与/对堕胎护理的兴趣；（3）患者获得长效可逆避孕法和药物流产（MAB）的机会。
我们采用了前后对比框架，比较了2013年和2014年住院医师提供的长效可逆避孕法服务数量、参与堕胎的住院医师数量以及整个机构提供的长效可逆避孕法和药物流产的总数。
研究地点为城市住院医师培训实践机构。
（1）增加长效可逆避孕法和药物流产的专用预约；（2）专用预约调度员；（3）全面的计划生育教学和临床工作坊；（4）教师支持的“选择居民”小组。
2014年：与2013年相比，住院医师提供的长效可逆避孕法服务大幅增加。放置数量从50例增加到90例，取出数量增加了两倍（从25例增加到73例）。2014年全机构的长效可逆避孕法放置数量也增加了（从98例增加到160例），取出数量增加了（2013年为44例，2014年为106例）。每年有12名住院医师有资格参与堕胎护理。2013年，有2人参与；2014年，有10人参与。2014年提供的药物流产数量（18例）与2013年（17例）相比没有变化。
马里兰大学RHEDI项目表明，关注护理提供系统和教育可加强住院医师培训，并增加患者获得计划生育服务的机会。有类似目标的项目可能会发现我们的方法很有帮助。
